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Primum non nocere

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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


— "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

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.

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: 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.

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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

Lenzen global healthcare radar chart

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


—equipment production


—heating & ventilation

—anesthetic gases


—disposal & recycling


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.


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.



New Zealand—

United Kingdom—

United States—


European Union—


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