Climate change confronts the health care sector with a dual challenge. Accumulating climate impacts are putting an increased burden on the service provision of already stressed health care systems in many regions of the world. At the same time, the Paris agreement requires rapid emission reductions in all sectors of the global economy to stay well below the 2 °C target. This study shows that in OECD countries, China, and India, health care on average accounts for 5% of the national CO₂ footprint making the sector comparable in importance to the food sector. Some countries have seen reduced CO₂ emissions related to health care despite growing expenditures since 2000, mirroring their economy wide emission trends. The average per capita health carbon footprint across the country sample in 2014 was 0.6 tCO₂, varying between 1.51 tCO₂/cap in the US and 0.06 tCO₂/cap in India. A statistical analysis shows that the carbon intensity of the domestic energy system, the energy intensity of the domestic economy, and health care expenditure together explain half of the variance in per capita health carbon footprints. Our results indicate that important leverage points exist inside and outside the health sector. We discuss our findings in the context of the existing literature on the potentials and challenges of reducing GHG emissions in the health and energy sector.

Meat is an important food for human nutrition, by especially providing high-quality protein and also some essential micronutrients, in front iron, zinc, and vitamin B₁₂. However, a high intake of red and processed meat is associated with an increased risk for diseases, especially type 2 diabetes and colorectal cancer, as several epidemiological studies and meta-analyses have shown. This review summarizes meta-analyses of publications studying the association between red and processed meat intake and type 2 diabetes, cardiovascular diseases, colorectal and other cancers, and all-cause mortality. Various potential mechanisms involved in the increased disease risk are discussed. Furthermore, the beneficial effects of healthy alternatives for meat, like fish, nuts, vegetables and fruits, pulses and legumes, whole grains, and dairy products are reviewed by including selected papers and recent meta-analyses.

Although sustainable development is closely interrelated with health and health promotion, in health care systems these themes are hardly ever discussed and even more rarely implemented in combination. We see opportunities for sustainable development and health promotion, particularly in hospitals, since they play a central role in health care systems. Furthermore, hospitals have significant and growing economic, social, and environmental impacts, which in turn cause adverse effects upon health. In a transdisciplinary project involving scientists and health care practitioners we examined how sustainability can be conceptualized for hospitals in line with both a socio-ecological understanding of sustainable development and with "hospitals' reality". Our approach aims at avoiding unintended long-term and side effects of health care – hospitals' core business – by expanding quality criteria for decision making to include sustainability and health gain improvement. An example demonstrates that a hospital can thereby improve its future viability and contribute to global sustainability.

There is growing recognition that implementation of low-carbon policies in urban passenger transport has near-term health co-benefits through increased physical activity and improved air quality. Nevertheless, co-benefits and related cost reductions are often not taken into account in decision processes, likely because they are not easy to capture. In an interdisciplinary multi-model approach we address this gap, investigating the co-benefits resulting from increased physical activity and improved air quality due to climate mitigation policies for three urban areas. Additionally we take a (macro-)economic perspective, since that is the ultimate interest of policy-makers. Methodologically, we link a transport modelling tool, a transport emission model, an emission dispersion model, a health model and a macroeconomic Computable General Equilibrium (CGE) model to analyze three climate change mitigation scenarios. We show that higher levels of physical exercise and reduced exposure to pollutants due to mitigation measures substantially decrease morbidity and mortality. Expenditures are mainly born by the public sector but are mostly offset by the emerging co-benefits. Our macroeconomic results indicate a strong positive welfare effect, yet with slightly negative GDP and employment effects. We conclude that considering economic co-benefits of climate change mitigation policies in urban mobility can be put forward as a forceful argument for policy makers to take action.

As health-care systems and organisations worldwide transition to sustainable health care, reliable guidance and standardised approaches are needed to monitor and report progress. A robust measurement framework can inform the development of indicators to track progress, compare performance, guide interventions, and reduce the risk of greenwashing. The Lancet Commission on Sustainable Health Care convened a working group to develop a measurement framework to support data-driven and evidence-based indicators in comprehensively assessing health-care system performance across environmental and health outcomes dimensions. The working group included representatives from several disciplines, such as environmental engineering, industrial and social ecology, health promotion theory, environmental chemistry, sustainability, health-care quality and safety, clinical care, epidemiology, and public policy, and diverse geographical settings. The measurement framework developed by the Lancet Commission on Sustainable Health Care integrates concepts from previous frameworks and approaches and encompasses sustainability concepts across two domains: the physical domain (contributing directly and indirectly to resource use, operational resilience, emissions, and environmental impacts) and the people, policies, and programmes domain (contextual characteristics surrounding operations in nations and organisations). Each domain is divided into five categories: inputs, structures, processes, outputs, and outcomes or effects, including health effects. In this Personal View, we describe the conceptual development of this measurement framework; the indicators for performance measurement by health-care organisations and countries will be presented in companion papers. The framework aims to address all three aspects of performance measurement-namely, research, improvement of health-care system performance, and accountability to external entities. The proposed measurement framework can guide the development and implementation of indicators for health-care system benchmarking and monitoring, aiming to accelerate the global advancement of sustainability-related health-care performance by adopting evidence-based policies and practices.