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Queue of ambulances at the accident and emergency department at Queen Alexandra Hospital in Portsmouth, Hampshire
Queue of ambulances at the accident and emergency department at Queen Alexandra Hospital in Portsmouth. 信用:保罗雅各布/ alamy股票照片。
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2021年2月18日16.:32

帖子:计算英格兰NHS的碳足迹

Marina Romanello医生

Marina Romanello医生

2021年2月18日下午4:32
来宾帖子 帖子:计算英格兰NHS的碳足迹

2017年Lancet Countdown on Health and Climate Changewarned that the impact of climate change on human health is now so severe that it should be considered “21世纪的主要威胁”.

但是,尽管世界各地的卫生服务机构将面临应对这些影响的挑战,但该行业本身每年都要为大气中增加的大量二氧化碳负责。

这意味着,在全球变暖的情况下,加快医疗保健部门的缓解工作对于帮助确保健康得到保护至关重要。

In our recent study, published in the柳叶刀行星健康,我们估计全国的碳足迹Health Service (NHS) in England. Unpacking where these CO2 emissions are coming from, we calculate a total for 2019 of around 25m tonnes of CO2 equivalent. This is around 7% of the UK’s total carbon footprint for that year.

While this is sizeable, total emissions have dropped by approximately a quarter since 1990. And the emissions per patient have fallen by almost two-thirds. However, with the NHS aiming to reach net-zero emissions in 2045, there is still some way to go.

医疗保健对气候变化的回应

卫生界肩负着保护公众的责任,在减缓气候变化的努力中发挥着突出的作用——促进其可持续发展health co-benefitsand building resilience to face future increases in healthcare demand.

This extends to reducing its carbon footprint. For example, healthcare in the world’s largest economies currently accounts for4.4% of global CO2 emissions.

任何努力减少卫生体制的足迹ms must be underpinned by a thorough understanding of emission sources and the activities that drive them.

为此,美国已经公布了医疗保健系统的碳足迹澳大利亚,Austria,Canada,中国,Japan,而且我们– alongsideinternational estimates.

However, the National Health Service (NHS) in England holds the only such effort carried out by the health system itself, which it has been developing and refining since 2008.

In 2020, a year dominated by the Covid-19 pandemic, the NHS announced its commitment to become theworld’s first net-zero national health systemby 2045.

The benefits of this commitment will hopefully spill over to other healthcare systems. As the largest single employer in Europe and the largest single-payer healthcare system in the world, the NHS can use its size and influence to drive its own emissions reductions, while paving the way for other health systems to follow suit.

NHS的碳核算方法

在其温室气体(GHG)排放会计中,NHS遵循“温室气体协议公司标准“–由世界资源研究所(WRI) and the促进可持续发展世界商业理事会(WBCSD).

该协议将排放分为三类,或“scopes“,如下图所示。范围1涵盖来自拥有或控制来源的直接排放的排放;范围2涵盖购买电力,热和冷却的间接排放;和范围3涵盖与组织业务相关的所有其他间接排放。最后一类包括从医疗设备到食品和餐饮的一切。

The NHS approach also incorporates patient and visitor travel, which it is not directly responsible for, but it can influence.

The method covers seven GHGs: carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O), hydrofluorocarbons (HFCs), perfluorocarbons (PCFs), sulphur hexafluoride (SF6) and nitrogen trifluoride (NF3).

按温室气体议定书范围和NHS排放类别组织的排放源
温室气体协议范围和NHS排放类别组织的排放源。列代表NHS排放类别,行代表温室气体协议范围*通常不在温室气体议定书中考虑。资料来源:Tennison等人(20.21.).

NHS采用了一种混合模型,该模型利用了大量可用的“自下而上”的监测数据,并将其与经典的“自上而下”经济模型的数据相结合。该模型将经济支出与不同活动的碳强度相匹配。

In this way, the approach combines the accuracy and adaptability of available data from monitoring and reporting efforts with the broad coverage of top-down carbon accounting.

In addition, this approach lends itself to the incorporation of new monitoring data as it becomes available. This last point is essential to measuring progress and assessing the impact of decarbonisation, as well as for breaking down the carbon footprint to the individual facility level.

The carbon footprint of the NHS in England

词汇表
一氧化碳2等价物:温室气体可以以二氧化碳当量或CO2EQ表示。对于给定的金额,不同的温室气体在大气中捕获不同的热量,这是一种称为...的数量阅读更多

We estimate the carbon footprint of the NHS in England in 2019 at 25m tonnes of CO2 equivalent. This is roughly equivalent to theannual CO2 emissions of Sri Lanka.

虽然相当大,但从1990年级别减少了26%。这种转变主要由a驱动decarbonisation of the national electricity system,从而减少了运营医院和其他建筑的排放。这可以通过下面图表中粉红色阴影的区域看到,该区域按温室气体源进行分解。

Timeseries of total greenhouse gas emissions of the NHS in England, broken down by source of emission for 1990 to 2019
Timeseries of total greenhouse gas emissions of the NHS in England, broken down by source of emission (in MtCO2e) for 1990 to 2019. Source: Tennison et al. (20.21.).

与此同时,自1990年以来,NHS提供了越来越复杂的医疗服务,如更先进的成像技术,病人数量翻了一番(按单个住院病人的数量计算)。实际上,在同一时间内,按每位病人计算的NHS服务的碳强度降低了64%。

在其总足迹中,24%来自NHS可以直接影响的来源(“直接排放”)。其中包括舰队和商务旅行、建筑、麻醉气体,prescribed metered dose inhalers(MDIs), waste and water, and electricity consumption.

然而,它的大部分排放源都来自国家医疗服务系统(NHS)几乎无法控制的来源,包括它的供应链(62%)——上图中的蓝色阴影——以及病人、访客和员工旅行(10%)——绿色阴影。

We also separated out the NHS carbon footprint by type of clinical activity, which further enables the identification of mitigation targets.

For example, providing “acute care” – which deals with short-term treatment for a severe injury or episode of illness, an urgent medical condition or during recovery from surgery – comprised more than half of the total footprint in 2019.

This makes it the most carbon-intensive care pathway, with 125kg of CO2e per day for hospitalised patients, and 76kg of CO2e per outpatient acute care appointment. The large carbon footprint is because acute care typically requires more medical equipment, protective equipment and other resources.

In contrast, “primary care” – the first point of contact in the healthcare system – is considerably less carbon intense. For example, a visit to a general practitioner produces an average of 66kg of CO2e.

总体而言,初级保健占所有排放量的23%——主要通过其供应链和计量吸入器处方。它还可以通过提供预防性保健,帮助甚至减少保健服务的需求。

医疗保健的净零的未来

Shifting to a net-zero health system presents unique challenges, requiring the reduction of emissions without compromising on healthcare quality.

投资于加强初级、社区和长期护理,以及优先考虑早期疾病检测和治疗,可以帮助实现这一目标。通过早期和改进疾病管理、减少病人出院时间、增强病人能力和减少对急症护理的需求,NHS可以提供帮助minimise healthcare demand and resource consumption, deliver health gains, and lower costs.

Shifting to remote digital care whenever suitable can also drive emission reductions, as well as increase access to health and patient comfort. However, while remote delivery has accelerated during the Covid-19 pandemic, rollout plans will need to be closely accompanied by adequate access to digital technologies and digital literacy to avoid exacerbating inequalities.

在降低其活动的碳强度方面,NHS对其“直接排放”的控制程度最高。在它的脱碳计划为了减少建筑和能源排放,需要对建筑进行升级,提高隔热性能,并采用先进的系统来控制能源需求。此外,转向低碳能源和现场可再生能源发电将在这些领域带来额外的缓解。

NHS舰队的电气化与积极的旅行激励措施相结合,使用公共交通工具,将有助于缓解与旅行相关的排放。这些努力也可以通过更多的体力活动和更清洁的空气来改善公共卫生。

挥发性麻醉剂和MDI推进剂的排放 - 贡献NHS所有排放量的巨大温室均可通过废物管理和有效的交付减少,并在临床上适当地转移到低碳选项。

然而,NHS碳足迹的最大分数与NHS对较少控制的供应链排放有关。

That said, through implementation of green procurement guidance, the NHS can reduce consumption and promote shifts to low-carbon or reusable alternatives whenever these are available.

此外,作为世界上最大的单一医疗体系,它可以激励供应商对自己的流程进行脱碳。事实上,它已经承诺,到2030年,它将不再从没有达到或超过自身脱碳承诺的供应商那里采购——这一政策有可能减少全球其他卫生系统的供应链排放。

Our work reflects more than 10 years of analytical effort dedicated by the NHS to tracking its carbon footprint. We hope it will help guide other health systems in developing their own carbon accounting.

Tennison,I.等人。(2021)卫生保健对气候变化的反应:英格兰NHS的碳足迹评估,兰蔻行星卫生,doi:10.1016/S2542-5196(20)30271-0

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