Planetary health care Shaping sustainable clinical practice through environmental impact assessment and patient engagement

The healthcare sector is a major contributor to greenhouse gas emissions, environmental pollution and resource scarcity. This thesis aims to shape the integration of environmental sustainability into clinical practice trough quantifying the environmental impact of healthcare practices, exploring patients’ and physicians’ attitudes, and analysing ethical implications of integrating environmental sustainability into clinical decision-making. Collectively, the studies provide an overview of hospital-based environmental impacts and strategies to reduce them, consistent with the planetary health care framework.
The systematic reviews and life cycle assessments reveal key environmental hotspots and mitigation opportunities in hospital-based care, while the qualitative and ethical studies demonstrate that both patients and physicians are open to considering environmental impacts in healthcare decision-making when supported by robust data and institutional commitment. However, methodological and quality heterogeneity within healthcare environmental impact studies currently limits the validity and comparability of findings. Although hotspot analyses can inform mitigation strategies, data-driven comparisons across care pathways remain challenging.
Achieving just and sustainable health care requires transformative rather than incremental change. Hospitals – institutions devoted to promoting health – are uniquely positioned to be at the forefront of this change. Embedding environmental accountability in healthcare policies will depend on the development of standardised assessment methodologies that integrate environmental, financial and human health damages. Integrating patient and citizen perspectives early in decision-making, research, and policy development can further strengthen accountability and societal relevance. Only through such coordinated efforts, grounded in inter- and intragenerational responsibility and environmental justice, can health care both protect human health and safeguard the ecological systems on which it depends.