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Abstract
Objective Given the demand for net-zero healthcare, the carbon footprint (CF) of healthcare systems has attracted increasing interest in research in recent years. This systematic review investigates the results and methodological transparency of CF calculations of healthcare systems. The methodological emphasis lies specifically on input–output based calculations.
Design Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.
Data sources PubMed, Web of Science, EconBiz, Scopus and Google Scholar were initially searched on 25 November 2019. Search updates in PubMed and Web of Science were considered until December 2023. The search was complemented by reference tracking within all the included studies.
Eligibility criteria We included original studies that calculated and reported the CF of one or more healthcare systems. Studies were excluded if the specific systems were not named or no information on the calculation method was provided.
Data extraction and synthesis Within the initial search, two independent reviewers searched, screened and extracted information from the included studies. A checklist was developed to extract information on results and methodology and assess the included studies’ transparency.
Results 15 studies were included. The mean ratio of healthcare system emissions to total national emissions was 4.9% (minimum 1.5%; maximum 9.8%), and CFs were growing in most countries. Hospital care led to the largest relative share of the total CF. At least 71% of the methodological items were reported by each study.
Conclusions The results of this review show that healthcare systems contribute substantially to national carbon emissions, and hospitals are one of the main contributors in this regard. They also show that mitigation measures can help reduce emissions over time. The checklist developed here can serve as a reference point to help make methodological decisions in future research reports as well as report homogeneous results.
- decision making
- health services administration & management
- change management
- international health services
- organisation of health services
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request. The data that support the findings of this study are available in online supplemental file 4 'System description and results' and online supplemental file 5 'Methods and transparency'. Further data are available from the corresponding author (MKeil), upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- decision making
- health services administration & management
- change management
- international health services
- organisation of health services
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request. The data that support the findings of this study are available in online supplemental file 4 'System description and results' and online supplemental file 5 'Methods and transparency'. Further data are available from the corresponding author (MKeil), upon reasonable request.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @MattisKeil
Contributors MKeil (guarantor): methodology, screening, formal analysis, writing – original draft, writing – review and editing, visualisation; LF, MH, MKnieß: methodology, screening, formal analysis, writing – original draft; OL: conceptualisation, methodology, writing – review and editing; TK: methodology, writing – review and editing. WR: conceptualising, methodology, writing – review and editing, supervision, project administration. All authors have read and approved the final manuscript for publication.
Funding This work was supported by the Leibniz ScienceCampus Bremen Digital Public Health (lsc-diph.de), which is jointly funded by the Leibniz Association (W4/2018), the Federal State of Bremen, and the Leibniz Institute for Prevention Research and Epidemiology (BIPS) for OL’s inputs to the research project. The funder had no role in the study design, the collection, analysis, interpretation or submission of the data. MKeil’s inputs were supported by the research cluster 'Health City Bremen' which is funded by the Federal State of Bremen. The funder had no role in the study design, the collection, analysis, interpretation or submission of the data.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.