![]() It will require a whole of system approach, with macro (government), meso (organisational) and micro (individual) level elements. That alone would save Australia over 8000 kilotonnes of carbon dioxide equivalent emissions per year ( Box). One thing that can be done today is a cull of low value care. 11 However, these changes will take time. ![]() We must prioritise decarbonised energy and low carbon options, for example, by switching away from desflurane and nitrous oxide anaesthetic gases, which have large footprints. The 60% of care that is effective care 6 is critically important and will become ever more so as climate change unfolds. The widespread occurrence of low value care helps explain why the carbon footprint of Australian health care is so large, representing almost half that of the entire construction sector (residential and non‐residential). Rather, we highlight that no matter how green the pathology laboratory, low value health care has a sizeable footprint, wherever it occurs. We do not intend to single out pathology for criticism, as pathologists have shown leadership in greening laboratory practice. 10 Substantial carbon 10 (and financial) savings could be achieved by omitting unnecessary pathology tests, without any detriment to health. 7 There were at least 80 million haematology, biochemistry and immunology tests requested in the community in 2020, 8 of which an estimated 10–40% were likely unnecessary. 5 It is clear, however, that many laboratory tests are overused, with vitamin D testing providing a good example. It can be hard to define and measure low value and harmful care, as evidence of a test or treatment’s benefit may be lacking and harms may be incompletely measured. This is where two key challenges to health system sustainability - low value care and climate risk - intersect, and why better value, low carbon emissions models of clinical care are urgently needed. Greening hospitals’ electricity and water supplies and ending use of fossil gas is essential, but clearly changes to models of clinical care are also needed. 6 Using these data, we can make explicit the carbon cost of low value and harmful health care in Australia ( Box). 5 Recent estimates show that about 30% of health care is wasteful or low value, and a further 10% is harmful. Low value care remains stubbornly common and may be increasing, including in low and middle income countries. 4 In short, the business of clinical care itself.Īs we face the unprecedented challenge of climate change, it is widely acknowledged that much health care is wasteful and low value. 3 Similarly, a more detailed United Kingdom breakdown revealed that emissions from building energy, water and sanitation together accounted for less than 20% of health care emissions, with the remainder coming from pharmaceuticals, medical devices, equipment and their supply chains, anaesthetic gases, metered dose inhalers, staff, patient and visitor travel, and other goods and services for patient care. ![]() Of note, 90% of Australia’s health care emissions are indirect, stemming from the extensive national and global supply chains involved in the manufacture, distribution and provision of health care goods and services. 3 Using economic data from 360 sectors, Malik and colleagues estimated carbon emissions by Australian Institute of Health and Welfare categories of health care expenditure, finding that the hospital and pharmaceutical sectors had the largest footprints, together accounting for 63% of health care emissions. In response, the Australian health care community must both adapt to increased demand and to deteriorating environmental conditions, and mitigate the carbon footprint of health care, currently 7% of our national carbon emissions. 1 As well as physical health threats, climate change and its effects are adversely affecting Australians’ mental health, 2 and worsening the health inequities suffered by vulnerable populations. We are in a health emergency precipitated by climate change. Statistics, epidemiology and research designĬulling low value care will cut health care carbon emissions.
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