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Résumé :
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Background : Until recently, health systems’ responsibility in the alteration, depletion or pollution of world resources was not much presented nor discussed. However, amidst vivid debates around the concept of Planetary Health, the precise role & responsibility of health systems to adapt to environmental needs, met the growing evidence that they are both part of the problem and the solution (Lenzen et al., 2020). Methods Mixed methods were used. A scoping review to assess how researchers present sustainability of health care system. A health-economic evaluation to understand how Carbon Footprint could be integrated into Health Technology Assessment. A qualitative analysis to analyze the determinants of political priority in France. Findings 89% of scientific articles writing about environmental transition of health systems, between 2021 to 2023, didn’t refer to any definition of sustainable healthcare. Only 33% of articles have a definition logically correlated with a foot-printing method. 61% of articles presenting primary data use Greenhouse Gases (GHGs) as the main measurement of environmental impact. This tends to show the reeminent use of the Carbon Footprint as a measurement of environmental impact over these last 2 years. Preliminary findings of the health economic assessment suggest that treatments of moderate depressive disorders in France amount 107 kg CO2 for one episode of a year per patient treated by pharmacotherapy, 184 kg CO2 for a psychotherapy, and 328 kgCO2 for a combined therapy. When it comes to decision making, the context in which political determinants are unfolding doesn’t appear quite mature or aligned yet for a strong political ownership and action in favor of a more sustainable health system in France. However, a better convergence of top-down intentions to transition, with available resources, broader civil society participation, bottom-up initiatives and territorial dialogues could pave the way for a positive iterative process towards building a more sustainable system. Interpreta5on Public health advocates may tactically accept that carbon footprint, a proxy indicator, serves a short-term operational objective to limit global warming and embark decision makers on board. But if we want to make health systems environmentally sustainable, we will have to find a way to address all threats to planetary health, efficiently and concomitantly.
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