There is a scientific consensus that climate change is an immediate issue. It has a detrimental impact not only on the planet, but also on human health, resulting in a rise in chronic conditions such as heart disease, stroke, lung cancer, and respiratory illness. The World Health Organisation (WHO), estimates that air pollution alone causes seven million premature deaths each year. Although climate change has been shown as a threat to human health, the healthcare sector is a significant contributor to this, responsible for 4.4% of global carbon dioxide emissions, the largest share coming from the U.S, EU and China. Emissions from healthcare are derived from sources including supply chain, production, and disposal of goods.
Reducing carbon emissions has been high on government agendas in recent years. For example, the NHS has pledged net zero emissions by 2024. Access to digital health, specifically online consultations are a major part of this. NHS initiatives also include electronic messaging and prescriptions, as well as the development of online booking systems. Further areas identified for government digital health initiatives include: patient care, management and monitoring, e-learning and disease surveillance.
The Role of Digital Health in Reducing Carbon Emissions
Transport-related Emissions
The utilization of digital health can assist in reducing carbon emissions through solutions such as: wearable devices, biosensors, video consultations and telehealth, remote patient monitoring, remote diagnostic solutions, virtual reality devices, and implementing artificial intelligence (AI) to improve efficiencies from manufacturing to patient care.
These solutions benefit carbon emissions mostly by reducing transport-related emissions. The transport sector produces the largest amount of greenhouse gasses, and although travel for healthcare represents only 1.5% of this, digital health could help to reduce this.
Virtual telemedicine can be used as an alternative to face-to-face interactions, reducing the need for patient travel, and healthcare professionals travel. These virtual consultations can lead to a carbon reduction of 0.7 to 4.35 metric tones, regardless of the mode of transport, type of fuel used, or travel from a remote area, however, local travel is found to have a minimal effect on emissions, only becoming cost effective when telehealth replaces trips of more than 7.2km. There are some limitations to measuring carbon reductions from telemedicine, as the carbon footprint of the telemedicine service itself is rarely assessed.
Travel emissions can be further reduced through remote patient monitoring. Wearables by companies such as Apple and Samsung have FDA-approved capabilities to track biomarkers via ECG, as well as multiple other measurements including: gait, activity, and sleep. This will be particularly effective for reducing routine follow-ups for patients with chronic conditions, many of which will have symptom flare-ups outside of regular consultations. Tracking these through digital health solutions may provide more accurate insights and eliminate the need for numerous face-to-face appointments.
Digitization of patient and administrative records and patient prescriptions could reduce dependency on paper-based prescriptions and records. Furthermore, having these digitized would increase patient and healthcare professional (HCP) access to these records, reducing the need for in-person consultations further.
Artificial Intelligence
The use of artificial intelligence (AI) within the healthcare sector is increasing and has the potential to reduce carbon emissions in some areas. AI can improve the quality and efficiency of healthcare, performing tasks which mimic those of healthcare professionals. Autonomous AI has the potential to significantly lower healthcare emissions in some fields. For example, an autonomous AI system trained to perform a diabetic eye exam can result in <1% the carbon emission, compared to a specialist with 8-10 year training. This is due to the high carbon emissions from higher education, coupled with the unlimited scalability of autonomous AI.
Clinical Trials
Clinical trials represent up to 100 million tons of carbon dioxide emissions per year. Digital health tools have been playing a more significant role in clinical trials, driving efficiencies and reducing emissions. This can be seen through:
A reduction in trial time, through the use of digital biomarkers, as well as AI for planning, and recruitment of patients.
Optimization of data capture and processes.
Fewer trial participants, using digital twins or synthetic control arms.
Decentralization of clinical trials resulting in a reduction in patient travel.
Increasing patient recruitment and retention, by using data to target more relevant patients and monitoring patients remotely.
The benefits of use of digital tools in clinical trials would seem to outweigh their carbon footprint, however this has yet to be properly assessed. Furthermore, barriers remain to utilizing some of these benefits to their full potential, such as skills to use these digital tools, patient awareness, and regulation.
Manufacturing and Supply Chain
Manufacturing and supply chain contribute significantly to carbon emissions, supply chain alone accounts for almost 50% of all healthcare emissions. Implementation of digitized supply chains or digital supply networks can decrease costs, enhance patient care, and spur innovation for healthcare providers and pharmaceutical companies by creating a more connected system. These systems have the potential to utilize data to track quantities of medication and supplies, potentially reducing wastage.
Similarly within manufacturing, specifically in drug development, AI can be utilized to analyze data for patient recruitment, candidate selection, as well as repurposing drugs. These create efficiencies within systems, reducing the need for humans to perform repetitive tasks and reduce waste in the manufacturing process.
The Impact of Digital Health on Emissions
Digital health has the potential to decrease carbon emissions of healthcare, however, the benefits of digital health must be balanced against significant carbon impacts generated by the infrastructure needed to sustain it.
There is little evidence assessing the environmental impact of digital health. A consistent framework for estimation of carbon emissions is yet to be established, with methods varying widely. Furthermore, for those that do assess the environmental impact, findings are very context specific. However, the carbon emissions from the use of services such as telemedicine, have been found to be very low in comparison to emissions saved travel reductions for example.
Minimizing environmental harm from digital health solutions will be pivotal, as digital health continues to expand rapidly. For example, the mining of raw materials for these technologies produces toxic waste, toxic chemicals, and carbon produced during the manufacturing of these devices makes up approximately 8% of carbon globally. Emissions due to electricity usage from storing vast amounts of cloud data generated from devices, as well as electricity used for call centers and telehealth centers are also of concern, with emissions from computing devices, data centers, and communications networks account for up to 4% of global emissions.
As the adoption of digital health continues to rise rapidly, there is a need to account for the environmental impact of the technology itself. Developing a standardized approach for evaluation will allow stakeholders to make informed decisions regarding the use of digital health in reducing carbon emissions. This will also allow governments and policymakers to encourage wider utilization of digital solutions, developing and aligning on guidelines, as well as incentivizing the creation of greener healthcare technologies.
Reaching beyond healthcare to address this issue, and working with all stakeholders involved in healthcare to develop a greener healthcare system, will be necessary, as healthcare alone cannot address this issue. As one stakeholder commits to greener practices, there will likely be a knock on effect within the industry and create more of an opportunity for others to follow. Big tech in particular will need to buy in to make digital health more sustainable long-term, through green manufacturing practices and ensuring devices are sustainable wherever possible.