Health care's response to climate change: a carbon footprint assessment of the NHS in England.

BACKGROUND: Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. METHODS: A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. FINDINGS: In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. INTERPRETATION: This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. FUNDING: Wellcome Trust.

[The transformation to environmentally sustainable health systems: The National Health Service example in England]. / En nationell, miljömässigt hållbar hälso- och sjukvård i sikte - Process som drivs från högsta förvaltningsnivå kan ge resultat, visar erfarenheter från England.

This article provides insight from the Sustainable Development Unit, a top down policy, monitoring and delivery unit to support a large complex health system, the National Health Service, to embed sustainable development. The dedicated unit nurtured and supported bottom up action through top down change, it translated legal requirements, embedded good governance and engaged with stakeholders.By identifying a specific and manageable topic area the unit created an entry point to broader change and enabled action, in this case the unit started with carbon footprinting and reduction. Engagement of stakeholders was a mandate for strong governance and provided feedback of successes and future challenges. Progress was monitored through carbon reduction (18.5% over ten years), with over £1.8bn energy related savings, board approved Sustainable Development Measurement Plans (71% of trusts), and public annual sustainability reporting (85% of Clinical Commissioning Groups and trusts).

The carbon footprint of behavioural support services for smoking cessation.

OBJECTIVE: To estimate the carbon footprint of behavioural support services for smoking cessation: text message support, telephone counselling, group counselling and individual counselling. DESIGN: Carbon footprint analysis. DATA SOURCE: Publicly available data on National Health Service Stop Smoking Services and per unit carbon emissions; published effectiveness data from the txt2stop trial and systematic reviews of smoking cessation services. MAIN OUTCOME MEASURES: Carbon dioxide equivalents (CO2e) per 1000 smokers, per lifetime quitter, and per quality-adjusted life year gained, and cost-effectiveness, including social cost of carbon, of smoking cessation services. RESULTS: Emissions per 1000 participants were 8143 kg CO2e for text message support, 8619 kg CO2e for telephone counselling, 16 114 kg CO2e for group counselling and 16 372 kg CO2e for individual counselling. Emissions per intervention lifetime quitter were 636 (95% CI 455 to 958) kg CO2e for text message support, 1051 (95% CI 560 to 2873) kg CO2e for telephone counselling, 1143 (95% CI 695 to 2270) kg CO2e for group counselling and 2823 (95% CI 1688 to 6549) kg CO2e for individual counselling. Text message, telephone and group counselling remained cost-effective when cost-effectiveness analysis was revised to include the environmental and economic cost of damage from carbon emissions. CONCLUSIONS: All smoking cessation services had low emissions compared to the health gains produced. Text message support had the lowest emissions of the services evaluated. Smoking cessation services have small carbon footprints and were cost-effective after accounting for the societal costs of greenhouse gas emissions.