Environmental Sustainability in Health Technology Assessment (ESHTA)
Overview
Climate change is a major health threat to humanity. If we don’t act, climate change will soon overwhelm the world’s health systems. The Intergovernmental Panel on Climate Change (IPCC) has stated if we continue to produce the same amount of greenhouse gas (GHG) emissions we are currently emitting, we will reach 5.7 °C (global average) above pre-industrial temperatures, within this century.
The global healthcare sector is responsible for 4.4% of total global GHG emissions with 71% of its carbon footprint attributable to the supply chain. More concerning is that since 2016, health care GHG emissions have increased by 36%, making health systems increasingly unprepared to operate in global conditions and propelling health care further from its guiding principle of doing no harm.
Healthcare’s environmental impact contributes to human ill health (e.g., air pollution, ecotoxicity and particulate matter), biodiversity loss (e.g., food shortages and risk of pandemics) and resource depletion (e.g., finite fossil fuel use and water scarcity). Planetary health “the health of human civilization and the state of the natural systems on which it depends”, is becoming more essential in health policy making, particularly with the ambition of achieving universal health coverage.
Universal health coverage requires healthcare to align with sustainable development defined as “meeting the needs of the present without compromising the ability of future generations to meet their own needs”. More specifically, human health and critical ecological support depends on an integrated transdisciplinary and cross-sectoral approach, to enable policy and regulatory changes, the widespread adoption of technological innovations and shifts in individual and collective behaviours.
Critical to support healthcare sustainable development, HTA needs to embed environmental sustainability “the condition of resilience, balance, and connection to allow society (humans) to meet its requirements without surpassing the capacity of its supporting ecosystem and to continue the regeneration of the services, without harming the biological diversity”.
The (new) definition of HTA emphasizes the inclusion of environmental criteria in the assessment of health technologies. However, environmental sustainability criteria in the context of HTA is not currently standardised within reference case frameworks and guidance. There are challenges to developing appropriate methods to evaluate environmental sustainability in HTA, including prioritisation of environmental criteria, assessment scope and boundary, data availability and quality, analytical perspectives and how to “trade off” sustainability criteria.
Methodological solutions may be provided through the application of environmental life cycle assessment techniques, one health and circular economy frameworks, alignment with healthcare system sustainability frameworks and decision analytical models. In combination with HTA principles, these approaches and techniques provide a sizable opportunity to optimise global HTA sustainable development across the life cycle of health technologies.
Supported by a broad membership, the ESHTA Working Group includes regulators, providers, purchasers, payers, policy makers, principal investigators, product makers, public, patients, subject matter experts, researchers and HTA representatives. We have come together to contribute to the discourse on value frameworks and processes to incorporate environmental sustainability into HTA.
We welcome new members who are committed to furthering the understanding, practice, incorporation, dissemination, and implementation of environmental sustainability into HTA.
Purpose
We intend to
▪ Define the role of HTA in relation to environmental sustainability
▪ Define the scope for environmental sustainability in HTA
▪ Propose value frameworks that incorporate environmental sustainability and its operationalization thereof
▪ Foster consensus on such approaches, providing feasible and comprehensive solutions that can be piloted and implemented to achieve environmental sustainability recommendations in HTA
Contacts
▪ Debjani Mueller (jmueller@htai.org)
- Melissa Pegg (melissa.pegg@york.ac.uk)