The carbon footprint of the Chinese health-care system: an environmentally extended input–output and structural path analysis study

Abstract

Background The health sector plays an important part in adapting to climate change; however, the sector is also responsible for significant greenhouse gas (GHG) emissions. In high-income countries, the carbon footprints of health-care systems have been estimated to be 3-10% of the total national GHG emissions, but no in-depth investigation has been done for China. This study aims to examine the carbon footprint of the Chinese health-care system and identify emission hotspots. MethodsEnvironmentally extended input-output analysis and structural path analysis were used to assess the lifecycle GHG emissions of the Chinese health-care system. A satellite account of GHG emissions was constructed for 46 economic sectors in China using energy data from the National Bureau of Statistics based on the numbers reported by a large number of enterprises. Data on health expenditure for medical institutions, pharmaceuticals, construction, administration, and research were obtained from multiple Chinese official statistics yearbooks and the national input-output table. Findings In 2012, China spent CNY 2539 billion on health care, leading to emissions of 315 (68% CI 267-363) megatonnes CO 2 equivalent. Health care accounted for 2·7% (68% CI 2·3-3·1) of China's total GHG emissions. The major contributors of GHG emissions in the health-care system were public hospitals (148 megatonnes [47%]), nonhospital purchased pharmaceuticals (56 megatonnes [18%]), and construction (46 megatonnes [15%]). In medical institutions, energy use for buildings and transport accounted for only 16% of the total carbon footprint, whereas 84% was embodied in the purchased goods and services.Interpretation China has a much smaller health-care carbon footprint per capita than developed countries, such as the USA and Australia. However, its carbon emissions per unit of health expenditure are relatively high because of the expenditure structure and the carbon intensity of the country's entire economy. The results suggest the need for a nationwide carbon-efficient target for health care and use of low-carbon alternatives in making supply chain choices to achieve reductions in the carbon footprint.

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

“…Due to the hybrid approach combining multiple bottomup datasets with top-down MRIO-based results, it was not feasible to conduct a comprehensive uncertainty analysis, such as the Monte Carlo simulation-based analyses done for MRIO-only studies of health-care emissions. 5,6 Bottom-up datasets used for this analysis, including building energy use and anaesthetic gas and MDI use, did not have reported error values. For the MRIO-based results, previous work can provide context: an uncertainty analysis done for an earlier version of the UK MRIO model found that total UK consumer greenhouse gas emissions carried a relative SE of approximately 4-6%; previous health-care footprinting analyses found an SD of less than 5% globally and relative SEs of approximately 15% for China and 28% for Australia.…”

“…For the MRIO-based results, previous work can provide context: an uncertainty analysis done for an earlier version of the UK MRIO model found that total UK consumer greenhouse gas emissions carried a relative SE of approximately 4-6%; previous health-care footprinting analyses found an SD of less than 5% globally and relative SEs of approximately 15% for China and 28% for Australia. 5,6,30 Qualitative sources of uncertainty are elaborated on in the Discussion.…”

“…To this end, carbon footprints have been published for health-care systems in Australia, Austria, Canada, China, Japan, and the USA, alongside international estimates. 1,2,[5][6][7][8][9][10][11][12] These studies have identified general patterns of contributions among health-care activities in each country, which can form a baseline for long-term mitigation planning.…”

The environmental footprint of health care: a global assessment

“…There are numerous ways to dissect the global PM footprint into underlying constituents. Here we extract some significant findings for countries with detailed healthcare and inputoutput information (appendix pp [4][5][6][7][8][9][10][11][12][13][14], in absolute terms (figure 3A, C) and per capita (figure 3B, D). PM footprints do not necessarily follow healthcare expenditure; despite their healthcare expen diture being lower, China and India have higher footprints than Japan (figure 3A).…”

“…Greenhouse gas emissions and climate change are an important pathway of the negative health impact resulting from the environmental footprint of health care. The carbon footprint of health care has been calculated previously in specific countries, including the UK, 6 the USA, 7 Australia, 8 Canada, 9 China, 10 Japan, 11 and in inter national comparisons. 12,13 To the best of our knowledge, this is the first assessment of the global environmental footprint of health care, based on available data, and using a panel of indicators that are relevant to health outcomes and that enable a cycle of adverse feedback to be captured.…”