Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, WC1E 7HT, England.
Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Bull World Health Organ. 2024 Mar 1;102(3):159-175B. doi: 10.2471/BLT.23.290464. Epub 2023 Jan 31.
To identify evidence-based interventions that reduce greenhouse gas emissions in health-care systems in low- and middle-income countries and explore potential synergies from these interventions that aid climate change adaptation while mitigating emissions.
We systematically searched 11 electronic databases for articles published between 1990 and March 2023. We assessed risk of bias in each article and graded the quality of evidence across interventions in health-care operations, energy and supply chains.
After screening 25 570 unique records, we included 22 studies published between 2000 and 2022 from 11 countries across six World Health Organization regions. Identified articles reported on interventions spanning six different sources of emissions, namely energy, waste, heating and cooling, operations and logistics, building design and anaesthetic gases; all of which demonstrated potential for significant greenhouse gas emission reductions, cost savings and positive health impacts. The overall quality of evidence is low because of wide variation in greenhouse gas emissions measuring and reporting.
There are opportunities to reduce the greenhouse gas emissions from health-care systems in low- and middle-income countries, but gaps in evidence were identified across sources of emissions, such as the supply chain, as well as a lack of consideration of interactions with adaptation goals. As efforts to mitigate greenhouse gas intensify, rigorous monitoring, evaluation and reporting of these efforts are needed. Such actions will contribute to a strong evidence base that can inform policy-makers across contexts.
确定在中低收入国家的医疗保健系统中减少温室气体排放的循证干预措施，并探索这些干预措施在减轻排放的同时促进气候变化适应的潜在协同作用。
我们系统地搜索了 11 个电子数据库，以获取 1990 年至 2023 年 3 月期间发表的文章。我们评估了每篇文章的偏倚风险，并对医疗保健运营、能源和供应链中的干预措施的证据质量进行了分级。
在筛选了 25570 条独特记录后，我们纳入了来自六个世界卫生组织区域 11 个国家的 2000 年至 2022 年期间发表的 22 项研究。已识别的文章报告了跨越六种不同排放源的干预措施，即能源、废物、供暖和制冷、运营和物流、建筑设计和麻醉气体；所有这些措施都显示出了显著减少温室气体排放、节省成本和对健康产生积极影响的潜力。由于温室气体排放量的测量和报告存在广泛差异，整体证据质量较低。
在中低收入国家的医疗保健系统中减少温室气体排放是有机会的，但在排放源方面存在证据差距，例如供应链，并且缺乏对与适应目标相互作用的考虑。随着减轻温室气体排放的努力加剧，需要对这些努力进行严格的监测、评估和报告。这些行动将有助于建立一个强大的证据基础，为不同背景下的决策者提供信息。
