Climate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions. Electronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process. From the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO₂) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process. There is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.

Mobile health (mHealth) innovations are considered by governments as game changers toward more sustainable health systems. The existing literature focuses on the clinical aspects of mHealth but lacks an integrated framework on its sustainability. The foundational idea for this paper is to include disciplinary complementarities into a multi-dimensional vision to evaluate the non-clinical aspects of mHealth innovations. We performed a targeted literature review to find how the sustainability of mHealth innovations was appraised in each discipline. We found that each discipline considers a different outcome of interest and adopts different time horizons and perspectives for the evaluation. This article reflects on how the sustainability of mHealth innovation can be assessed at both the level of the device itself as well as the level of the health system. We identify some of the challenges ahead of researchers working on mobile health innovations in contributing to shaping a more sustainable health system.

The healthcare sector’s contribution to climate change and pollution more broadly is now widely recognised as problematic. Not only does it disrupt the ecosystems and the living environment, but it also paradoxically affects human health. In recent years, an increasing number of countries have committed to reducing the ecological footprint, or in other words, the ‘environmental cost’ of their healthcare system. Achieving a responsible transition toward a greener healthcare sector requires considering the perspectives and potential roles of various actors and stakeholders within the field. Thus far, very few studies have investigated the perspectives of (potential) healthcare consumers on challenges, ethical issues and social tensions that could arise during the transition to a greener healthcare system. To address this gap, we carried out five group interviews, exploring the views of 28 participants on climate change, healthcare pollution, and their sense of engagement in reducing healthcare pollution. Data were collected, coded and analysed using an inductive process. While most participants perceived climate change as a serious threat to human health, many were unaware of the healthcare sector’s significant contribution to it. Pharmaceutical waste and plastic pollution were identified as the main problems. Two promising avenues for reducing healthcare pollution emerged from the findings: promoting healthcare sobriety and improving education for actors and stakeholders on the sector’s contribution to global pollution. Participants defined healthcare sobriety through four key elements: adequate care, collective responsibility, ecological finance, and prevention. Regarding education, they underline that it should be done at the right time, by the right person and in an effective manner. Two important barriers to achieving these goals were identified: participants are less willing to accept trade-offs when it is health-related; and ethical concerns were raised about mobilizing vulnerable populations to achieve carbon neutrality in the healthcare sector.