Often parameter uncertainty is unquantified because data are reported to the government directly without statistical analysis or sampling. Other sources of uncertainty include: Temporal considerations arise largely because of the reliance on a static economic model.
Air Pollution and Human Health
Under this assumption, emissions intensities mass of pollutants emitted per unit of economic activity remains fixed for each economic sector, even though improvements in efficiencies and pollution control and the mix of technologies employed. Price changes have been controlled for using the Medical Price Index as noted. Outside of power generation, many other sectors have also experienced changes in emissions factors due to fuel switching, efficiency improvements, and improved pollution controls. For example, the truck transportation sector has experienced increases in fuel economy, improvements in engine and catalytic converter designs, and more widespread availability of ultra-low sulfur diesel fuel.
Other sources of uncertainty include the characterization factors that relate emissions to changes in ambient concentrations and from ambient concentrations to exposure and disease onset. Though this has been an area of intensive modeling and research recently, it is well-known that factors for human health toxicity are among the most uncertain of all impact categories, especially for toxicity stemming from metal emissions [ 33 ].
Future work should take advantage of upcoming model updates to both EIOLCA and life cycle impact assessment methods to re-run the analysis and investigate the largest contributing expenditure categories and supply sectors. Model updates may also reduce uncertainty for cancer and non-cancer impact categories including additional toxic releases in the EIOLCA inventory as well as updating characterization factors and eliminating the need for inter-model conversions. We believe, however, that the main finding is robust, namely that the health care sector is responsible for a significant proportion of emissions and public health damages in the U.
Conversely, efforts to improve resource efficiency in health care, through energy efficiency projects or effective waste prevention and management practices, for example, will not only reap economic rewards for health care facilities but will also produce significant indirect public health benefits. Reducing waste can improve both economic and environmental performance without compromising quality of care [ 30 ].
Associated Data
Reducing direct and indirect emissions should be considered a key aspect of building a safer health system to improve health care quality and efficiency and reduce unintended adverse effects, both direct and indirect. Decreases in emissions that are attributable to the health care sector will have direct benefits in the U.
Economic damages from electricity generation emissions alone in the U. For GHGs specifically, climate change mitigation efforts have been specifically called for by the WHO and other leading health care bodies [ 38 ]. Potential health benefits include reducing the estimated , annual fatalities that occur worldwide as a result of climate change [ 39 ].
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Efforts to improve the carbon footprint of health care will also have environmental and health co-benefits, as has been demonstrated for several other sectors including food and agriculture [ 40 ], urban transport and land use [ 41 ], and household energy use [ 42 ]. The World Health Organization notes the health sector, itself, can reap gains from rapid and early adoption of mitigation strategies that improve access to renewable energy, through environmentally friendly operational and building solutions [ 43 ].
Both offer recommendations to improve the environmental footprint of key areas that reduce both direct on-site and indirect supply chain emissions, including cleaner and more efficient energy use, water conservation, waste reduction, environmentally preferable supply chain management, safer cleaning chemicals, and healthier foods. The Coalition for Sustainable Pharmaceutical and Medical Devices is seeking to develop manufacturing standards for best practices and reporting transparency, guided by life cycle assessment http: Clinicians play a critical, yet unaddressed role in health care resource use and represent a key opportunity for waste prevention.
Seemingly small changes in how medical supplies are utilized or services delivered could have substantial benefits for resource conservation and public health when magnified over this large sector.
Efforts such as the Choosing Wisely Campaign http: A critical knowledge gap exists in the medical community regarding the indirect health consequences of wasteful, non-value added practices in all their forms, making resource conservation education and leadership crucial to improving the health system. We quantify life cycle emissions of the health care sector, including upstream and downstream activities, and estimate the magnitude of subsequent impacts to human health.
We found this amount of disease burden, unreported and largely unrecognized in health care, is similar in magnitude to annual deaths stemming from preventable medical errors first reported in To Err is Human [ 23 ], which is a topic of national discourse and institutional efforts to improve health care safety. These findings underscore the need to measure, mitigate, and educate on the considerable human health and environmental impacts associated with health care practice itself. Efforts to improve the environmental performance of health care can reduce expenditures directly through waste reduction and energy savings, but also indirectly through reducing the pollution burden on public health, and ought to be included in efforts to improve health care quality and safety.
MJE received no specific funding for this work. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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National Center for Biotechnology Information , U. Published online Jun 9. Author information Article notes Copyright and License information Disclaimer. The authors have declared that no competing interests exist. Received Jan 7; Accepted May This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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This article has been cited by other articles in PMC. Medical Price Index by Health Expenditure category, — Methods Negative environmental and public health outcomes attributable to the health care sector were estimated for the U. Open in a separate window. Non-GHG Emissions Total results for in all environmental categories are shown in Table 2 , with the proportion of national totals in each category and the total disease burden, in DALYs. Table 2 Environmental and health effects due to health care sector direct and indirect emissions for Time series of all life cycle impact impacts from U.
Shown for —, in absolute terms. Discussion Patient Health and Public Health Indirect health damages stemming from health sector pollution are currently unreported and largely unrecognized in health care, and it is useful to compare these results to other estimates of patient health and public health damages. Assumptions and Uncertainty Uncertainty associated with the EIOLCA model structure and construction is discussed in the model documentation and in supporting literature [ 12 , 13 ].
DOCX Click here for additional data file. Funding Statement MJE received no specific funding for this work. Data Availability All relevant data are within the paper and its Supporting Information files. National Academies Press; National Health Expenditure Data. Accessed 22 November Estimate of the carbon footprint of the US health care sector.
The Journal of the American Medical Association. Environmental Impacts of Surgical Procedures: Life cycle greenhouse gas emissions of anesthetic drugs. The carbon footprints of home and in-center maintenance hemodialysis in the United Kingdom.
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Toggle navigation Additional Book Information. Description Table of Contents. Summary RFF research on policy includes the evaluation of command-and-control and incentive-based policy instruments, the comparative analyses of different regulatory strategies in a variety of settings, and the performance of alternative policy instruments like voluntary measures. The fourteen books in this collection range from theoretical works on the definition and governance of common property to applied studies on the enforcement of pollution control laws.