Primary Healthcare's Carbon Footprint and Sustainable Strategies to Mitigate Its Contribution: a Scoping Review

Background: The escalating climate crisis poses a significant threat to global public health. The healthcare sector, designed to protect human health is a major contributor to greenhouse gas emissions, and thus, a key driver of climate degradation. This paradox endangers both planetary and human health, making the decarbonization of healthcare, including primary care, critical. However, research on primary care's contribution to emissions and strategies for mitigation remains limited.

Aim: This scoping review aimed to map how primary care contributes to healthcare's environmental footprint and determine contributing factors. Additionally, it sought to identify existing and innovative strategies to reduce the carbon footprint of primary healthcare.

Methods: A comprehensive strategy was developed to systematically search both published databases and grey literature. Key terms were identified and employed in the exploration of relevant databases and internet search engines.

Results: An initial search yielded 246 published articles and 25 grey literature sources. 14 additional articles were included following forward and backward searching of prominent authors and key articles. After screening and full-text review, 39 articles and 12 reports/toolkits were included. The majority of sources were opinion pieces, with limited quantitative, observational, or qualitative studies. Primary care's carbon footprint can be classified into clinical and non-clinical sources, with significant impacts from pharmaceuticals and inhaler propellant gases. Contributing factors include limited knowledge of emission sources, lack of awareness of sustainable practices, low prioritization of sustainability, barriers including ethical concerns and over-medicalization. Identified strategies to reduce emissions include decarbonization of patient care, increasing education and awareness, implementing non-clinical decarbonization efforts, and conducting more research to support sustainable initiatives. Developing metrics to track progress and securing policy supports to improve adoption and implementation were also highlighted as critical.

Conclusion: The identification of sources of carbon hotspots in primary care is an essential precursor to enable the development of targeted decarbonization strategies. Decarbonizing primary care requires a multifaceted approach that addresses the underlying factors driving unsustainable practices. This would allow healthcare professionals to effectively balance the provision of high-quality patient care, while reducing their environmental impact, ultimately improving both human and planetary health.