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Andrieu B, Marrauld L, Vidal O, Egnell M, Boyer L, Fond G. Health-care systems' resource footprints and their access and quality in 49 regions between 1995 and 2015: an input-output analysis. Lancet Planet Health 2023; 7:e747-e758. [PMID: 37673545 PMCID: PMC10495829 DOI: 10.1016/s2542-5196(23)00169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Strategies to reduce the environmental impact of health care are often limited to greenhouse gas emissions. To broaden their scope, our aim was to determine the evolution of the resource footprints, dependency, and efficiency of health-care systems and to determine the relationship between this evolution and their Healthcare Access and Quality (HAQ) index. METHODS We carried out an input-output analysis of 49 health-care systems from 1995 to 2015. We harmonised the EXIOBASE v3.8.2 database-providing data for 49 world regions-to the World Health Organization Health Expenditures Database. We then performed a panel data analysis to understand the relationship between Healthcare Access and Quality index and energy footprint per capita of health-care systems. EXIOBASE3 does not provide measurement errors so it was not possible to propagate the uncertainties as can be done with other input-output databases. FINDINGS Health-care systems' footprint increased over the past two decades, reaching 7% of global non-metallic minerals footprint, 4% of global metal ores footprint, and 5% of global fossil fuels footprint in 2013. This increase was mostly due to China, rising from 7% of the non-metallic minerals footprint in 1995 to 45% in 2013. 80% of the health-care systems studied were dependent at more than 50% on fossil fuel imports. The energy footprint per capita was correlated exponentially with the HAQ index but some countries performed much better than others at a given energy footprint. Health-care systems have not become more efficient between 2002 and 2015. INTERPRETATION Health-care systems' resources footprint are exponentially linked to their HAQ. Both prevention and efficiency measures will be needed to change this relationship. If it is not enough, high-income countries will have to choose between further reducing the resource consumption of their health-care systems or shifting the efforts to other sectors, health being considered an incompressible need. We call for the creation of a HAQE (health-care access, quality, and efficiency) index that would add resource efficiency to access and quality when ranking health-care systems. FUNDING The Shift Project.
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Affiliation(s)
- Baptiste Andrieu
- Institut de Sciences de la Terre (ISTerre), CNRS-University of Grenoble, Grenoble, France; The Shift Project, Paris, France.
| | - Laurie Marrauld
- The Shift Project, Paris, France; Université Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS (Recherche sur les Services et Management en Santé)-U 1309, Rennes, France
| | - Olivier Vidal
- Institut de Sciences de la Terre (ISTerre), CNRS-University of Grenoble, Grenoble, France
| | - Mathis Egnell
- P4H Network-World Health Organization, Geneva, Switzerland
| | - Laurent Boyer
- Faculté des sciences médicales et paramédicales, AP-HM, Aix-Marseille Université, Marseille, France; CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Marseille, France; Fondation FondaMental, Créteil, France
| | - Guillaume Fond
- Faculté des sciences médicales et paramédicales, AP-HM, Aix-Marseille Université, Marseille, France; CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Marseille, France; Fondation FondaMental, Créteil, France
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Lister HE, Mostert K, Botha T, van der Linde S, van Wyk E, Rocher SA, Laing R, Wu L, Müller S, des Tombe A, Kganyago T, Zwane N, Mphogo B, Maric F. South African Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study. Int J Environ Res Public Health 2022; 19:10121. [PMID: 36011760 PMCID: PMC9408692 DOI: 10.3390/ijerph191610121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Climate change, biodiversity loss and large-scale environmental degradation are widely recognized as the biggest health threats of the 21st century, with the African continent already amongst the most severely affected and vulnerable to their further progression. The healthcare system's contribution to climate change and environmental degradation requires healthcare professionals to address environmental issues urgently. However, the foundation for context-relevant interventions across research, practice, and education is not readily available. Therefore, we conducted a convergent mixed-methods study to investigate South African healthcare professionals' knowledge, attitudes, practices, and barriers to environmental sustainability. Healthcare professionals participated in a cross-sectional questionnaire (n = 100) and in-depth semi-structured focus group discussions (n = 18). Data were analyzed using descriptive statistics and thematic analysis, respectively, and integrated to provide holistic findings. Our results confirm overwhelmingly positive attitudes and a high degree of interest in education, implementation, and taking on more corresponding responsibility, but a lack of substantial knowledge of the subject matter, and only tentative implementation of practices. Identified barriers include a lack of knowledge, resources, and policies. Further research, education, and policy development on overcoming these barriers is required. This will facilitate harnessing the extant enthusiasm and advance environmental sustainability in South Africa's healthcare practice.
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Affiliation(s)
- Helga E. Lister
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Karien Mostert
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Simoné van der Linde
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Elaine van Wyk
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Su-Ané Rocher
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Richelle Laing
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Lucy Wu
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Selma Müller
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Alexander des Tombe
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Tebogo Kganyago
- Department of Occupational Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Nonhlanhla Zwane
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Boitumelo Mphogo
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Filip Maric
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9020 Tromsø, Norway
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Cherry MJ. Bioethics: An International, Morally Diverse, and Often Political Endeavor. HEC Forum 2022; 34:103-114. [PMID: 35604507 DOI: 10.1007/s10730-022-09482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
Bioethicists often remind health care professionals to pay close attention to issues of diversity and inclusion. Approaches to ethics consultation, where the perspective of the bioethicist is taken to be more morally correct or necessarily authoritative, have been critiqued as inappropriately authoritarian. Despite such apparent recognition of the importance of respecting moral diversity and the inclusion of different viewpoints, authoritarianism is all too often the approach adopted, especially as bioethics has shifted evermore into concerns for public policy. Yet, secular values and philosophical principles are not morally neutral; nor are the private moral convictions of bioethicists. Such analysis is always grounded in particular understandings of the right and the good, the virtuous and the just. Critical examination of common treatments and new alternatives is essential for the careful scientific practice of medicine. The same is true with regard to bioethics. Stagnating in customary or accepted claims of a common secular morality or a standard set of bioethical principles out of an unwillingness to explore the real diversity of moral thought, including traditional religious and cultural worldviews, fails to tap the human capacity to find innovative solutions to the complex challenges facing medicine.
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Affiliation(s)
- Mark J Cherry
- Department of Philosophy, St. Edward's University, 3001 S. Congress Ave., Austin, TX, USA.
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Parker JC. Bioethical Boundaries, Critiques of Current Paradigms, and the Importance of Transparency. The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 2021. [DOI: 10.1093/jmp/jhab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
This issue of The Journal of Medicine and Philosophy is dedicated to topics in clinical ethics with essays addressing clinician participation in state sponsored execution, duties to decrease ecological footprints in medicine, the concept of caring and its relationship to conscientious refusal, the dilemmas involved in dual use research, a philosophical and practical critique of principlism, conundrums that arise when applying surrogate decision-making models to patients with moderate intellectual disabilities, the phenomenology of chronic disease, and ethical concerns surrounding the use of artificial intelligence in medicine. Throughout the issue, the themes of conceptual and moral boundaries in bioethics, critiques of current clinical ethics paradigms, and the importance of transparency are prominent.
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Affiliation(s)
- J Clint Parker
- East Carolina University, Greenville, North Carolina, USA
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