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Planetary health care: a framework for sustainable health systems (2021 Dec)

MacNeill AJ, McGain F, Sherman JD. Planetary health care: a framework for sustainable health systems. The Lancet Planetary Health. 2021;5(2):e66-e8.

Open access link to article:

Relevant to: 

All Dietitians-Nutritionists.


This commentary outlines three principles for global health care to radically decrease greenhouse gas emissions.  

Bottom line for nutrition practice: 

The three principles for shifting to environmentally sustainable health services include: reducing demand for health services; matching the supply of health services to demand (i.e., ensuring appropriate care and avoiding unnecessary investigations and treatment), and reducing emissions from the supply of health services.

The authors see this shift as not just a climate change mitigation strategy; they also see it as a societal transformation toward health and wellbeing, promoting fiscal and environmental stewardship, and advancing sustainable intergenerational health equity.



Details of results: 

The authors pose that health systems across the globe should match the commitment made by the
the UK National Health Service in 2020 to meet net zero greenhouse gas emissions by 2040. They cite the UN “race to zero” campaign for strategies (see “Of additional interest”). While the carbon intensity of health care has been decreasing, this reduction has been offset by the growing demand for health care (related to “population growth and ageing, increasing global burden of disease, and increasingly complex diagnostic and treatment methods”, p.e66). Therefore, the authors suggest that actions to decarbonize the health system need to be combined with strategies to reduce the incidence and severity of disease.

Decreasing disease will reduce the amount of health care services – the first principle cited in shifting toward environmentally sustainable health services. The authors stress the centrality of health promotion in the form of public policies focusing on the social determinants of health (e.g., access to food security, jobs, education, and affordable housing) to decreasing health care; they cite the Pan American “Health in All Policies” initiative as a guide (see “Of additional interest”). Disease prevention strategies include increased funding for public health and access to primary care services.

The second principle, matching the supply of health services to demand, includes avoiding both excessive investigations and treatment and inadequate capacity. They suggest that treatment delays can result in advanced stages of disease, and thus create the need for more services. To avoid hospital-based treatments, funding should be strengthened to primary care services for conditions such as diabetes and hypertension. Incentives should be provided to key stakeholders including private and public health systems and physicians to advance resource stewardship. They also suggest that educational reforms are required to strengthen planetary health action by stakeholders.

While much progress has be made toward decreasing emissions in the UK through improving the environmental performance of buildings, decarbonizing energy supplies of hospitals and electrifying transportation fleets, the supply chain comprises 62 to 82% of the greenhouse gas footprint. As 90% of emissions from products generated in the supply chain are created during manufacturing, the authors stress that recycling programs cannot compensate for these emissions. Rather, they suggest a systemic change to a circular economy (e.g., where medical devices are designed for reuse and kept for use as long as possible).

Finally, the authors suggest that the COVID-19 pandemic has demonstrated the potential for transformation in the health system and suggest that virtual health care system is one example of advances made as a result.

Of additional interest: 

  • UN Race to Zero campaign – “Race To Zero is a global campaign to rally leadership and support from businesses, cities, regions, investors for a healthy, resilient, zero carbon recovery that prevents future threats, creates decent jobs, and unlocks inclusive, sustainable growth”.
  • Pan American “Health in All Policies” initiative – Though this particular page is archived it is still useful and provides information to newer information. This page is about Health in All Policies (HiAP) is “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies and avoids harmful health impacts in order to improve populations health and health equity”.

Editor’s comment:  

Dietitians-Nutritionists can play a role in all three principles (e.g., health promotion and disease prevention; advocating for Dietitian-Nutritionist services for appropriate disease intervention; decreasing emissions in the supply chain through sustainable procurement practices). They can also promote sustainable diets through policy, promotion, education, and counselling.

Conflict of interest/ Funding:  

The authors declare no competing interests.

External relevant links:  

Corresponding author: 

Andrea J MacNeill, Department of Surgery, University of British Columbia, Vancouver, BC, Canada;

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