Objectives. The objective of this technical brief is to assess the current use of life cycle assessment (LCA) frameworks in healthcare research and practice, understand the components of those frameworks, review LCA studies that have been conducted, and assess gaps in research and practice to guide future directions.
Review methods. A scoping review combined with Key Informant interviews provided input. We searched a combination of biomedical (PubMed), environmental (Agricultural & Environmental Science Collection; Environmental Science Database; Environment Index), and technical research (Web of Science, Scopus) databases for this interdisciplinary research topic. Gray literature sources included the research registries ClinicalTrials.gov, National Institutes of Health (NIH) RePORTER, Environmental Protection Agency (EPA) Health and Environmental Research Online (HERO), European Research Council projects, and the International Clinical Trials Registry Platform (ICTRP) for ongoing research. Citation screening was supported by machine learning and two independent reviewers who screened full text. Data were abstracted in a pilot-tested database. Key Informants included experts in LCA frameworks, healthcare operations, tools for healthcare organizations/providers, researchers, organizational policy, and industry.
Findings. Searches identified 5,043 citations, of which 749 were obtained as full text; 154 publications met eligibility criteria. We identified 5 LCA frameworks, the majority of which were adapted rather than developed for healthcare, using existing frameworks for residential construction, financial reporting, health technology assessment, and handprint analysis. The frameworks were published in the last five years and were not found to be applied in any other study. In total, we identified 147 LCAs published in the scientific literature originating in the U.S., U.K., and selected European countries, with approximately a third of the studies from U.S. based researchers. The studies explored a wide range of topics, from medical devices, products, and surgeries to emissions from healthcare systems. The majority addressed full life cycle from cradle to grave or cradle to gate. Key Informants emphasized the importance of LCA to support reduction of healthcare emissions, however noted time and resource limitations for conducting LCAs in clinical practice. Registered future research is sparse, with two studies included.
Conclusion. The frameworks explored were mainly adapted for healthcare and there is a need to develop a healthcare-specific LCA framework. Future research may need to focus on less resource-intensive LCA methods to address the multitude of timely decisions that need to be made in healthcare operations. Future work should focus on developing scalable solutions that can be rapidly adopted and implemented in disparate healthcare settings. To address gaps, research should include healthcare emission factor databases and a healthcare specific life cycle analysis methodology to ensure robustness of the studies. It is critical for healthcare to understand the sector’s role in climate change, to assess the impacts from healthcare delivery, and to address healthcare industry waste and greenhouse gas emissions.