Research Spotlight: How much does patient travel for healthcare contribute to carbon emissions?

Hanna Zurl, MD, a research fellow in the Department of Urology at Brigham and Women’s Hospital (BWH), and the Center for Surgery and Public Health at BWH, is the lead author of a paper published in JAMA Network Open, Carbon Emissions from Patient Travel for Healthcare: Insights from a National Transportation Survey.

Alexander Putnam Cole, MD, an associate surgeon in the Department of Urology at BWH, an assistant professor of Surgery at Harvard Medical School and junior core faculty at the Center for Surgery and Public Health, is the senior author of the paper.

How would you summarize your study for a lay audience?

The United States (U.S.) healthcare sector has been estimated to generate about 8.5% of national greenhouse gas emissions.

Greenhouse gas emissions are associated with significant downstream effects on public health. This means that healthcare-related pollution can paradoxically worsen many of the disease’s healthcare professionals work tirelessly to treat and cure.

In previously published research, investigators estimated that U.S. healthcare-related pollution leads to a loss of over 300,000 disability adjusted life years (DALY), which measures the overall disease burden by combining years of life lost due to premature death and years lived with disability.
An area that has seen considerable growth of interest lately is adapting selective healthcare appointments into a ‘telehealth’ format, which could reduce carbon emissions because of patients no longer needing to travel to clinics or hospitals.

When we started studying this, we realized that reliable estimates of emissions associated with healthcare–related travel were lacking.

In this study, our team therefore estimated the amount of greenhouse gas emissions generated by patients traveling to and from medical appointments in the U.S. We used a national transportation survey that includes distance travelled, vehicle and fuel type.

We found that health care travel generates about 35.7 megatons of carbon emissions each year—roughly the same as the emissions from the electricity used by seven million homes in a year.

What methods or approach did you use?

This cross-sectional study used data from the 2022 National Household Travel Survey. We used data on travel distance, vehicle type, and fuel type to estimated carbon dioxide equivalent (CO2e) emissions from patient healthcare–related travel. Estimates were calculated per year, per patient, per trip, and per mile.

Furthermore, we analyzed the association between patient characteristics and emissions, identifying factors associated with higher CO2e emissions per trip.

An alternative scenario analysis was performed to estimate CO2e reductions if 30% or 50% of private vehicle users switched to electric vehicles.

What did you find?

The sample included a weighted total of 3.5 billion U.S. healthcare trips. We estimated that patient healthcare-related travel in the U.S. generates approximately 35.7 megatons of CO2e annually, accounting for about 6% of the nation's total healthcare-related emissions.

Other notable takeaways:

-- Emissions per trip were higher for patients in rural areas compared to patients in urban areas.
-- A 30% shift to electric vehicles was estimated to reduce healthcare-related carbon emissions to 27.6 megatons CO2e, and a 50% shift was estimated to lower emissions to 22.2 megatons CO2e.  
-- Notably, this only focused on patient travel but did not include physicians or other staff members traveling to work.

What are the next steps?

These findings are essential for informing healthcare policy decisions and suggest that strategies such as telehealth appointment format and the adoption of electric vehicles may contribute to a small but significant reduction in healthcare–related greenhouse gas emissions.

Future research should focus on integrating emissions from healthcare-related travel into national estimates of carbon emissions from the U.S. healthcare sector. This would provide a more comprehensive understanding of the environmental impact of the healthcare sector and help guide policy decisions.  

Another important next step is linking these carbon emissions to specific health outcomes. Further studies should examine how the expansion of telehealth services influences travel-related emissions at a national level. Investigating the potential of telehealth to reduce patient travel could inform strategies for lowering the carbon footprint of health care while maintaining accessibility and quality of care.

If we can find situations where telehealth is already working for patients and simultaneously reduce the environmental impact of health care, then that is a win for everyone involved.


 

Authorship: In addition to Zurl and Cole, Mass General Brigham authors include Zhiyu Qian, Daniel R Stelzl, Filippo Dagnino, Stephan Korn, Muhieddine Labban, Stuart Lipsitz, and Quoc-Dien Trinh,. Additional authors include Marianne Leitsmann, Sascha Ahyai, Chad Ellimoottil, Stacy Loeb, and Hari S. Iyer.

Paper cited: Zurl H et al. “Carbon Emissions from Patient Travel for Healthcare: Insights from a National Transportation Survey” JAMA Open DOI: 10.1001/jamanetworkopen.2025.2513

Disclosures: Korn reported receiving personal fees and speaker’s honoraria from Janssen and speaker’s honoraria from Astellas outside the submitted work. Loeb reported receiving personal fees from Astellas and Doceree outside the submitted work. Trinh reported receiving personal fees from Astellas, Bayer, Intuitive Surgical, Janssen, and Novartis, and grants from Pfizer outside the submitted work. Cole reported receiving personal fees from EDAP/TMS. Leitsmann reported receiving personal fees from Astellas, Ibsa, Ipsen, and Novartis. No other disclosures were reported.