臺灣博碩士論文加值系統

Climate change significantly impacts human health, and while health systems address this burden, they also contribute to environmental pollution. Given the demand for net-zero healthcare, a carbon footprint has attracted increasing research interest in healthcare systems in recent years. A synthesis work of carbon footprint in healthcare research is still lacking. Moreover, the CF of diseases is an important but often overlooked aspect of the climate change issue and still has no formula to calculate. This thesis addressed this gap through two studies with two primary objectives:
(1) To determine the trends of recent research regarding healthcare field impacts on the environment and identify topical research trends and methodology they use to evaluate the carbon footprint in the healthcare field.
(2) To define the carbon footprint burden of diseases using diabetes type 2 as an example.
Specifically:
Study 1 determined the trends of recent research regarding healthcare field impacts on the environment and identified research trends and methodology scientists use to evaluate the carbon footprint in the healthcare field using systemic review. The study included 205 articles focused on healthcare's carbon footprint from 1996 to 2023. Most of the studies were conducted in upper-middle-income countries. According to our review, twenty-five areas were described with a concentrate on equipment (20% of total studies), telemedicine (14.1% of total), surgery (11,2% of total), healthcare system (8.3% of total), conference and medical services (7.3% of total) with limited attention paid to diseases. There were two main methodologies to calculate carbon emissions: the life cycle assessment approach to emphasize the multifaceted nature of healthcare's carbon footprint with 11 types of LCA methodologies and consumption-based estimates to evaluate detailed components.
Study 2 defined the carbon footprint burden of diseases using diabetes type 2 (T2DM) as an example using the results of study 1 as a literature review. The scopes of CF were provided with detailed sectors and subsectors. To accurately assess these emissions, comprehensive data collection is essential, using methodologies such as Hybrid LCA with ISO standards. Two potential approaches can be employed: the patient approach, which focuses on individual patients and provides detailed insights for personalized care, and the institutional approach, which evaluates the broader impact at the healthcare facility level, enabling systemic changes. Both methods highlight the importance of energy efficiency, sustainable medication practices, reducing travel emissions, and effective waste management to minimize the environmental impact of T2DM management.
In summary, the research underscores the critical need for comprehensive strategies to reduce the healthcare sector's carbon footprint, particularly through targeted approaches in patient care and institutional practices. By synthesizing existing methodologies and applying them to diseases like T2DM, this thesis provides a framework for assessing and mitigating the environmental impact of healthcare, contributing to the global goal of net-zero emissions.

Climate change significantly impacts human health, and while health systems address this burden, they also contribute to environmental pollution. Given the demand for net-zero healthcare, a carbon footprint has attracted increasing research interest in healthcare systems in recent years. A synthesis work of carbon footprint in healthcare research is still lacking. Moreover, the CF of diseases is an important but often overlooked aspect of the climate change issue and still has no formula to calculate. This thesis addressed this gap through two studies with two primary objectives:
(1) To determine the trends of recent research regarding healthcare field impacts on the environment and identify topical research trends and methodology they use to evaluate the carbon footprint in the healthcare field.
(2) To define the carbon footprint burden of diseases using diabetes type 2 as an example.
Specifically:
Study 1 determined the trends of recent research regarding healthcare field impacts on the environment and identified research trends and methodology scientists use to evaluate the carbon footprint in the healthcare field using systemic review. The study included 205 articles focused on healthcare's carbon footprint from 1996 to 2023. Most of the studies were conducted in upper-middle-income countries. According to our review, twenty-five areas were described with a concentrate on equipment (20% of total studies), telemedicine (14.1% of total), surgery (11,2% of total), healthcare system (8.3% of total), conference and medical services (7.3% of total) with limited attention paid to diseases. There were two main methodologies to calculate carbon emissions: the life cycle assessment approach to emphasize the multifaceted nature of healthcare's carbon footprint with 11 types of LCA methodologies and consumption-based estimates to evaluate detailed components.
Study 2 defined the carbon footprint burden of diseases using diabetes type 2 (T2DM) as an example using the results of study 1 as a literature review. The scopes of CF were provided with detailed sectors and subsectors. To accurately assess these emissions, comprehensive data collection is essential, using methodologies such as Hybrid LCA with ISO standards. Two potential approaches can be employed: the patient approach, which focuses on individual patients and provides detailed insights for personalized care, and the institutional approach, which evaluates the broader impact at the healthcare facility level, enabling systemic changes. Both methods highlight the importance of energy efficiency, sustainable medication practices, reducing travel emissions, and effective waste management to minimize the environmental impact of T2DM management.
In summary, the research underscores the critical need for comprehensive strategies to reduce the healthcare sector's carbon footprint, particularly through targeted approaches in patient care and institutional practices. By synthesizing existing methodologies and applying them to diseases like T2DM, this thesis provides a framework for assessing and mitigating the environmental impact of healthcare, contributing to the global goal of net-zero emissions.

ABSTRACT I
ACKNOWLEDGMENTS III
TABLE OF CONTENTS IV
LIST OF FIGURES VI
LIST OF TABLE VII
LIST OF ABBREVIATIONS 1
Chapter 1 Introduction 2
1.1 Background 2
1.2 Objectives 4
Chapter 2 Literature Review 5
2.1 Literature Review of Study 1 5
2.1.1 Climate change 5
2.1.2 Carbon footprint 12
2.1.3 Healthcare has an impact on climate change through carbon emission 15
2.2 Literature Review of Study 2 19
2.2.1 Co-benefits of climate action and health outcomes 19
2.2.2 Taiwan strategy on carbon footprint 23
2.2.3 Taiwan clinical practice guidelines for diabetes care 25
2.3 Systematic review 32
Chapter 3 Study Design and Methods 35
3.1 Study Design 35
3.2 Eligibility criteria 35
3.3 Information sources 35
3.4 Search strategy 36
3.5 Selection and data collection process 36
3.6 Data summary and presentation 37
3.7 Ethical approval 38
Chapter 4 Result 39
4.1 Result of Objective 1 39
4.1.1 Prisma flowchart for searching process 39
4.1.2 Characteristics Included Studies 41
4.1.3 Theme of the carbon footprint in healthcare 44
4.1.4 Methodology for calculating carbon footprint in healthcare 49
4.2 Result of Objective 2 53
4.2.1 Scopes of the carbon footprint burden of diabetes. 53
4.2.2 Subsector breakdown to calculate the carbon footprint of T2DM 54
4.2.3 Approaching calculating the carbon footprint of Type 2 diabetes 57
4.2.4 Fomulas calculating the carbon footprint of Type 2 diabetes 65
Chapter 5 Discussion 66
5.1 Study 1 66
5.2 Study 2 72
Chapter 6 Conclusion 77
Appendix 78
References 111

 
LIST OF FIGURES
Figure 2.1 Pathways from Driving Forces to Potential Health (McMichael et al., 2003) 6
Figure 2.2 Carbon management trends throughout the world 14
Figure 2.3. Summarized the treatment algorithm for people with type 2 diabetes (Diabetes Association Of The Republic Of China, 2020) 26
Figure 2.4 Check-up and test/ examination in a year timeline 32
Figure 4.1 Flow diagram detailing study identification, screening, and selection process. 40
Figure 4.2. Publication time of the included studies (n=205) 41
Figure 4.3. Countries investigated the carbon footprint in the field of healthcare (n=205) 42
Figure 4.4. Comparative in countries classified by income that investigated the carbon footprint in the field of healthcare (n=205) 43
Figure 4.5. Total of the themes of the carbon footprint in healthcare research (n=205) 44
Figure 4.6 The distribution of articles’ themes from 2019 to 2024 (n=150) 46
Figure 4.7. The theme of articles categorized in the healthcare sector (n=140) 48
Figure 4.8. Methodology for calculating carbon footprint in healthcare (n=205) 49
Figure 4.9. Detailed LCA for calculating carbon footprint in healthcare (n=90) 50
Figure 4.10. Summary of the scope of the carbon footprint in healthcare 51
Figure 4.11. Summary of the scope of the carbon footprint in type 2 diabetes 54
 
LIST OF TABLE
Table 2.1. The type 2 diabetes mellitus (T2DM) diagnosis 26
Table 2.2 Test and Examination guideline for T2DM 28
Table 2.3 List of potential equipment 29
Table 3.1 Theme category in areas of expenditure for health-care sector 37
Table 4.1 Sector and Subsector breakdown in general 55
Table 4.2 Sector and Subsector breakdown in patient approach 59
Table 4.3 Sector and Subsector breakdown in institutional approach 62

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