The environmental impact of the Dutch health-care sector beyond climate change: an input-output analysis.

Background: Studies suggest that the Dutch health-care sector is responsible for 4-8% of the national carbon footprint, but the environmental footprint of this sector beyond climate change is not well understood. Therefore, we aimed to estimate the environmental footprint of the Dutch health-care sector for a range of environmental impact categories.

Methods: In this input-output analysis, we used Exiobase (version 3), which contains data on global trade flows and their associated environmental impact, in combination with health-care expenditure data from Statistics Netherlands. We covered the impact categories: climate change, blue water consumption, abiotic material extraction, land use, and total waste generation. The calculated sectoral footprint was the sum of all impacts associated with the operational phase (direct impact) and impacts occurring in the value chain of purchased goods and services (indirect impact) given an expenditure vector. The expenditure vector was the sum of three elements of health-care expenditure: health-care services; pharmaceuticals and chemical products; and medical appliances. We calculated the impact share of health care on the total Dutch consumption footprint. We evaluated the contribution to the impact categories from the categories that composed the expenditure vector. We did a hotspot analysis in which the indirect impact was split according to where (sector, geography, or both) the impact physically occurred. These top-down results were complemented with bottom-up data on emissions from pressurised metered-dose inhalers, anaesthetic gases, and private travel.

Findings: The health-care sector's share of the national footprint was highest for material extraction (13·0%), followed by blue water consumption (7·5%), climate change (7·3%), land use (7·2%), and waste generation (4·2%). Pharmaceuticals and other chemical products were the biggest contributors to all impacts. The sectors contributing to climate change were more evenly distributed than the sectors contributing to the other impact categories. The mining sector mostly contributed to material extraction and the agricultural sector contributed largely to blue water consumption and land use. The mining sector and the agricultural sector were the main contributors to waste generation. Climate change occurred mainly in the Netherlands, whereas the other impacts mainly occurred abroad.

Interpretation: The Dutch health-care sector contributes to a broad set of environmental impact categories beyond climate change. Our results will help stakeholders involved in the health-care sector to pinpoint topics that need to be prioritised and to prevent trade-offs by addressing multiple environmental issues simultaneously.

Funding: Dutch Ministry of Health, Welfare and Sport.