Carbon emissions and public health: an inverse association?
Authors: Peng Bi, Alana Hansen
Journal: The Lancet Planetary Health (2018)

The link between increasing atmospheric concentrations of greenhouse gases and climate change is well established, as are the effects of climate change on public health. These include heat-related morbidity and mortality,1Ebi KL Mills DM Smith JB Grambsch A Climate change and human health impacts in the United States: an update on the results of the US national assessment.Environ Health Perspect. 2006; 114: 1318-1324Crossref PubMed Scopus (96) Google Scholar and effects on the transmission of vector-borne and food-borne diseases.2Campbell-Lendrum D Manga L Bagayoko M Sommerfeld J Climate change and vector-borne diseases: what are the implications for public health research and policy?.Philos Trans R Soc Lond B Biol Sci. 2015; 370: 20130552Crossref PubMed Scopus (183) Google Scholar Individuals affected by adverse health outcomes are likely to have encounters with the health sector, which has its own significant carbon footprint as shown in the Article in The Lancet Planetary Health by Arunima Malik and colleagues.3Malik A Lenzen M McAlister S McGain F The carbon footprint of Australian health care.Lancet Planet Health. 2018; 2: e27-e35Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar This paper makes an interesting contribution to the climate change literature, highlighting that health care has a carbon footprint in the order of 3–10% of national carbon dioxide equivalent (CO2e) emissions in countries around the world. The authors calculate that, in Australia, the health-care sector represents 7·2% of Australia's total CO2e emissions, with more than a third of these emissions contributed by public hospitals, more so if capital expenditure is included.3Malik A Lenzen M McAlister S McGain F The carbon footprint of Australian health care.Lancet Planet Health. 2018; 2: e27-e35Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar Reducing this carbon footprint will be difficult given that Australia has an ageing population and, therefore, an increasing need for health care. A simplistic approach could be to address the carbon footprint of hospitals or aim for a healthier population, requiring less access to health care. Of all building types, hospitals are the second most intensive users of energy for reasons that include the use of energy-intensive equipment and the need to be well lit, well ventilated, and temperature controlled 24 h per day.4Opray M Sensors, plants and waste heat: Adelaide hospital's bid to be most energy-efficient.The Guardian (London). June 5, 2017; (accessed Dec 8, 2017).https://www.theguardian.com/sustainable-business/2017/jun/05/sensors-plants-waste-heat-adelaide-hospitals-bid-to-be-most-energy-efficientGoogle Scholar In Adelaide, SA, the largest and most advanced health-care facility in Australia, the Royal Adelaide Hospital has recently opened. This cost AUS$2·3 billion, and the 800 bed hospital aims to have 50% lower greenhouse gas emissions than its predecessor, with a high reliance on new technologies for energy efficiency; ample use of natural sunlight, gardens, and green spaces; and co-generation of power via waste heat for heating and cooling.4Opray M Sensors, plants and waste heat: Adelaide hospital's bid to be most energy-efficient.The Guardian (London). June 5, 2017; (accessed Dec 8, 2017).https://www.theguardian.com/sustainable-business/2017/jun/05/sensors-plants-waste-heat-adelaide-hospitals-bid-to-be-most-energy-efficientGoogle Scholar There are also high efficiency water fittings, and captured or recycled water is used for toilet flushing and irrigation. As such, the hospital has been recognised by the Green Building Council of Australia for its commitment to environmentally-sustainable building design,5Government of South AustraliaRoyal Adelaide Hospital.https://www.rah.sa.gov.au/Date: 2017Google Scholar which sets an example for reducing carbon footprint. The Royal Adelaide Hospital also features telehealth facilities so that consultations can be done with patients in regional and remote areas.5Government of South AustraliaRoyal Adelaide Hospital.https://www.rah.sa.gov.au/Date: 2017Google Scholar Telemedicine and e-health files have been shown to reduce the carbon footprint of health care and a useful climate change mitigation strategy.6Holmner A Ebi KL Lazuardi L Nilsson M Carbon footprint of telemedicine solutions—unexplored opportunity for reducing carbon emissions in the health sector.PLoS One. 2014; 9: e105040Crossref PubMed Scopus (70) Google Scholar A study in Sweden6Holmner A Ebi KL Lazuardi L Nilsson M Carbon footprint of telemedicine solutions—unexplored opportunity for reducing carbon emissions in the health sector.PLoS One. 2014; 9: e105040Crossref PubMed Scopus (70) Google Scholar has shown that because of the reduction in transportation-associated carbon emissions, telemedicine results in a 40–70 times decrease in the amount of carbon emissions produced compared with the traditional model of patients visiting their health-care practitioner. The second option to reduce the carbon footprint of the health-care sector is to minimise the number of patients. As Malik and colleagues point out, public health can play a major role in preventing hospital admissions.3Malik A Lenzen M McAlister S McGain F The carbon footprint of Australian health care.Lancet Planet Health. 2018; 2: e27-e35Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar In 2011, the Australian Burden of Disease Study7AIHWAustralian Burden of Disease study: impact and causes of illness and death in Australia 2011. Australian Institute of Health and Welfare, Canberra2016Google Scholar showed that most of the burden of diseases was attributed to chronic diseases including cancers, cardiovascular diseases, mental and substance use disorders, and musculoskeletal conditions and injuries. At least 31% of this burden was preventable. The use of tobacco and alcohol, high body mass, and physical inactivity were among the major risk factors.7AIHWAustralian Burden of Disease study: impact and causes of illness and death in Australia 2011. Australian Institute of Health and Welfare, Canberra2016Google Scholar Health promotion efforts to encourage healthy lifestyles will help to reduce the need for access to health care and on the reliance for pharmaceuticals, the sectors with the highest direct CO2e emissions.3Malik A Lenzen M McAlister S McGain F The carbon footprint of Australian health care.Lancet Planet Health. 2018; 2: e27-e35Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar It would therefore appear that improving population health could lower hospital admissions and reduce the carbon footprint of health care; and lowering greenhouse gas emissions will reduce the burden of climate change on population health. Malik and colleagues3Malik A Lenzen M McAlister S McGain F The carbon footprint of Australian health care.Lancet Planet Health. 2018; 2: e27-e35Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar have calculated the environmental footprint of Australia's health-care system, and the key message is the burden it places on Australia's total emissions. This work highlights the need for further research to investigate additional mitigation strategies in health care. Adaptation measures and risk communication messages are also useful to reduce the increased burden on the health-care system, particularly those as a consequence of extreme weather events that will become more frequent with climate change. Community-based adaptation can help build community resilience and reduce vulnerability to climate stressors8Ebi KL Semenza JC Community-based adaptation to the health impacts of climate change.Am J Prev Med. 2008; 35: 501-507Summary Full Text Full Text PDF PubMed Scopus (224) Google Scholar and heat-health warnings to the public have been shown to reduce morbidity during severe heatwaves.9Nitschke M Tucker G Hansen A Williams S Zhang Y Bi P Evaluation of a heat warning system in Adelaide, South Australia, using case-series analysis.BMJ Open. 2016; 6: e012125Crossref PubMed Scopus (41) Google Scholar Together with mitigation strategies, adaptation options could also be considered by the health sector. Health practitioners could play a leadership role distributing targeted information at the start of summer to susceptible patients on how to stay healthy in the heat. This information, together with messages on how to maintain a healthy lifestyle, might help to reduce individual and community vulnerability to the health effects of climate change and, ironically, help lower the main contributing factor—carbon emissions. We declare no competing interests The carbon footprint of Australian health careThe carbon footprint attributed to health care was 7% of Australia's total; with hospitals and pharmaceuticals the major contributors. We quantified Australian carbon footprint attributed to health care and identified health-care sectors that could be ameliorated. Our results suggest the need for carbon-efficient procedures, including greater public health measures, to lower the impact of health-care services on the environment. Full-Text PDF Open Access