An In-Focus analysis in Lancet Haematology calls for greater understanding of greenhouse gas (GHG) emissions, to inform effective and prudent health practice in haematology care. Authors propose the use of Life Cycle Assessment (LCA) methodology to address environmentally unsustainable practices in haematology.
Healthcare processes account for 5-6% of greenhouse gas (GHG) emissions. While the NHS and other healthcare organisations have set carbon-neutral targets, progress towards these goals requires a clear understanding of emission sources and effective mitigation strategies.
Life Cycle Assessment (LCA) methodology quantifies the GHG emissions associated with a process, and has been used successfully in healthcare, as evidenced in two examples, leading to the withdrawal of the anaesthetic gas desflurane (with 26x the CO2 equivalent GHG emissions of the clinically similar sevoflurane), and to the widespread switch in asthma inhalers from solvent-propelled devices to dry powder inhalers.
Advocating the use of LCA to assess haematology practice, Stephen Hibbs and colleagues cite a previous paper (Hibbs et al, 2024) which used this methodology to determine the carbon footprint for red blood cell transfusions in England. The study showed that each transfusion generated ≈7·5 kg CO2 eq (equivalent to driving 40km in a petrol fuelled car) and identified refrigeration, transport, and plastic blood bags as the largest emission contributors. They note that other LCAs relevant to haematology have also been undertaken, including decentralised outpatient cancer care, emissions of common laboratory tests, and non-clinical professional practices such as international conferences, but the environmental impact of many haematology practices remain unexplored.
The authors demonstrate how LCA methods could make further useful contributions in other areas of haematology practice. They suggest that assessing GHG emissions through LCA would be clinically valuable for reducing low-value practices (eg: unrestricted thrombophilia screening or red cell transfusions in patients with chronic iron deficiency, who instead could be treated with intravenous iron), incentivising high-value practices (eg: iron deficiency screening in pregnancy could offer environmental co-benefits due to avoidance of downstream health complications), and making informed choices when multiple clinically equivalent options exist.
This paper asserts that, in addition to assessing existing practices, clinical trials of new treatments, investigations, or care strategies should measure cradle-to-grave environmental impact alongside financial cost-effectiveness. By embedding environmental assessment from the start, mitigation can be incentivised during the design and planning of new medical practices. LCA research fosters cross-fertilisation, as models can be adapted for new practices, and existing LCA data are freely available through resources such as the HealthcareLCA database.
The study concludes: If the goal of medicine is the promotion of health, then we are obliged to optimise individual care while reducing inadvertent harms to others through the emissions we produce.
Author Stephen Hibbs said:
Life cycle assessment (LCA) methodology is a powerful tool to understand where healthcare practices generate carbon emissions. In this article, my co-authors and I aim to share our experiences using LCA and highlight its application in haematology. This application extends beyond hospital practices to include professional activities like scientific meetings. We also identify areas in haematology where LCA could drive environmentally conscious changes, but has yet to be applied.
I hope this article encourages other clinical and laboratory professionals to collaborate with environmental engineers in assessing additional healthcare practices. Those working in clinical or laboratory settings are uniquely positioned to contribute to LCA processes, and to lead efforts in identifying and implementing effective actions.
Stephen Thomas, Stephen P Hibbs, Andrew Hantel. Environmental impact of haematology care - measurement and mitigation. 22 August 2024. The Lancet Haematology