Bhopal Anand, Bærøe Kristine, Norheim Ole F
Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
Centre for Energy and Climate Transformation (CET), University of Bergen, Bergen, Norway.
Int J Health Policy Manag. 2025;14:8440. doi: 10.34172/ijhpm.8440. Epub 2025 Jan 15.
Over 80 countries have now signed up to the COP26 Health Programme-a World Health Organization (WHO)-led initiative on climate change and health-of which 45 countries have committed to reaching emissions before 2050. Efforts to reduce healthcare's carbon footprint raise conceptual, ethical and practical challenges for efficient and fair resource allocation. This study investigates how civil servants leading the development and implementation of national net zero healthcare strategies conceptualise the responsibility of health systems to cut emissions and describe potential trade-offs along the way.
We undertook 11 online, semi-structured qualitative research interviews between September 2022 - May 2023 with civil servants leading national net zero healthcare strategies. The interview guide explored three main areas: responsibility for emissions, priority setting and international perspectives. Interviews were coded and analysed the data using Malterud's systematic text condensation (STC).
Four main themes emerged: obligation to act, leadership, governance, and prioritization. Participants described that the healthcare system should take responsibility for its entire carbon footprint, including harms inflicted beyond national borders. We also found indications of synergistic, multi-scalar health leadership-clinical, civil service, and political-helping to accelerate the net zero healthcare agenda. Participants generally rejected the notion of direct "trade-offs" between efforts to reduce emissions and patient care, emphasising ways net zero healthcare can leverage societal health improvements more broadly. These empirical findings inform the emerging literature exploring how health systems should account for their environmental impacts.
Our findings highlight the sincerity of ambitions to deliver net zero healthcare and uncertainties on how to get there. Further work characterising the types of constraints and trade-offs policy-makers face on the path to net zero healthcare systems, including examples of how these have been overcome, could help integrate climate concerns into healthcare decision-making and resource allocation processes.
目前已有80多个国家签署了《联合国气候变化框架公约》第26次缔约方大会卫生计划——这是一项由世界卫生组织（WHO）牵头的关于气候变化与健康的倡议，其中45个国家已承诺在2050年前实现净零排放。减少医疗保健领域碳足迹的努力在高效且公平的资源分配方面带来了概念、伦理和实际挑战。本研究调查了负责制定和实施国家医疗保健净零战略的公务员如何理解卫生系统在减排方面的责任，并描述在此过程中可能存在的权衡取舍。
2022年9月至2023年5月期间，我们对负责国家医疗保健净零战略的公务员进行了11次在线半结构化定性研究访谈。访谈指南探讨了三个主要领域：排放责任、优先事项设定和国际视角。使用马尔特鲁德的系统文本浓缩法（STC）对访谈进行编码并分析数据。
出现了四个主要主题：行动义务、领导力、治理和优先排序。参与者表示，医疗保健系统应对其整个碳足迹负责，包括境外造成的危害。我们还发现了协同、多层面健康领导力（临床、公务员和政治层面）的迹象，有助于加速医疗保健净零议程。参与者普遍反对在减排努力与患者护理之间进行直接“权衡取舍”的观点，强调医疗保健净零如何能更广泛地推动社会健康改善。这些实证研究结果为探索卫生系统应如何考量其环境影响的新兴文献提供了参考。
我们的研究结果凸显了实现医疗保健净零目标的决心以及如何实现这一目标的不确定性。进一步开展工作，明确政策制定者在迈向医疗保健净零系统的道路上面临的制约因素和权衡取舍类型，包括这些问题是如何被克服的实例，有助于将气候问题纳入医疗保健决策和资源分配过程。
