A race to net zero-early lessons from healthcare's decarbonization marathon

Sustainable healthcare and medical laboratories: The impact of global collaborations between frameworks and initiatives

Climate change is a pressing global challenge that requires urgent action. The Paris Agreement and the 2030 Agenda of United Nations (UN) set clear global targets for emission reduction and sustainability to limit warming to 1.5 °C. Partnerships between standardization organizations are crucial in accelerating climate action. The Geneva Sustainability Centre (GSC) is at the forefront of healthcare sustainability, launching the Sustainability Accelerator Tool (SAT) in 2023 to help hospitals assess their environmental impact. In partnership with GSC, Joint Commission International (JCI) has integrated sustainability into its accreditation standards and will introduce the JCI-GSC Healthcare Sustainability Certification in 2025, built on the SAT. To accelerate the achievement of the Sustainable Development Goals (SDGs), ISO and the UN formed a strategic partnership in 2023 to create the first global SDG standard. ISO has published the IWA 42:2022 Net Zero Guidelines and is developing its first global Standard on Net Zero, set for release in 2025. Additionally, ISO introduced the Climate Change Amendments, embedding climate considerations into over 30 existing management system standards, including ISO 9001. With these amendments now shaping all newly developed or revised standards, future updates to ISO 15189 will likely incorporate sustainability requirements, especially as ISO 9001 is an essential part of ISO 15189. Reducing operational emissions from healthcare and medical laboratories alone will not achieve net zero. A sector-wide approach is essential, tackling supply chain emissions from energy, pharmaceuticals, and medical devices. Combating climate change requires a coordinated, cross-sector effort, making international collaboration indispensable. This review highlights key global frameworks, standards, guidelines, and initiatives that have evolved through collaboration to help healthcare organizations, including medical laboratories, to advance sustainability and climate resilience.

Canadian Association of Radiologists Statement on Planetary Health Education in Radiology

The health of Canadians is already impacted by climate change due to wildfire smoke, heat domes, floods, droughts, and the changing distribution of vector borne disease. The healthcare sector contributes to climate change, accounting for approximately 4.6% of annual greenhouse gas emissions in Canada. Healthcare teams have a responsibility and opportunity to reduce harm by limiting emissions and waste, and engaging the public in understanding the planetary health links between clean air and water, a stable climate, a healthy planet and human health. Transformation of Canadian healthcare to a low carbon, climate resilient system will be enhanced by physician engagement and leadership. Cornerstones to physician participation include knowledge of the anthropogenic etiology of the climate crisis, the human health impacts, and the contribution providing healthcare makes to the climate crisis. Integration of climate change knowledge into the Canadian Radiology educational curricula is essential to position radiologists to lead transformative change in mitigation and adaptation of the healthcare system to the climate crisis. This statement is intended to provide guidelines to optimize education and research for current and future Canadian radiologists, and builds on existing planetary healthcare education publications and the Canadian Association of Radiologists Statement on Environmental Sustainability in Medical Imaging.

Environmental impact of colorectal cancer screening with colonoscopy and multi-target stool DNA (mt-sDNA) testing

The substantial carbon footprint imparted by medical services warrants increased attention to their environmental impact. National guideline organizations such as the US Preventive Services Task Force (USPSTF) recommend multiple modalities for average-risk colorectal cancer (CRC) screening with varying resource intensity. The aim of this study was to quantify the environmental burden for 2 of the most used CRC screening modalities, colonoscopy and the multi-target stool DNA (mt-sDNA) test. A validated CRC microsimulation model was used to estimate the number of screening and follow-up tests for a cohort of 1 million average-risk individuals who underwent screening between ages 45 and 75. Component resources used for mt-sDNA, including waste products, energy, and transportation for colonoscopy and mt-sDNA, were collected from January 1, 2023, to January 1, 2024, and converted to carbon-equivalent emissions. Resources used for colonoscopy were captured from the literature. Resources devoted to screening colonoscopy were substantially (59%) higher than those to mt-sDNA, even when including follow-up colonoscopy. Of note, follow-up colonoscopy accounted for the majority (64%) of total emissions for the mt-sDNA screening strategy. Compared with colonoscopy screening, mt-sDNA substantially reduces the carbon emissions attributable to population-level CRC screening. Environmental impact should be included as a factor when choosing among guideline-recommended CRC screening strategies.

THE GORDON WILSON LECTURE: CLIMATE, HEALTH, AND EQUITY: THE CASE FOR COLLECTIVE ACTION FROM THE HEALTH SYSTEM

The rapid and unprecedented climate changes driven by human-induced greenhouse gas emissions present a critical challenge for society today. However, the link between climate change and health remains inadequately explored in both literature and policy discussions. Thousands of individuals die each year in the United States due to climate-related factors, including extreme temperatures, severe weather, air pollution, and vector-borne diseases, and these health impacts disproportionately affect already vulnerable populations. Climate change is not just an environmental concern but also an imminent threat to individual and population health, as well as a major challenge to health equity. Moreover, the health sector significantly contributes to greenhouse gas emissions. Recognizing their roles as health care providers and contributors to the climate crisis, clinicians and health professionals have a moral obligation to emphasize the profound significance of climate impacts on human health and equity. This lecture provides an overview of efforts by the U.S. National Academy of Medicine and others to address the intersection of climate change and health, with an aim to raise awareness about the immediate threats to patient health and to build a proactive path forward for the health sector. The health sector must unite to collectively tackle these challenges, safeguard patient well-being, and promote the common good in the face of climate-induced health crises.

The Transformative Role of Adaptation Strategies in Designing Climate-Resilient and Sustainable Health Systems

This article describes the growing repository of evidence-informed climate-related health actions and builds a case for transformative adaptation strategies. The health impacts of climate change are far-reaching and diverse, affecting vulnerable populations disproportionately and at varying scales. While adaptation policies and plans are becoming increasingly intersectional, there is limited implementation of health-focused adaptation interventions. Securing finance at scale, for one, is a challenge. Funds are not being mobilized at the rate or scale required. Least developed countries and small island developing states are most at-risk and the least likely to recover, even under conservative global warming scenarios. Thus, this article spotlights opportunities for more resilient and equitable health systems across key dimensions of health surveillance, service delivery, infrastructure, finance, capacity development and policy coherence. Given limits to adaptation, co-benefits of mitigation and adaptation actions will need to be systematically assessed and prioritized to address the residual effects of climate disasters.