Licensing

Environment, health & equity

Both human health and the health systems we depend on are increasingly threatened by a range of environmental crises, including climate change.

Paradoxically, healthcare provision itself is a significant driver of environmental pollution, and is responsible for 2-5% of global greenhouse gas, sulfur dioxide, nitrogen oxide, and particulate matter emissions.¹

Contrary to the 'first, do no harm' axiom, healthcare pollution is associated with a substantial health burden. In the United States, conservative estimates suggest that healthcare pollution is responsible for a health burden similar to that caused by preventable medical errors.²

background

— "The progression of climate change is such that physicians urgently need to mobilize, not only with regard to research and treatment, but also and perhaps especially in terms of political action."

Selvy et al., 2020

Jump to section:

— background

— measuring pollution

— our work

— support

— license

Environmental impacts of healthcare as a percentage of total global impact

Figure note: chart reproduced from Lenzen et al., 2020 (Figure 1). Impact contributions from healthcare to seven environmental parameters are reported as a percentage of total global impact.

Suggested citation: Lenzen M, Malik A, Li M, Fry J, Weisz H, Pichler PP, Chaves LS, Capon A, Pencheon D. The environmental footprint of health care: a global assessment. The Lancet Planetary Health. 2020 Jul 1;4(7):e271-9.

Healthcare professionals have a critical role to play in both reducing the environmental impacts of their workplace and advocating for the rapid decarbonization of society as a whole.

Furthermore, because nations and communities that have contributed least to environmental pollution are expected to suffer most from its impacts, healthcare workers also have a duty to advocate for greater health and environmental equity.⁶

Per capita healthcare-related climate pollution

Figure note: data from Lenzen et al., 2020. Unit, metric tonnes of carbon dioxide equivalents per capita.

Suggested citation: HealthLCA (2020). Per capita healthcare-related climate pollution [Figure]. Published online at HealthLCA.com. Retrieved from: healthlca.com/per-capita-climate-impact-of-health-systems [Online resource].

View figure

Thirteen of the twenty least vulnerable countries to climate change also find themselves among the twenty most climate polluting nations in terms of healthcare emissions.

— Comparing data from Lenzen et al., 2020 and ND-Gain, 2018

Measuring healthcare pollution

environmental assessments

— Healthcare sustainability science explores dimensions of resource consumption and environmental emissions associated with healthcare activities. This emerging field provides tools and metrics to quantify the unintended consequences of healthcare delivery and evaluate effective approaches that improve patient safety while protecting public health.

Sherman et al., 2020

Assessing the environmental impacts of healthcare is the first step toward creating sustainable health systems. By identifying high impact activities and pointing toward more environmentally-friendly alternatives, such assessments provide impetus for evidence-based policy change.

There are two main approaches to measuring the environmental impacts of healthcare activities: process-based life cycle assessment (LCA) and economic input-output analysis.

Life cycle assessment is an internationally-standardized approach for quantifying the environmental impacts associated with the entire lifecycle (e.g. production through disposal) of a given product, process, or service. Life cycle assessment takes a so-called 'bottom-up' approach, measuring the energy and materials entering and exiting a defined system along with their environmental impacts. This approach is both very precise and well-suited to studying environmental impacts at the product-level (e.g. medical equipment and pharmaceuticals).

Economic input-output analysis, also referred to as environmental input-output analysis or economic input-output life cycle assessment (EIO-LCA), examines the relationships between various sectors of the economy, using aggregate expenditure data to assign environmental impacts to the system of interest. This 'top-down' approach is well-suited to estimating the impacts of highly complex systems, such as a hospitals or entire health systems, where a process-based LCA approach is simply not feasible or possible.

—energy production

—infrastructure

—equipment production

—transportation

—heating & ventilation

—anesthetic gases

—pharmaceuticals

—disposal & recycling

Supporters

The creation of HealthLCA was not commissioned by any funding agency in the public, commercial, or not-for-profit sectors. Our website and database is maintained free-of-charge.

Our annual operating expenses, which include the costs associated with hosting this platform online, total $350 CAD.

This amount is generously covered by the Creating Sustainable Health Systems in a Climate Crisis project within the Healthy Populations Institute, a multi-faculty research institute at Dalhousie University in Nova Scotia, Canada. This project is run in collaboration with the Centre for Sustainable Health Systems in Ontario, Canada and the Centre for Sustainable Healthcare in the UK.

funding

HealthLCA relies on generous support from the health community. To ensure that our database remains freely available, we depend on annual or one-off donations from individuals or organisations. Our annual fundraising target is $350 CAD. This simply covers the cost of hosting our platform online.

Take action

Get involved

If you are interested in joining the global movement of healthcare workers fighting for a healthy and sustainable planet, get involved with one of the many advocacy groups.

International—

New Zealand—

United Kingdom—

United States—

Canada—

European Union—

Australia—

1. Reduce health care’s climate footprint now

2. The health sector must support a societal transition to clean, renewable energy

3. Chart the course for zero emissions health care by 2050

4. Make development assistance for health climate-smart

5. Establish and implement government action plans for climate-smart health care

6. Deepen research on health care and climate change

Six action areas for climate-smart healthcare from Healthcare Without Harm's 2019 report

Use Policies

HealthcareLCA Legal, Licensing & Data Access Policies

Acknowledgement of Terms

By accessing and using this website, you acknowledge and agree to abide by all the terms, licensing conditions, and usage rules outlined below. These policies are designed to ensure transparency and protect the integrity of HealthcareLCA's underlying data.

1. Overview

HealthcareLCA is an independent academic research initiative. Its creation was not commissioned by any public, commercial, or not-for-profit funding body.

This document outlines HealthcareLCA's legal, licensing, and data access policies.

2. Definitions

2.1 HealthcareLCA Database (Public Interface)

The “Public Interface” refers solely to the publicly accessible, read-only website at healthcarelca.com where users may explore curated healthcare sustainability information through tables, visualizations, and textual summaries.

2.2 Proprietary Backend Dataset

The “Proprietary Backend Dataset” refers to the specific compilation, arrangement, and infrastructure of the data, including but not limited to:

The master dataset, including all raw or compiled data tables
Database schemas, taxonomy, and metadata structure
Backend technical infrastructure and query logic
Curation, harmonization, and quality-assurance processes
Any derivative files, vector embeddings, or transformations capable of reproducing the dataset.

These materials are not publicly accessible.

3. Licensing

3.1 Public Interface Content – Creative Commons (CC BY-NC-SA 4.0)

The Public Interface—including visualizations, charts, textual summaries, and presentation—is licensed under Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International (CC BY-NC-SA 4.0).

Permitted Use: Academic, educational, or non-commercial research purposes. Users may share, copy, and adapt Public Interface content under CC terms.
Restrictions: This license applies only to the visual presentation. It does not grant rights to the Proprietary Backend Dataset or underlying data values. Users may not extract, aggregate, or reconstruct the dataset or create derivative databases or AI systems without written permission.

Recommended Citation:

Drew, J., & Rizan, C. (2022). HealthcareLCA Database. HealthcareLCA. Retrieved [Date Accessed] from https://healthcarelca.com/database

The Proprietary Backend Dataset is protected by copyright (© 2025 Jonathan Drew). It is protected specifically as a literary work (compilation) reflecting the arrangement, curation, and harmonization of data, and by any applicable sui generis database rights under relevant international law. All rights are reserved.

No license—express or implied—is granted for:

Commercial use of the backend data
Training Artificial Intelligence (AI) or Machine Learning (ML) models.
Creating vector embeddings, RAG (Retrieval-Augmented Generation) applications, or knowledge graphs.
Bulk extraction, reconstruction, or redistribution of the dataset.

Access to the Proprietary Backend Dataset requires a formal written agreement. The curator reserves the right to refuse any request for access. No raw data, backend files, or API access is available outside of such an agreement.

4. Permitted and Prohibited Use

4.1 Permitted Use

Viewing, referencing, and citing the Public Interface for non-commercial scholarly purposes
Sharing or adapting Public Interface materials under CC BY-NC-SA 4.0

4.2 Prohibited Use

Extraction: Attempting to extract, reconstruct, or copy the Proprietary Backend Dataset, whether obtained in a single act or through repeated systematic acts (scraping).
Automated Access: Using automated tools (bots, scrapers, crawlers, spiders) to access the website or underlying data.
AI Training: Creating derivative databases, datasets, or AI/ML models using HealthcareLCA content without express written permission.
Reverse Engineering: Using the Public Interface to reconstruct or reverse-engineer backend data structures or logic.
Security: Circumventing technical access restrictions or interfering with the site’s security.

5. Data Access and Collaboration

Requests for access to the Proprietary Backend Dataset for academic collaboration, validation, or research may be considered on a case-by-case basis at the curator’s discretion. Access requires a written agreement defining scope, permitted uses, licensing terms, and restrictions.

6. Disclaimer and Limitation of Liability

HealthcareLCA and all content on the Public Interface are provided “as is” and “as available,” without warranties of any kind. Jonathan Drew shall not be liable for any direct, indirect, or consequential damages arising from use of the Public Interface.

7. Indemnification

Users agree to indemnify and hold harmless Jonathan Drew from claims, liabilities, damages, or costs arising from:

Breach of these policies
Misuse of Public Interface content
Unauthorized use of intellectual property

8. Governing Law

Law: Province of Nova Scotia, Canada, and applicable federal laws
Jurisdiction: Courts of Nova Scotia have exclusive jurisdiction over disputes arising from use of HealthcareLCA

Effective: December 15, 2025. Last Updated: December 15, 2025