Environmental sustainability and quality care: Not one without the other

Abstract

Contributorship: N.P. and M.N. contributed equally to the inception, development and writing of this comment. There are increasing calls for attention to environmental sustainability within health systems and healthcare. This is essential given their environmental impact, their need for climate resilience and their role in managing climate-mediated conditions [1]. Quality of care, or the ‘degree to which health services for individuals and populations increase the likelihood of desired health outcomes’, is similarly a key health systems goal given the huge human suffering and mortality associated with care that is not effective, safe or people-centred [2, 3]. As health systems pursue these dual objectives, we must understand the interface between them, conceptually and operationally. Environmental sustainability and quality of care are extensively linked. As health services are scaled up in pursuit of Universal Health Coverage, it is vital that they are both high quality and sustainable. The health sector is a major polluter, generating an estimated 4.6% of global emissions [4]. Improving quality of care has potential bidirectional impacts on pollution: improving quality can reduce adverse impacts, for example, as preventative and patient safety measures reduce unnecessary hospital procedures [5]. Conversely, if quality improves without attention to environmental factors, this may increase adverse impacts on the environment, for example, as improved access to chronic disease medication increases pharmaceutical pollution [6] or as enhanced Infection Prevention and Control (IPC) increases the use of single-use personal protective equipment, especially apparent during the corona virus disease 2019 (COVID-19) pandemic [7, 8]. An increase in healthcare-mediated pollution as quality services are scaled up is not a certainty: these footprints vary considerably by country, with many countries expanding healthcare while maintaining or decreasing carbon outputs [9]. Efficiency is already a widely recognized domain of quality health services [10]; as the costs of inaction on environmental sustainability become ever more stark, the case for its inclusion as a key determinant of efficiency is clear.