Attention has recently been paid to the contribution of health services to greenhouse gas emissions: the climate footprint of healthcare worldwide is equivalent to approximately 5% of global net carbon emissions, a value equivalent to approximately double the entire air transport (1).
If the health sector were a country, it would be the fifth largest emitter on the planet (2).
Given that clinical activities are responsible for approximately 80% of the climate footprint of health services, the role of professionals is fundamental for its possible reduction (3). Consider, for example, that a thousand blood tests (formula, hemoglobin, hematocrit) produce the CO2 equivalent of 700 km traveled by car and a single MRI produces the CO2 equivalent of a car traveling 145 km.
The control of overuse, such as that implemented through the Choosing Wisely campaigns, is therefore considered among the most important measures to contain the climatological footprint of health services (4), as well as a valid tool for avoiding waste and improving the quality and safety of care.
Choosing Wisely International (5) supports the important role of Choosing Wisely campaigns towards climate change, encouraging awareness and assumption of responsibility among healthcare professionals and their professional societies around the world.
The important magazine BMJ has recently launched a campaign (6, 7, 8) to reduce carbon emissions in the healthcare sector by addressing concrete actions that healthcare professionals can and must undertake: among them the implementation of the Choosing Wisely recommendations is repeatedly reported in order to avoid or reduce unnecessary or even harmful practices which amount, according to all estimates, to at least 20-30% of the total (9).

Green Choosing Wisely Italy

In Italy, as part of the Choosing Wisely Italy campaign, the Green Choosing Wisely Italy initiative was launched at the conference at the IRCCS Mario Negri in Milan in 2022, in collaboration with the International Society of Doctors for the Environment – ISDE Italian section and in line with a One Health and Planetary Health approach. Italian professional societies and associations were invited to:

  • describe the environmental consequences of unnecessary tests, treatments and procedures (antibiotics, other drugs, imaging, etc.) as a further motivation for their reduction;
  • develop recommendations on practices that cause harm to the environment.

Recommendations can also be developed to reduce the demand for healthcare services through healthy lifestyle habits, which bring co-benefits to the health of people and the environment. In the Choosing Wisely Italy campaign there were already important examples: 5 recommendations from the International Society of Doctors for the Environment – ISDE Italian section (10) were published in 2015 focused on the environmental impact of practices at risk of inappropriateness by professionals and citizens. Recommendations from ANIPIO (11) and ANMDO-SITI (12) aim to reduce the improper use of disposable gloves. The 2021 recommendation of ADI-Italian Association of Dietetics and Clinical Nutrition highlights the damage to our health and the environment from Western-style dietary regimes (13). Since 2022, new green recommendations were published and are reported below.

Health Care Without Harm (HCWH) Europe has published the conference held by Francesco Bortoluzzi of the Italian Association of Gastroenterologists and Digestive Endoscopists – AIGO in Brussels on 23 November 2023 on Choosing Wisely Italy and its green recommendations on digestive endoscopy.


Green Pills
The “Green Pills” (maximum 500 words) are published monthly on the Bergamo Medical Doctors’ and Dentists’ Order website by Dr. Antonio Bonaldi and sent to all members of the Order, as suggestions for health professionals about the environment and the climate crisis.

Plastic project
Choosing Wisely Italy, together with some professional societies, collaborates in the campaign to raise awareness among doctors on the problem of plastic damage to health, launched by ISDE Italian Section and the Italian Network of Sentinel Doctors (RIMSA). At the link you can find all the information materials including a poster (for medical practices) that we ask doctors to print and display in their practices.

Furthermore, an online educational course for health professionals “HUMAN HEALTH AND THE ENVIRONMENT: PREVENTION OF HEALTH RISKS FROM EXPOSURE TO PLASTIC” was promoted. The course has as teachers some of the leading national experts on the topic and addresses the topic at 360°, from legislation to the main epidemiological evidence, from the methods developed for the detection of microplastics in human tissues to the measures for reducing exposure and more. Dr. Sandra Vernero, coordinator of Choosing Wisely Italy, discussed the topic: Plastic and healthcare activities, what can be done?

Choosing Wisely recommendations aimed at reducing the unnecessary use of disposable gloves, other personal protective equipment, bladder and venous catheters, nasogastric and PEG feeding tubes as well as some surgical site dressings can help reduce the consumption of plastic material in healthcare.

See also:

5 recommendations from AIGO GREEN ENDOSCOPY

5 GREEN recommendations from ANIPIO

5 recommendations from ISDE Italian Section for a GREEN GENERAL PRACTITIONER

1. Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet 2022;400:1619-54.

2. Health Care Without Harm. Health care climate footprint report.

3. Bonaldi A, Vernero S, Giustetto G, Romizi R. L’impronta ecologica dei servizi sanitari: cosa dovrebbero fare i professionisti della salute. Il Cesalpino 2022;56:14-17

4. Sherman J D, McGain F, Lem M, Mortimer F, Jonas W B, MacNeill A J et al. Net zero healthcare: a call for clinician action BMJ 2021; 374 :n1323 doi:10.1136/bmj.n1323

5. Born KB, Levinson W, Vaux E Choosing Wisely and the climate crisis: a role for clinicians. BMJ Quality & Safety Published Online First: 02 June 2023. doi: 10.1136/bmjqs-2023-015928

6. Braithwaite J, Pichumani A, Crowley P. Tackling climate change: the pivotal role of clinicians BMJ 2023; 382 :e076963 doi:10.1136/bmj-2023-076963

7. Wedmore F, Nolan T, Watts N. Sustainable practice: what can I do? BMJ 2023; 383 :p2461 doi:10.1136/bmj.p2461


9. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Med 2020; 18:102.