Carbon footprint of the Chinese healthcare service: An environmentally extended input-output analysis.

backgroundWith the healthcare sector contributing nearly 5% of total global greenhouse gas (GHG) emissions globally, a precise assessment of their carbon footprint is crucial for achieving carbon neutrality targets. This study aims to comprehensively assess the carbon footprint of Chinese healthcare service providers, to identify their driving activities and sources across different time periods, and to provide a solid foundation for the development of effective emission reduction policies in healthcare service in China. METHODS AND

findingsThe data on overall national health expenditures for 2012 and 2018, as well as expenditures by different levels of hospitals, various hospital departments, and specific diseases, were sourced from China's Health Statistics Yearbooks and national input-output tables (IOTs). Environmentally extended input-output analysis (EEIOA) and structural path analysis (SPA) were utilized to assess the carbon footprint of healthcare services in China in 2012 and 2018. Overall, the total carbon footprint of Chinese healthcare service providers increased by 51 MtCO2e (15%) in 2018 compared to that in 2012, accounting for about 3.7% of the total domestic GHG emissions. In 2018, public hospitals made the largest contribution to the carbon footprint within the national health expenditure categories, with their carbon emissions increasing by 29 MtCO2e (19%). Among medical institutions, procurement was the largest contributor to the carbon footprint, with emissions increasing by 46 MtCO2e (25%). Within hospital departments, the internal medicine department had the highest carbon footprint, reaching 47.66 MtCO2e (26%) in 2018. When classified by hospital grades, tertiary hospitals contributed the most, emitting 126.50 MtCO2e (70%). When classified by disease category, circulatory system diseases had the largest carbon footprint of 12.68 MtCO2e (19%), while malignant neoplasms were the primary contributor among subcategory diseases, emitting 5.52 MtCO2e (8%). The main limitation of this study lies in the fact that national IOTs are updated approximately every 5 years, and data for methane (CH₄) and nitrous oxide (N₂O) have not been updated since 2018. As a result, the analysis could only be performed for the years 2012 and 2018.

conclusionsThese findings highlighted the substantial GHG emission contributions in China from public hospitals, especially tertiary hospitals, procurement activities, Internal Medicine Departments, and specific diseases in the carbon footprint. The findings provided robust scientific evidence for formulating strategies to reduce carbon emissions within the healthcare service in China and will also have implications for other countries.