Inequalities in health-care carbon footprints and implications for demand-side interventions: a global assessment across population groups.

BACKGROUND: Reducing emissions from health care is now recognised as an urgent priority on the climate-health agenda. Although studies have quantified the environmental impacts of health systems at national and global scales, inequalities in health-care carbon footprints (HCFs) across population groups (both between and within countries) and their trajectories remain unexplored. This study quantified these disparities and evaluated the potential of targeted demand-side interventions to achieve equitable, low-carbon health care while expanding delivery of care. METHODS: We estimated the HCFs of different income groups within 121 countries from 2005 to 2017 by integrating consumer expenditure surveys, national health expenditure data, and a global multiregional input-output model. Our approach enabled the disaggregation of emission patterns by income groups, health expenditure groups, health-care expenditure category, as well as health-care products and services. Scenario analyses were then carried out to evaluate the potential of demand-side interventions in reducing health care-related carbon emissions under different strategies. FINDINGS: e in 2017, representing more than a three-fold increase. By estimating the health expenditure-carbon elasticity, we found that health-care spending embodies higher marginal emissions among high-spending groups than that among low-spending groups. Scenario analyses indicated that without compromising on health outcomes, demand-side controls targeting carbon-intensive overuse of health care among the top 10-20% while simultaneously advancing ambitious universal health coverage could deliver a 25-40% reduction in carbon footprints and even ease costs. INTERPRETATION: Our study moves beyond cross-country comparisons based on national averages or totals by examining HCFs across different population groups within countries. The highest-spending populations were found to contribute disproportionately to health-care carbon emissions, thus highlighting that achieving equitable, low-carbon health-care transitions requires attention to within-country population disparities to target interventions. Our findings provide quantitative evidence for pathways to meet fair health-care emission-reduction targets while maintaining care quality. Expanding access to essential health care, combined with addressing carbon-intensive overuse among high-spending populations, could achieve substantial reductions in emissions. FUNDING: National Natural Science Foundation of China, Youth Innovation Team of the China Meteorological Administration, Tsinghua-Rio Tinto Joint Research Center for Resource Energy and Sustainable Development.