Guiding principles for the next generation of health-care sustainability metrics.

Metrics for health-care sustainability are crucial for tracking progress and understanding the advantages of different operations or systems as the health-care sector addresses the climate crisis and other environmental challenges. Measurement of the key metrics of absolute energy use and greenhouse gas emissions now has substantial momentum, but our overall measurement framework generally has serious deficiencies. Because existing metrics are often borrowed from other sectors, many are unconnected to the specifics of health-care provision or existing health system performance indicators, the potential negative effects of health care on public health are largely absent, a consistent and standardised set of health-care sustainability measurement concepts does not yet exist, and current dynamics in health systems such as privatisation are largely ignored.

The environmental footprint of health care: a global assessment.

Background: Health-care services are necessary for sustaining and improving human wellbeing, yet they have an environmental footprint that contributes to environment-related threats to human health. Previous studies have quantified the carbon emissions resulting from health care at a global level. We aimed to provide a global assessment of the wide-ranging environmental impacts of this sector.

Physical and virtual carbon metabolism of global cities.

Urban activities have profound and lasting effects on the global carbon balance. Here we develop a consistent metabolic approach that combines two complementary carbon accounts, the physical carbon balance and the fossil fuel-derived gaseous carbon footprint, to track carbon coming into, being added to urban stocks, and eventually leaving the city. We find that over 88% of the physical carbon in 16 global cities is imported from outside their urban boundaries, and this outsourcing of carbon is notably amplified by virtual emissions from upstream activities that contribute 33-68% to their total carbon inflows.

City-level climate change mitigation in China.

As national efforts to reduce CO emissions intensify, policy-makers need increasingly specific, subnational information about the sources of CO and the potential reductions and economic implications of different possible policies. This is particularly true in China, a large and economically diverse country that has rapidly industrialized and urbanized and that has pledged under the Paris Agreement that its emissions will peak by 2030. We present new, city-level estimates of CO emissions for 182 Chinese cities, decomposed into 17 different fossil fuels, 46 socioeconomic sectors, and 7 industrial processes.

Reducing Urban Greenhouse Gas Footprints.

Cities are economically open systems that depend on goods and services imported from national and global markets to satisfy their material and energy requirements. Greenhouse Gas (GHG) footprints are thus a highly relevant metric for urban climate change mitigation since they not only include direct emissions from urban consumption activities, but also upstream emissions, i.e.