Library

Dear greenviu members,

we have accumulated some of the available data on sustainable medicine here in our library.

This is a summary of scientific literature regarding the ecological impact healthcare has on nature. Furthermore, literature that affects sustainable medicine is also included. The scientific basis for sustainable medicine leaves room for improvement and we will be happily working on that.

This overview is free to use for everybody, if you use literature found in this library please have a short note on your presentation such as: found in the greenviu library.

1. Studies focusing on the ecological footprint of medicine

1.1 Worldwide and nation-orientated investigations

Excellent in-depth study about the ecological footprint of medicine worldwide. Up to 5mio tons of waste and close to 5% of the greenhouse emissions come from medicine.

https://www.arup.com/-/media/arup/files/publications/h/health-cares-climate-footprint.pdf

How big is the footprint medicine leaves? This review published in the renowned „ lancet“ shows its up to 5% of the total ecological footprint, a finding that is consistent its the ARUP investigation

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30121-2/fulltext

“The health care sector’s environmental footprint is outsize”

Very interesting article on the pollution of the US healthcare sector regarding the various sources of this pollution, considering the damage also done to human health and how pollution can be reduced. A quote from the article: “In 2018 greenhouse gas and toxic air pollutant emissions resulted in the loss of 388,000 disability-adjusted life-years.”

https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01247

Overview of the ecological footprint of the NHS in Britain. It features a clear distinction of the sources of carbon emissions and also some basic steps how to improve

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30271-0/fulltext

Ho to make the NHS net zero – long report about the NHS status and improvement options

https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf

1.2 Footprint of a clinic

Article on the carbon footprint of the NHS and a summary of the British medical association on measures how to reduce the carbon footprint of general physicians’ offices. As the prescription and use of pharmaceuticals is a large factor in the carbon footprint of medicine in total the prescription strategy is a major topic in the survey. It also features a link to the “green impact for health toolkit”, a network with several hundred members.

https://www.bma.org.uk/media/2570/bma-sustainable-and-environmentally-friendly-general-practice-report-june-2020.pdf

What is the footprint of a clinic and what can be done about it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465872/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8723904/

https://noharm-europe.org/sites/default/files/documents-files/5624/2018-09-25_Reducing_carbon_footprint_healthcare%20WEB.pdf

1.3 Ecological footprint of pharmaceuticals

A book chapter that features both the contamination left by the making and use of pharmaceuticals and the corporate social responsibility to deal with it.

https://www.researchgate.net/publication/308667613_Reducing_the_Ecological_Footprint_of_Pharmaceutical_Usage_Linkages_between_Healthcare_Practices_and_the_Environment

Information about the carbon footprint on various pharmaceuticals from AstraZeneca

https://www.astrazeneca.com/content/dam/az/PDF/Sustainability/AZ_Our%20Sustainability%20Journey_FULL.pdf

This very interesting guideline features the ecological impact of preventable adverse events of medication. More than 200 tons of greenhouse gas emissions for 100,000 people could be saved if this guideline is followed thoroughly. Non-preventable side effects of drug use are not included. This makes this study so interesting!

https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/resource-impact-assessment/Medicines-optimisation-sustainability-report.pdf

In this special article the ecological impact of COVID-19 vaccinations is examined. The article shows that transport features more than 99% of the carbon emissions of the vaccination strategies.

https://www.mdpi.com/1660-4601/18/14/7425

Interesting article on the ecological impact of illegal drugs

https://www.dw.com/en/drugs-environment-impacts-cannabis-cocaine-opium-ecstasy/a-55177638

1.4 Energy consumption

Very important paper in the energy consumption in a dental office

https://www.researchgate.net/publication/331617162_Environmentally_sustainable_dentistry_energy_use_within_the_dental_practice

Various articles on energy consumption in medicine and dentistry

https://pubmed.ncbi.nlm.nih.gov/29074898/

https://ec.europa.eu/info/energy-climate-change-environment/standards-tools-and-labels/products-labelling-rules-and-requirements/energy-label-and-ecodesign/rules-and-requirements_en

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6012498/

https://pubmed.ncbi.nlm.nih.gov/26939306/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519304/

1.5 Digital medicine

Telemedicine can help healthcare reduce its carbon emissions footprint especially by reducing the need to travel.

https://www.rcpjournals.org/content/futurehosp/8/1/e85

Various articles that investigate the impact of digital medicine on the ecologic footprint of medicine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004323/

https://pubmed.ncbi.nlm.nih.gov/25188322/

https://pubmed.ncbi.nlm.nih.gov/31077768/

https://pubmed.ncbi.nlm.nih.gov/10847368/

https://pubmed.ncbi.nlm.nih.gov/10847400/

https://pubmed.ncbi.nlm.nih.gov/12105711/

1.6 The ecological footprint of dentistry and digital dentistry

The ecologic footprint of dentistry classified by various procedures and materials

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/724777/Carbon_modelling_within_dentistry.pdf

https://www.researchgate.net/publication/329776711_Ecological_footprint_of_biomaterials_for_implant_dentistry_is_the_metal-free_practice_an_eco-friendly_shift

https://www.dtmd.eu/en/digitization-in-dentistry/

Digital vs. analoge Dentistry

https://www.dentistryiq.com/dentistry/occlusion-tmj-and-sleep-medicine/article/14035239/digital-or-analog-the-concept-of-complete-dentistry-is-the-same

https://www.researchgate.net/publication/326483302_Digital_versus_Analog_Procedures_for_the_Prosthetic_Restoration_of_Single_Implants_A_Randomized_Controlled_Trial_with_1_Year_of_Follow-Up

https://www.dental-tribune.com/news/digital-vs-analogue-workfl-ow-on-ten-ceramic-veneers-in-the-maxilla/

https://www.rolandberger.com/en/Insights/Publications/The-Future-of-Dentistry-is-Digital.html

https://pubmed.ncbi.nlm.nih.gov/32329094/

1.7 Waste in medicine and dentistry

Waste generation in medicine, how it is composed and some ideas on how it can be tackled

https://pubmed.ncbi.nlm.nih.gov/31652534/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012496/

https://www.researchgate.net/publication/

https://www.arup.com/-/media/arup/files/publications/h/health-cares-climate-footprint.pdf

https://pubmed.ncbi.nlm.nih.gov/23063307/

Waste production in dental clinics – how much in total, how much toxic and bio-hazardous solid waste comes from dentists?

https://www.researchgate.net/publication/266379512_Solid_Waste_Production_and_Its_Management_in_Dental_Clinics_in_Gorgan_Northern_Iran

1.8 Consumables in medicine and dentistry

Medical masks as waste, what kind of threads it poses during the environment and how the Covid-19 pandemic influenced it.

https://www.greenpeace.org/international/story/44629/where-did-5500-tonnes-of-discarded-face-masks-end-up/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543915/

https://www.sciencedirect.com/science/article/abs/pii/S0048969721026991

Personal protective equipment: the environmental impact

https://journals.sagepub.com/doi/full/10.1177/01410768211001583

The problem of disposable cups and the problems of recycling plastics

https://pubmed.ncbi.nlm.nih.gov/24994469/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873020/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791860/

https://plastic.education/the-problem-with-disposable-cups/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299092/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324921/

The ecological and medical effect of hand sanitisers

https://pubmed.ncbi.nlm.nih.gov/32623176/

Paper towels are from a hygienic standpoint better than hand dryers and multiple-use cotton towels. But of course, they produce large amounts of waste and their ecological impact is worse than modern hand dryers

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538484/

https://pubmed.ncbi.nlm.nih.gov/23063307/

https://ec.europa.eu/environment/biodiversity/business/assets/pdf/case-studies/Case%20study%2016_ReCiPe%20Hand%20drying%20systems_final.pdf

(nice graphics !!!!!!)

https://www.exceldryer.com/wp-content/uploads/2017/02/LCAFinal9-091.pdf

1.9 Transport and travel

Transport and travel have a high impact on medicines´ ecological footprint. Some interesting studies that focus on this area:

https://www.ugpti.org/resources/reports/downloads/dp-236.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465872/

https://noharm-europe.org/sites/default/files/documents-files/5624/2018-09-25_Reducing_carbon_footprint_healthcare%20WEB.pdf

1.10 The impact of preventive medicine

Already a timeframe of just 3years shows a clear impact of prevention

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296930/

The request for a carbon tax from a medical standpoint

https://pubmed.ncbi.nlm.nih.gov/29676643/

Diabetes and climate change – how they are related to each other

https://pubmed.ncbi.nlm.nih.gov/33039261/

https://pubmed.ncbi.nlm.nih.gov/29304014/

https://pubmed.ncbi.nlm.nih.gov/21442161/

https://pubmed.ncbi.nlm.nih.gov/34792619/

https://pubmed.ncbi.nlm.nih.gov/33127474/

https://diabetesjournals.org/care/article/41/5/929/36592/The-Cost-of-Diabetes-Care-An-Elephant-in-the-Room

https://www.diabetologie-online.de/a/gesundheitsausgaben-was-kostet-der-typ-die-kassen-1821777

Preventive dentistry saves money

https://pubmed.ncbi.nlm.nih.gov/29194610/

1.11 Footprint of general medicine surgery

Anesthesia scores around 20kg/ intervention

https://pubs.asahq.org/anesthesiology/article/135/6/976/117564/Carbon-Footprint-of-General-Regional-and-Combined

Ophthalmologies interventions can cause up to 180kg Co2 per patient

https://www.sciencedaily.com/releases/2022/06/220606134432.htm

https://pubmed.ncbi.nlm.nih.gov/23429413/

Insights on how to address sustainability in orthopaedic surgery:

https://pubmed.ncbi.nlm.nih.gov/35412500/

The carbon footprint of surgery can go up to 800kg CO2 per procedure!

https://pubmed.ncbi.nlm.nih.gov/32516230/

2. The climate change and human health

Articles that focus on the impact climate change has on human health

https://pubmed.ncbi.nlm.nih.gov/2511446/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210172/

https://www.arup.com/perspectives/publications/research/section/healthcares-climate-footprint

https://pubmed.ncbi.nlm.nih.gov/34108165/

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30121-2/fulltext

https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01247

3. Economical and political aspects

Consumer surveys for climate-friendly products

https://www.climatepartner.com/en/news/climate-awareness-report-2021-consumer-survey

https://ec.europa.eu/clima/citizens/citizen-support-climate-action_en

Economical aspects especially on the importance of sustainability for the clinics’ staff and for clients

https://www.mckinsey.de/~/media/mckinsey/locations/europe%20and%20middle%20east/deutschland/news/presse/2021/2021-09-10%20net-zero%20deutschland/210910_mckinsey_net-zero%20deutschland.pdf

https://press.hp.com/content/dam/hpi/press/press-kits/2019/earth-day-2019/HP%20Workforce%20Sustainability%20Survey.pdf

https://reba.global/content/sustainability-in-the-workplace-and-its-importance-to-tomorrow-s-workforce

https://www.umweltbundesamt.de/en/topics/economics-consumption/economy-environment/environmental-protection-employment

https://fashionunited.de/nachrichten/business/gruene-mode-ein-verbrauchertrend-den-die-pandemie-verstaerkt/2020072236459

https://www.climatepartner.com/en/news/climate-awareness-report-2021-consumer-survey

https://www.mckinsey.com/industries/retail/our-insights/prioritizing-sustainability-in-the-consumer-sector

https://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/nef-spotlight-the-path-forward-for-retails-sustainable-future

Political aspects of sustainability

https://ec.europa.eu/clima/citizens/citizen-support-climate-action_en

https://ec.europa.eu/commission/presscorner/detail/en/ip_20_335

Sustainability in organisations

https://www.accenture.com/de-de/insights/sustainability/sustainable-organization

https://www.accenture.com/us-en/insights/strategy/delivering-promise-sustainability

Important EU ISO norms

https://www.iso.org/standard/60857.html

https://www.iso.org/standard/38498.html

https://www.iso.org/iso-26000-social-responsibility.html

4. How sustainable are our everyday products?

How sustainable are certain technologies and products? A closer look at energy forms, plastic bags, etc.

http://www.niassembly.gov.uk/globalassets/documents/raise/publications/2011/environment/3611.pdf

https://www.forbes.com/sites/christopherhelman/2021/04/28/how-green-is-wind-power-really-a-new-report-tallies-up-the-carbon-cost-of-renewables/?sh=5a68ae1173cd

https://www.sciencedirect.com/science/article/abs/pii/S0960148111002254

https://yaleclimateconnections.org/2021/06/whats-the-carbon-footprint-of-a-wind-turbine/

https://www.umweltbundesamt.de/sites/default/files/medien/1410/publikationen/2019-08-15_cc_30-2019_marktanalyse_oekostrom_ii.pdf

https://www.tech-for-future.de/oekostrom/

https://www.bbc.com/news/business-47027792

https://www.webarchive.org.uk/wayback/archive/3000/https://www.gov.scot/Resource/Doc/57346/0016899.pdf

Articles on energy mixes

www.ofgem.gov.uk/data-portal/electricitygenerationmixquarterandfuelsource-gb

https://www.energy.gov/energysaver/thermostats

https://www.umweltbundesamt.de/sites/default/files/medien/1410/publikationen/2019-08-15_cc_30-2019_marktanalyse_oekostrom_ii.pdf

https://www.forbes.com/sites/christopherhelman/2021/04/28/how-green-is-wind-power-really-a-new-report-tallies-up-the-carbon-cost-of-renewables/?sh=5a68ae1173cd

https://www.sciencedirect.com/science/article/abs/pii/S0960148111002254

https://yaleclimateconnections.org/2021/06/whats-the-carbon-footprint-of-a-wind-turbine/

5. Climate change in the media

https://edition.cnn.com/2021/06/17/us/lake-mead-drought-water-shortage-climate/index.html

https://www.nationalgeographic.de/umwelt/2021/11/26-harte-fakten-zum-klimawandel?utm_source=pocket-newtab-global-de-DE

https://www.bbc.co.uk/news/scienceenvironment39053678

https://www.bbc.com/news/science-environment-59670396

https://www.bbc.com/news/science-environment-56921164

https://www.economist.com/international/2021/07/21/as-wildfires-continue-to-ravage-america-floods-are-wreaking-havoc-elsewhere

https://pubmed.ncbi.nlm.nih.gov/22532707/

6. Climate change effect on endangered species

There seems to be a gap between climate change sensitivity to endangered species in the US and the official recognition. Data shows that nearly all endangered species are sensitive to one or more climate change aspects while the official recognition is at 64%. Only 18% of these species will see official action.

(ESP: piping plover, California condors)

https://www.nature.com/articles/s41558-019-0620-8

https://defenders.org/blog/2019/11/endangered-species-are-overwhelmingly-threatened-climate-change

The various impacts on Earth done by climate change affect the species living in various areas. This leads to ecological, behavioural, physiological and genetic changes. The first call to action is to reduce CO2e emissions.

https://www.iucn.org/resources/issues-briefs/species-and-climate-change

List of 10 example animals threatened by climate change, featuring the individual impact climate change has on the specific species

https://brightly.eco/endangered-animals-threatened-by-climate-change/

Climate change might lead to the extinction of up to 30% of species until 2070. This study examines how species might evade extinction by dispersal and niche shifts.

https://www.pnas.org/doi/10.1073/pnas.1913007117

Climate change seems to affect bees more than the disturbance of their habitats

https://www.sciencedaily.com/releases/2021/01/210112085357.htm

http://www.nicra-icar.in/nicrarevised/images/publications/Research_art/HRT20_Potential%20impact%20of%20climate%20change.pdf

https://www.vice.com/en/article/gynewm/heres-what-climate-change-could-do-to-honey-bees

7. Natural sources of greenhouse gas emissions and their comparison to human activities

Greenhouse gases are naturally emitted e.g. by forest fires, oceans, wetlands, permafrost, volcanoes, earthquakes and many more natural events. Natural emissions account for 18 – 40 Gigatons CO2 equivalents, while anthropogenic emissions reach the same levels

https://www.sciencedirect.com/science/article/pii/S1674927818300376

A Chinese study examined the effects of the Tonga volcano underwater eruption in January 2022 on CO2 levels: the one eruption equalled the CO2 production on earth of one year

https://english.cas.cn/newsroom/research_news/tech/202202/t20220218_300957.shtml

In a contrast, the UN published research that all volcanic activities on earth are equal to 3 days of human emissions

https://unric.org/en/even-volcanos-do-not-surpass-the-human-contribution-to-co2-emissions/

The US Department of the Interior published data on how volcanoes impact climate and also states that human activities surpass volcanoes by far.

https://www.usgs.gov/programs/VHP/volcanoes-can-affect-climate

Nature study on the emissions of Co2 from volcanoes, also features how nature handles CO2 – stored below the crust, consumed by microbial activity or formed into diamonds

https://www.nature.com/articles/s41598-019-54682-1

In this NASA report it is stated that human emissions vastly surpass volcanoes. Humans emit the same CO2 as the Mount St. Helens eruption every 2.5hours

https://climate.nasa.gov/faq/42/what-do-volcanoes-have-to-do-with-climate-change/

Already in 1992, it was stated that volcanoes only erupt 0.22% of the anthropogenic yearly emissions

https://www.sciencedirect.com/science/article/abs/pii/001670379290243C

Volcanic eruptions play an important role in the carbon geochemical cycle

https://pubs.er.usgs.gov/publication/70016080

Wildfires and climate change affect each other

https://www.nationalgeographic.com/science/article/climate-change-increases-risk-fires-western-us

8. Effects of climate change on vectors for diseases

Climate change induces the spread of Lyme disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582486/

https://pubmed.ncbi.nlm.nih.gov/31524884/

https://pubmed.ncbi.nlm.nih.gov/28213980/

https://www.rki.de/DE/Content/InfAZ/F/FSME/Karte_Tab.html

Seroprevalence in Germany for Borrelia burgdorferi-Specific Antibodies is about 20% of the population

https://pubmed.ncbi.nlm.nih.gov/33255673/