Abstract
Introduction: The reduction of carbon footprints across all sectors is a crucial aspect of climate action. The implementation of specific strategies to achieve this goal includes the actions of healthcare services. Costa Rica has been noted for a robust health system with a primary care approach. However, there is a paucity of scientific evidence regarding the roles and impacts of the health sector in reducing the national carbon footprint. Objective: To analyze the scientific production on carbon footprint in health services at a global level and contrast it with the Costa Rican reality. Method: A mapping of the literature in Spanish and English was carried out in the Scopus database, based on online thesaurus terms. Inclusion and exclusion criteria were applied, and the Bibliometrix tool in R software was used for the analysis. Subsequently, an integrative review of the selected documents was conducted with the support of the Covidence platform. A total of 46 publications were analyzed in the bibliographic analysis and 25 documents in the scoping review, identifying currently researched topics for carbon footprint reduction in healthcare. These topics include hospital input analysis, solid waste management, environmental impact assessment techniques, sustainability strategy design, environmental education, healthcare infrastructure, sustainable purchasing, and energy consumption. Conclusions: The studies, regardless of region or country, present options for improving healthcare practice in relation to the carbon footprint, also impacting the health of the populations. However, the majority of these studies, according to the GRADE methodology, present low evidence due to the particularities of the methodological design employed. International collaborations can be a useful tool to advance the implementation of technologies and political strategies that are adaptable to the Costa Rican reality, thereby making the health sector and, consequently, healthcare sustainable.
References
Aguayo-Albasini, J., Flores-Pastor, B., & Soria-Aledo, V. (2014). Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cirugía Española, 92(2), 82-88. https://doi.org/10.1016/j.ciresp.2013.08.002
Aria, M., & Cuccurullo, C. (2017). Bibliometrix: An R-tool for comprehensive science mapping analysis. Journal of Informetrics, 11(4), 959-975. https://doi.org/10.1016/j.joi.2017.08.007
Asaduzzaman, M., Ara, R., Afrin, S., Meiring, J. E., & Saif-Ur-Rahman, K. M. (2022). Planetary health education and capacity building for healthcare professionals in a global context: current opportunities, gaps and future directions. International Journal of Environmental Research and Public Health, 19(18), 11786. https://doi.org/10.3390/ijerph191811786
Banco Mundial. (2017). Climate Smart Health Care: Low Carbon and Resilience Strategies for the Health Sector [Cuidado de la salud climáticamente inteligente: Estrategias de resiliencia y baja emisión de carbono para el sector de la salud]. http://documents.worldbank.org/curated/en/322251495434571418/Climate-smart-healthcare-lowcarbon-and-resilience-strategies-for-the-health-sector.
Bárcena, A., Samaniego, J., Peres Núñez, W., & Alatorre, J. (2020). La emergencia del cambio climático en América Latina y el Caribe: ¿seguimos esperando la catástrofe o pasamos a la acción? Comisión Económica para América Latina y el Caribe (CEPAL), UN. https://doi.org/10.18356/1f198404-es
Bermejo, R. (2014) Del desarrollo sostenible según Brundtland a la sostenibilidad como biomimesis. Bilbao, Hegoa, 1, 59. https://publicaciones.hegoa.ehu.eus/publications/315
Cabello, J. (2005). Plantilla para ayudarte a entender una Revisión Sistemática. En: CASPE. Guías CASPe de Lectura Crítica de la Literatura Médica (pp.13-17). CASPe. https://redcaspe.org/materiales/
Caja Costarricense del Seguro Social [CCSS]. (2022). Programa de Gestión Ambiental Institucional 2019-2022 [Manuscrito no publicado]. Dirección de Gestión Ambiental.
Chiarini, A., Opoku, A., & Vagnoni, E. (2017). Public healthcare practices and criteria for a sustainable procurement: A comparative study between UK and Italy. Journal of Cleaner Production, 162, 391-399. https://doi.org/10.1016/j.jclepro.2017.06.027
Comisión Técnica Evaluadora del Ministerio de Ambiente y Energía - Ministerio de Salud. (2011). Guía para la elaboración de Programas de Gestión Ambiental Institucional (PGAI) en el sector público de Costa Rica. Decreto Ejecutivo N° 36499-S-MINAET. [Archivo PDF]. https://www.seguridadpublica.go.cr/ministerio/gestion%20ambiental/guias%20y%20manuales/Guia%20elaboracion%20Programas%20Gestion%20Ambiental%20Institucional.pdf
Das, O., Neisiany, R. E., Capezza, A. J., Hedenqvist, M. S., Försth, M., Xu, Q., Jiang, L., Ji, D., & Ramakrishna, S. (2020). The need for fully bio-based facemasks to counter coronavirus outbreaks: A perspective. Science of the Total Environment, 736. https://doi.org/10.1016/j.scitotenv.2020.139611
De Ridder, E. F., Friedericy, H. J., van der Eijk, A. C., Dankelman, J., & Jansen, F. W. (2022). A New Method to Improve the Environmental Sustainability of the Operating Room: Healthcare Sustainability Mode and Effect Analysis (HSMEA). Sustainability (Switzerland), 14 (21). https://doi.org/10.3390/su142113957
Decreto 39945-RE de 2016. [Poder Ejecutivo]. Ratificación de la República de Costa Rica al Acuerdo de París. 06 de octubre del 2016.
Decreto 9357 de 2016. [Asamblea Legislativa]. Aprobación de la Enmienda de DOHA al Protocolo de KYOTO, "Aprobación del Protocolo de Kyoto de la Convención Marco de las Naciones Unidas sobre el Cambio Climático". 08 de julio del 2016.
Duane, B., Ashley, P., Saget, S., Richards, D., Pasdeki-Clewer, E., & Lyne, A. (2020). Incorporating sustainability into assessment of oral health interventions. British Dental Journal, 229(5), 310-314. https://doi.org/10.1038/s41415-020-1993-9
García, F. (2020). Economía circular en la industria de la moda: avances y valorización del PET. Análisis de la huella de carbono. Repositorio Abierto de la Universidad de Cantabria. http://hdl.handle.net/10902/19160
García-Sanz-Calcedo, J., de Sousa, N., & Fernandes, J. (2020). Assessment of the global warming potential associated with the construction process of healthcare centres. Journal of Building Physics, 44(4), 309-325. https://doi.org/10.1177/1744259120914333
González-Domínguez, J., Sánchez-Barroso, G., & García-Sanz-Calcedo, J. (2020). Scheduling of preventive maintenance in healthcare buildings using Markov chain. Applied Sciences (Switzerland), 10(15), 5263. https://doi.org/10.3390/APP10155263
Guzmán-Umaña, A. (2021). Situación de los residuos bioinfecciosos en tres establecimientos de salud de diferente complejidad en Costa Rica [Tesis de maestría]. Escuela de Química, Tecnológico de Costa Rica. https://repositoriotec.tec.ac.cr/bitstream/handle/2238/12454/TFG_Abiga%c3%adl_Guzman_Uma%c3%b1a.pdf?sequence=1&isAllowed=y
Herrera, M. (2019). Sistema de Gestión de Residuos Sólidos Hospitalarios para Reducir el Impacto Ambiental en el Hospital III Daniel Alcides Carrión de Tacna-2018 [Tesis de maestría] Universidad Privada de Tacna. https://repositorio.upt.edu.pe/bitstream/handle/20.500.12969/972/Herrera-Rejas-Milagros.pdf?sequence=1&isAllowed=y
Imran, M. S., Rahman, N. M. A., & Mohamed, R. (2020). Energy Performance Contracting Initiative in Malaysian Public Hospitals. International Journal of Integrated Engineering, 12(9), 234-245. https://doi.org/10.30880/ijie.2020.12.09.028
Keller, R., Muir, K., Roth, F., Jattke, M., & Stucki, M. (2021). From bandages to buildings: Identifying the environmental hotspots of hospitals. Journal of Cleaner Production, 319, 128479. https://doi.org/10.1016/j.jclepro.2021.128479
Kjaer, L., Høst-Madsen, N., Schmidt, J., & McAloone, T. (2015). Application of environmental input-output analysis for corporate and product environmental footprints-learnings from three cases. Sustainability, 7(9), 11438-11461. https://doi.org/10.3390/su70911438
Ley 8839 de 2010. Para la Gestión Integral de Residuos. 13 de julio de 2010. La Gaceta N°135.
Lokmic‐Tomkins, Z., Borda, A., & Humphrey, K. (2023). Designing digital health applications for climate change mitigation and adaptation. Medical Journal of Australia, 218(3), 106-110. https://doi.org/10.5694/mja2.51826
Mackenzie, J. (2011). The old care paradigm is dead, long live the new sustainable care paradigm: How can gp commissioning consortia meet the demand challenges of 21st century healthcare? London Journal of Primary Care, 1, 65-69. https://doi.org/10.1080/17571472.2011.11493330
Madroñero-Palacios, S., & Guzmán-Hernández, T. (2018). Desarrollo sostenible. Aplicabilidad y sus tendencias. Revista Tecnología En Marcha, 31(3), 122–130. https://doi.org/10.18845/tm.v31i3.3907
Merino, W., Quispe, I., Guentelicán, C., Herrero, S., Inostroza, S., Henríquez, G & Estrada, R. (2022). 5R y Sustentabilidad hospitalaria: Nuestro aporte en la emergencia climática. Parte I. Reducir, Reutilizar y Reciclar. Revista Chilena de Anestesia, 51(1), 10-16. https://doi.org/10.25237/revchilanestv5127121130
Mondragón-Suárez, J., Sandoval-Villalbazo, A., & Breña-Ramos, F. (2019). Calentamiento global: una secuencia didáctica. Revista Mexicana de Física E, 65(1), 52-57. http://dx.doi.org/10.31349/RevMexFisE.65.52
Nichols, A., & Mukonoweshuro, R. (2017). Understanding and knowledge of sustainable waste management within the neonatal unit: A qualitative investigation. Journal of Neonatal Nursing, 23(3), 127-133. https://doi.org/10.1016/j.jnn.2016.10.002
Organización para la Cooperación y el Desarrollo Económico, Eurostat y Organización Mundial de la Salud. (2017). A system of health accounts 2011: revised edition [Un sistema de cuentas de salud 2011: Edición revisada]. OECD Publishing. http://dx.doi.org/10.1787/9789264270985-en
Page, M., McKenzie, J., Bossuyt, P., Boutron, I., Hoffmann, T., Mulrow, C., Shamseer, L., Tetzlaff, J., Akl, E., Brennan, S., Chou, R., Glanville, J., Grimshaw, J., Hróbjartsson, A., Lalu, M., Li, T., Loder, E., Mayo-Wilson, E., McDonald, S., Moher, D. (2022). A declaração PRISMA 2020: Diretriz atualizada para relatar revisões sistemáticas. Revista Panamericana de Salud Pública, 46, e112. https://doi.org/10.26633/rpsp.2022.112
Panel Intergubernamental del Cambio Climático [IPCC]. (2013). Glosario [Planton, S. (ed.)]. Cambio Climático. Bases físicas. Contribución del Grupo de trabajo I al Quinto Informe de Evaluación del Grupo Intergubernamental de Expertos sobre el Cambio Climático. [Archivo PDF]. https://www.ipcc.ch/site/assets/uploads/2018/08/WGI_AR5_glossary_ES.pdf
Peng, J., Samad, S., Comite, U., Ahmad, N., Han, H., Ariza-Montes, A., & Vega-Muñoz, A. (2022). Environmentally Specific Servant Leadership and Employees’ Energy-Specific Pro-Environmental Behavior: Evidence from Healthcare Sector of a Developing Economy. International Journal of Environmental Research and Public Health, 19(13). https://doi.org/10.3390/ijerph19137641
Pichler, P., Jaccard, I., Weisz, U. y Weisz, H. (2019). International comparison of health care carbon footprints. [Comparación internacional de huellas de carbono del sector de la salud], Environmental Research Letters, 14(6),1-8. https://iopscience.iop.org/article/10.1088/1748-9326/ab19e1
Power, B., Brady, R., & Connell, P. (2021). Analyzing the carbon footprint of an intravitreal injection. Journal of Ophthalmic and Vision Research, 16(3), 367-376. https://doi.org/10.18502/jovr.v16i3.9433
Prasad, P., Joshi, D., Lighter, J., Agins, J., Allen, R., Collins, M., Pena, F., Velletri, J., & Thiel, C. (2022). Environmental footprint of regular and intensive inpatient care in a large US hospital. International Journal of Life Cycle Assessment, 27(1), 38-49. https://doi.org/10.1007/s11367-021-01998-8
Red Global de Hospitales Verdes y Saludables en América Latina. (2022). Hospitales que curan el planeta 2022. https://hospitalesporlasaludambiental.org/informe-2022
Red Global de Hospitales Verdes y Saludables en América Latina. (2021). Hospitales que curan el planeta 2021. https://hospitalesporlasaludambiental.org/informe-2021
Red Global de Hospitales Verdes y Saludables en América Latina. (2020). Hospitales que curan el planeta 2020. https://hospitalesporlasaludambiental.org/informe-2020
Roca, B., Beltrán, M., & Gómez, R. (2019). Cambio climático y salud. Revista Clínica Española, 219(5), 260-265. https://doi.org/10.1016/j.rce.2019.01.004
Salud sin Daño. (2019). Huella climática del sector de la salud. Cómo contribuye el sector de la salud a la crisis climática global: oportunidades para la acción. Serie Cuidado de la salud climáticamente inteligente. Libro Verde. [Archivo PDF]. https://saludsindanio.org/HuellaClimaticaSalud
Sharma, M., Walpole, S., & Shah, K. (2022). Spotlight environmental sustainability: A strategic priority for NICE. Journal of public health, 44(4), 593-595. https://doi.org/10.1093/pubmed/fdac077
Vergunst, F., Berry, H. L., Rugkåsa, J., Burns, T., Molodynski, A., & Maughan, D. L. (2020). Applying the triple bottom line of sustainability to healthcare research—A feasibility study. International Journal for Quality in Health Care, 32(1), 48-53. https://doi.org/10.1093/intqhc/mzz049
Vozzola, E., Overcash, M., & Griffing, E. (2018). Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives. American Journal of Infection Control, 46(8), 881-886. https://doi.org/10.1016/j.ajic.2018.02.002
Walsh, O., Harris, R., Flower, O., Anstey, M., & McGain, F. (2022). Everyone’s a winner if we test less: The CODA action plan. Australian Health Review, 46(4), 460-462. https://doi.org/10.1071/AH22145
Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546-553. https://doi.org/10.1111/j.1365-2648.2005.03621.x
Wight, J., & Middleton, J. (2019). Climate change: the greatest public health threat of the century. BMJ, 365, l2371. https://doi.org/10.1136/bmj.l2371
Williams, J., Bell, K., Morton, R., & Dieng, M. (2023). Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance. Applied Health Economics and Health Policy, 21(1), 23-30. https://doi.org/10.1007/s40258-022-00765-6
Zevallos, E. (2018). Contabilidad de gestión ambiental y costo de servicio de salud hospitalario–Lima Metropolitana. Quipukamayoc, 26(51), 91-99. http://dx.doi.org/10.15381/quipu.v26i51.15138
Comments
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright (c) 2024 Ericka Murillo-Rodríguez, Wendel Mora-Rivera