OBJECTIVES: Although medical treatments benefit our health in various ways, providing healthcare has also potential detrimental effects on the environment, with the global healthcare sector being responsible for 4.4% of global emissions. In addition, environment and human health are closely connected, about 12-18% of all deaths in Europe being caused by environmental pollution. The healthcare sector, in trying to improve health, can thus indirectly harm the population through its environmental impact. Despite the attention given to social and financial sustainability in clinical and policy decision-making, environmental sustainability has not been given the same consideration. The aim of this study is to develop a holistic framework for integrated sustainability assessments aiming to balance all aspects of sustainability.

METHODS: Overall, environmental damage in healthcare delivery arises from 3 levels: supply chain including pharmaceuticals production and use; delivery of hospital and physician care; and patient and staff travel. Notwithstanding this footprint, healthcare delivery has also a beneficial impact resulting from its intended use. In addition to health gain for the patient, healthcare delivery has also a broader social and economic benefit for the society as a whole. All these beneficial effects are called, the handprint. When striving for a sustainable health care system, healthcare delivery should be evaluated against the 3 pillars of sustainability: people, profit, planet.

RESULTS: Impact categories considered in the framework include: natural resource use, land and water use, greenhouse gas emissions, eco- and human toxicological impact, antimicrobial resistance, human rights at work, health and well-being, prosperity, and equal access to healthcare. The framework was supported using the concept of Life Cycle Thinking of a product/service over its entire life cycle.

CONCLUSIONS: The model is tailored to the needs of end-users such as regulators, industry and the healthcare sector, potentially allowing for inclusion in the HTA assessment and reimbursement decision making of new drugs.