Explaining cross-country variation in hospital-sector carbon footprint in OECD countries
Abstract
Background: Greenhouse gas (GHG) emissions from the hospital-sector make up around one-third of the healthcare system’s carbon footprint in OECD countries. Harmonised cross‑country analysis remains limited, and evidence on the distribution of carbon hotspots within the hospital-sector and the most effective mitigation levers is scarce. Emission drivers lie beyond the direct control of individual hospitals, making system-level mapping essential for targeting mitigation efforts where they are most effective. This study aims to identify key factors associated with cross-country variation in hospital-sector GHG emissions and to assess the governance levels at which mitigation efforts are most effective.
Methods: This sequential mixed‑methods study estimates hospital‑sector GHG emissions across OECD countries using the OECD Input–Output model based on health‑expenditure data. Multivariable regression analyses then examine associations between emissions and factors operating at different governance-levels. Expert interviews provide contextualised, policy‑relevant interpretation of findings.
Results: Across OECD countries, hospitals emit 153,2 kg CO2‑e per capita (25,5–391,5) and account for 30,03% (20,3–42,7) of health‑system emissions. Ongoing analyses further assess the contribution of supply-chain–related emissions to hospitals’ carbon footprints and examine the industries of origin of these emissions across both domestic and international supply chains. In addition, they explore associations between hospital‑sector emissions and health expenditure, life expectancy, and avoidable mortality.
Conclusions: Early findings highlight the importance of addressing hospital-sector emissions through a multi-level governance lens that recognises structural and system-level drivers. This approach will inform more effective decarbonisation strategies and support the development of environmental performance indicators applicable across OECD health systems.
Key messages: • Hospital-sector GHG emissions vary across countries due to governance and structural factors beyond hospital control.
• Decarbonisation strategies require action at hospital, health-system and structural levels.
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BibTeX
@article{lopes2026explaining,
title = {{Explaining cross-country variation in hospital-sector carbon footprint in OECD countries}},
author = {IE Lopes and M Mueller and E Suzuki and T Seuring and N Sperna-Weiland and O Brito-Fernandes and D S Kringos},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.953},
url = {https://doi.org/10.1093/eurpub/ckag169.953},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Explaining cross-country variation in hospital-sector carbon footprint in OECD countries
AU - IE Lopes
AU - M Mueller
AU - E Suzuki
AU - T Seuring
AU - N Sperna-Weiland
AU - O Brito-Fernandes
AU - D S Kringos
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.953
UR - https://doi.org/10.1093/eurpub/ckag169.953
AB - Background: Greenhouse gas (GHG) emissions from the hospital-sector make up around one-third of the healthcare system’s carbon footprint in OECD countries. Harmonised cross‑country analysis remains limited, and evidence on the distribution of carbon hotspots within the hospital-sector and the most effective mitigation levers is scarce. Emission drivers lie beyond the direct control of individual hospitals, making system-level mapping essential for targeting mitigation efforts where they are most effective. This study aims to identify key factors associated with cross-country variation in hospital-sector GHG emissions and to assess the governance levels at which mitigation efforts are most effective. Methods: This sequential mixed‑methods study estimates hospital‑sector GHG emissions across OECD countries using the OECD Input–Output model based on health‑expenditure data. Multivariable regression analyses then examine associations between emissions and factors operating at different governance-levels. Expert interviews provide contextualised, policy‑relevant interpretation of findings. Results: Across OECD countries, hospitals emit 153,2 kg CO2‑e per capita (25,5–391,5) and account for 30,03% (20,3–42,7) of health‑system emissions. Ongoing analyses further assess the contribution of supply-chain–related emissions to hospitals’ carbon footprints and examine the industries of origin of these emissions across both domestic and international supply chains. In addition, they explore associations between hospital‑sector emissions and health expenditure, life expectancy, and avoidable mortality. Conclusions: Early findings highlight the importance of addressing hospital-sector emissions through a multi-level governance lens that recognises structural and system-level drivers. This approach will inform more effective decarbonisation strategies and support the development of environmental performance indicators applicable across OECD health systems. Key messages: • Hospital-sector GHG emissions vary across countries due to governance and structural factors beyond hospital control. • Decarbonisation strategies require action at hospital, health-system and structural levels.
SN - 1101-1262
SN - 1464-360X
ER -