The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports

Introduction: Climate change threatens human well-being and planetary health, necessitating sector-wide transitions. Recent research has highlighted the carbon footprint of hospital care by identifying hotspots and mitigation areas, but key factors influencing these outcomes remain underexplored. Me...

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Main Authors: L.H.J.A. Kouwenberg, D.S. Kringos, W.J.K. Hehenkamp, E.S. Cohen, N.H. Sperna Weiland
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:The Journal of Climate Change and Health
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Online Access:http://www.sciencedirect.com/science/article/pii/S2667278225000124
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author L.H.J.A. Kouwenberg
D.S. Kringos
W.J.K. Hehenkamp
E.S. Cohen
N.H. Sperna Weiland
author_facet L.H.J.A. Kouwenberg
D.S. Kringos
W.J.K. Hehenkamp
E.S. Cohen
N.H. Sperna Weiland
author_sort L.H.J.A. Kouwenberg
collection DOAJ
description Introduction: Climate change threatens human well-being and planetary health, necessitating sector-wide transitions. Recent research has highlighted the carbon footprint of hospital care by identifying hotspots and mitigation areas, but key factors influencing these outcomes remain underexplored. Methods: This study used causal mapping of textual data to systematically evaluate scientific reports on the carbon footprint of hospital services and care pathways. The sample was drawn from a State-of-the-science literature review, focusing on quantitative reports on hospital services’ carbon footprint. Text fragments discussing factors influencing the carbon footprint were recorded, and variables and relationships were identified and visually mapped through iterative open, axial, and selective coding. Results: Twelve main factors influence four major domains of the carbon footprint of hospital services and care pathways. These factors are related to the volume of travel, facilities and equipment, consumables, waste disposal, and pharmaceuticals, and their carbon intensity. Over eighty subfactors were identified, including ten cross-cutting factors that affect multiple domains of the hospital care footprint. Conclusions: The carbon footprint of hospital care is a multifaceted and complex issue driven by multiple factors. Insight into these factors can inform targeted actions to reduce emissions. This study also improves the understanding of the causes of variability in carbon footprint outcomes of hospital care, which is important for the interpretation and transferability of results and conclusions in this rapidly growing field of research.
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spelling doaj-art-0e9cd5ced5de44ef924ab6ffbcc0a50a2025-08-20T03:31:53ZengElsevierThe Journal of Climate Change and Health2667-27822025-05-012310042710.1016/j.joclim.2025.100427The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reportsL.H.J.A. Kouwenberg0D.S. Kringos1W.J.K. Hehenkamp2E.S. Cohen3N.H. Sperna Weiland4Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Corresponding author at: Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the NetherlandsCentre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, De Boelelaan 1117, Amsterdam, the NetherlandsAmsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynecology, De Boelelaan 1117, Amsterdam, the NetherlandsCentre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the NetherlandsIntroduction: Climate change threatens human well-being and planetary health, necessitating sector-wide transitions. Recent research has highlighted the carbon footprint of hospital care by identifying hotspots and mitigation areas, but key factors influencing these outcomes remain underexplored. Methods: This study used causal mapping of textual data to systematically evaluate scientific reports on the carbon footprint of hospital services and care pathways. The sample was drawn from a State-of-the-science literature review, focusing on quantitative reports on hospital services’ carbon footprint. Text fragments discussing factors influencing the carbon footprint were recorded, and variables and relationships were identified and visually mapped through iterative open, axial, and selective coding. Results: Twelve main factors influence four major domains of the carbon footprint of hospital services and care pathways. These factors are related to the volume of travel, facilities and equipment, consumables, waste disposal, and pharmaceuticals, and their carbon intensity. Over eighty subfactors were identified, including ten cross-cutting factors that affect multiple domains of the hospital care footprint. Conclusions: The carbon footprint of hospital care is a multifaceted and complex issue driven by multiple factors. Insight into these factors can inform targeted actions to reduce emissions. This study also improves the understanding of the causes of variability in carbon footprint outcomes of hospital care, which is important for the interpretation and transferability of results and conclusions in this rapidly growing field of research.http://www.sciencedirect.com/science/article/pii/S2667278225000124Carbon footprintDeterminantsCausal mappingClimate changeHospitalHealthcare
spellingShingle L.H.J.A. Kouwenberg
D.S. Kringos
W.J.K. Hehenkamp
E.S. Cohen
N.H. Sperna Weiland
The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
The Journal of Climate Change and Health
Carbon footprint
Determinants
Causal mapping
Climate change
Hospital
Healthcare
title The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
title_full The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
title_fullStr The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
title_full_unstemmed The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
title_short The interplay of factors influencing the carbon footprint of hospital care—A causal mapping analysis of scientific reports
title_sort interplay of factors influencing the carbon footprint of hospital care a causal mapping analysis of scientific reports
topic Carbon footprint
Determinants
Causal mapping
Climate change
Hospital
Healthcare
url http://www.sciencedirect.com/science/article/pii/S2667278225000124
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