The carbon footprint of TB treatment

Pranay Lal

The energy required to produce, transport and dispose of diagnostic reagents and supplies (e.g., X-ray films or PPE), or antibiotics for treatment is a significant contributor to carbon footprint.

In this issue of Public Health Action, Correspondence by Harries et al._¹ highlights the importance of assessing the carbon footprint for TB treatment. This is an important topic that deserves greater attention for TB treatment, and for healthcare services as a whole. The term carbon footprint (CF) is an extension of the concept of ecological footprint, which was proposed in the 1990s.²

Since then, CF has become a measure to benchmark the total amount of greenhouse gases emitted over the lifecycle of a product, from the extraction and assembly of the raw materials, throughout its use and eventual disposal. Companies, sectors and interventions can develop and use such measures to quantify their impact on future climate change. To date, discussions in healthcare have focussed on the adverse health impacts that might be caused by climate change and how we must prepare to reduce the burden of climate-attributable disease. Only a few robust studies have estimated the CF of the healthcare sector itself, with the first perhaps from the United States in 2009,³ and more recent assessments have been done for Australia, Canada and the United Kingdom.^4-6

One analysis measured the CF for the healthcare sector for 36 countries (OECD countries, China and India), and found that healthcare on average accounts for 5% of the national CO2 footprint.⁷ This study found that the average per capita healthcare carbon footprint in 2014 was 0.6 tonne CO2 (tCO2), varying between 1.51 t CO² per capita in the United States and 0.06 t CO² per capita in India.

The study concluded that the healthcare sector has a significant potential to reduce its CF.

Thus, in a small way, the healthcare sector’s CF also contributes to disease, which therefore needs to be measured and mitigated. The study proposed by Harries et al.¹ is timely and contributes to the growing consciousness of public health practitioners to measure and reduce their CF. As in any disease control area within healthcare, TB treatment requires significant material input and energy to successfully overcome the infection. The energy required to produce, transport and dispose of diagnostic reagents and supplies (e.g., X-ray films or PPE), or antibiotics for treatment, are significant. If the costs to mitigate the impact of these synthetic (and often persistent) chemicals to avoid damage to
the environment is considered, the carbon footprint is even larger. Harries et al. can go further than conventional studies (such as Pichler et al.⁷) by extending their protocol to assess energy costs (and the funds required) to mitigate the environmental impact for all the inputs required to recycle or reuse reagents and the special provisions needed to ensure they are biodegradable and environmentally benign.¹

The preventive measures (such as active case finding) as proposed by Harries et al.¹ need to be prioritised in TB control, not only to reduce the burden of disease, but also to realise the significant gains that can be made by reducing the carbon footprint. By reducing material and energy intensity—and thereby, the CF for TB treatment advances, we can ensure that the first doctrines of medicine (“first, do no harm”) and in ecology (“the precautionary principle”) are being followed. In this way, we can guide health programmes to adopt a less carbon-intensive future.

References
1 Harries AD, Martinez L, Chakaya, J.M. Tackling climate change: measuring the carbon footprint of preventing, diagnosing and treating TB. Public Health Action 2021; 11(1): 40.
2 Wackernagel M, Rees WE. Our ecological footprint: reducing human impact on the earth. Gabriola Island, BC, Canada:
New Society Publishers, 1996.
3 Chung JW, Meltzer DO. Estimate of the carbon footprint of the US health care sector. JAMA 2009; 302: 1970–1972.
4 Eckelman MJ, et al. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental epidemiological analysis. PLoS Med 2018; 15: e1002623.
5 Malik A, et al. The carbon footprint of Australian health care.Lancet Planet Health 2018; 2: e27–35.
6 National Health Service. Carbon Footprint update for NHS in England 2012. Cambridge, UK: Sustainable Development Unit, 2013, https://www.sduhealth.org.uk/documents/carbon_footprint_summary_nhs_update_2013.pdf Accessed January 2021.
7 Pichler P-P, et al. International comparison of health care carbon footprints. Environ Res Lett 2019; 14: 064004.

Pranay Lal is associated with the International Union Against Tuberculosis and Lung Disease, New Delhi, India.