Sustainability: The seventh dimension of quality in health care

Beyond financial efficiency to support environmental sustainability in economic evaluations

The healthcare sector is one of the largest polluters in the UK, accounting for 25% of total emissions of carbon dioxide of the public sector. Ironically, it is the healthcare sector itself that is primarily affected by any deterioration in the environment affecting individuals' health and their demand for healthcare. Therefore, the healthcare sector is a direct beneficiary of its own steps towards sustainability and is more and more viewed as the one who should lead the change. In this article, we first review the concepts of financial and environmental sustainability. Second, we discuss the existing evidence of sustainable changes within this sector. Third, we propose a simple adaptation of the classic cost-effectiveness analysis to incorporate carbon footprinting to account for these external costs. We illustrate our method using the case of in-centre versus home haemodialysis. We conclude that home dialysis is always a preferable alternative to in-centre treatment based on a cost-effectiveness analysis. Finally, we discuss the limitations of our approach and the future research agenda.

Reducing the carbon footprint of hospital-based care

Climate change, driven by man-made greenhouse gas emissions, is a major threat to the health of this and future generations. Hospital-based healthcare generates large quantities of greenhouse gas emissions. Reducing the carbon footprint of healthcare requires direct action to reduce waste and energy use, but also requires radical reform of care pathways so that the only patients who come to or stay in hospital are people whose healthcare cannot safely be delivered closer to home. Achieving these reforms without major structural changes to the financial flows in the NHS will be extraordinarily difficult.

The carbon footprint of cataract surgery

BACKGROUND

Climate change is predicted to be one of the largest global health threats of the 21st century. Health care itself is a large contributor to carbon emissions. Determining the carbon footprint of specific health care activities such as cataract surgery allows the assessment of associated emissions and identifies opportunities for reduction.

AIM

To assess the carbon footprint of a cataract pathway in a British teaching hospital.

METHODS

This was a component analysis study for one patient having first eye cataract surgery in the University Hospital of Wales, Cardiff. Activity data was collected from three sectors, building and energy use, travel and procurement. Published emissions factors were applied to this data to provide figures in carbon dioxide equivalents (CO2eq).

RESULTS

The carbon footprint for one cataract operation was 181.8 kg CO2eq. On the basis that 2230 patients were treated for cataracts during 2011 in Cardiff, this has an associated carbon footprint of 405.4 tonnes CO2eq. Building and energy use was estimated to account for 36.1% of overall emissions, travel 10.1% and procurement 53.8%, with medical equipment accounting for the most emissions at 32.6%.

CONCLUSIONS

This is the first published carbon footprint of cataract surgery and acts as a benchmark for other studies as well as identifying areas for emissions reduction. Within the procurement sector, dialogue with industry is important to reduce the overall carbon footprint. Sustainability should be considered when cataract pathways are designed as there is potential for reduction in all sectors with the possible side effects of saving costs and improving patient care.