Lancet Commission on Sustainable Healthcare (LCSH)

The LCSH is dedicated to facilitating a rapid transition to low-carbon, sustainable, resilient health systems.

Sustainable healthcare systems provide universal access to appropriate care that optimizes health and wellbeing for today’s patients and communities, as well as for future generations, by delivery of care that is needed, wanted, clinically effective, affordable, equitable, responsible in its use of resources, and functioning within planetary boundaries.

Explore the latest international health sector greenhouse gas emissions data with the Lancet Countdown.

The healthcare sector has a critical role to play in addressing climate and ecological breakdown, both through adapting to serve populations most affected by environmental change, but also through tackling its own contribution. The health sector represents approximately 10% of global GDP and thus presents an opportunity to catalyze societal transformation beyond the scope of its own operations. The delivery of health care is commonly considered a service, but it is both energy- and material-intensive and relies on a complex supply chain to source medical devices, supplies, drugs, and equipment.

Health care is a major emitter of environmental pollutants that adversely affect health. The healthcare industry is responsible for nearly 5.2% of global greenhouse gas (GHG) emissions and similar fractions of toxic air pollutants. Health care pollution harms public health, yet remains underappreciated and largely unaddressed, despite the professional mandate to "first, do no harm." In the face of mounting evidence of the human health impacts of pollution, concepts of patient safety and healthcare quality must be expanded to include mitigation of health care pollution and resource stewardship.

In order to avoid planetary tipping points, healthcare - like all sectors - must undergo a systemic transformation to a sustainable model of care. This includes mitigation of ongoing environmental impacts, as well as adaptation of healthcare infrastructure and delivery systems across the spectrum of low- to high-income settings in anticipation of the increasing burden of climate- and pollution-related illness. Sustainable health system design requires reframing care through a paradigm of health promotion and wellness, focusing on appropriateness of care, and creating systems that prioritize both optimal clinical outcomes and environmental performance.

• The Lancet
• Lancet Planetary Health
• University of British Columbia, Andrea MacNeill, MD, Clinical Associate Professor of Surgery, Director, UBC Planetary Healthcare Lab, Vancouver, Canada
• Yale University, Jodi Sherman, MD, Associate Professor of Anesthesiology, and Associate Professor of Epidemiology in Environmental Health Sciences, Director, Yale Program on Healthcare Environmental Sustainability, Connecticut, USA