The elephant in the room in greenhouse gases emissions: rethinking healthcare systems to face climate change. A rapid scoping review

Healthcare systems (HSs) provide essential services to populations yet require a large amount of energy to perform duties and tasks. Specifically, 4.4% of global net carbon emissions can be attributed precisely to the activities of HSs. Therefore, it seems unlikely that the targets of zero carbon dioxide (CO 2 ) emissions by 2050, set by the Paris Agreement, will be met without rethinking the role and impact of HSs towards climate change. Here we summarize the available literature on CO 2 emissions depending on direct and indirect Hss activities. We show that the number of studies addressing this topic is still very limited and that most of the emissions derive from the supply chain HSs rely on to perform their tasks. Furthermore, we highlight how this topic is addressed unevenly among countries. Indeed, we found that less economically developed countries are less represented in the literature on this topic and that, even in economically developed countries, most of the studies come from English-speaking countries. In the discussion, we stress that health workers and policymakers should pay more attention to this issue in order to tackle climate change and related health issues, following the example of few virtuous countries. Finally, some potential impact mitigation strategies are discussed.