The objective of this study is to examine current practices regarding the integration of environmental and economic impact assessments in decision making for medical device procurement across French healthcare facilities. These findings will reveal the barriers to environmental criteria integration in Hospital-Based Health Technology Assessment (HB-HTA).

A cross-sectional survey, collected between 21 May and 12 July 2024, explored knowledge and implementation of environmental and economic assessments in hospital-based medical device procurement. Disseminated nationwide through the French Interregional Clinical Research and Innovation Groups (GIRCI), the French National Agency for Support to Healthcare Performance (ANAP) network, and via Territorial Hospital Groups, targeting public and private healthcare centers, the eight-section survey addressed governance, eco-responsible procurement, environmental data accessibility, and experience with joint assessments and certification practices.

Twenty-nine healthcare centers were analyzed, mostly regional or university hospitals or community hospitals (88 percent), primarily in the public sector. A structured approach to ecological transition was reported by 76 percent of institutions. Eco-responsible purchasing measures were implemented in nineteen centers (83 percent); however, access to life-cycle assessment data, especially for upstream manufacturing phases, remained limited. Forty-five percent of institutions had conducted joint environmental-economic assessments. Although 70 percent of respondents were aware of responsible procurement certifications schemes, only 36 percent used them.

French healthcare institutes demonstrate growing awareness and engagement in sustainable procurement practices. However, limited access to standardized environmental data blocks systematic integration of environmental criteria into procurement practices and thus HB-HTA. Strengthening supplier transparency, harmonizing evaluation frameworks, and embedding environmental metrics into both processes could accelerate sustainable transition.

The Dutch National Health Care Institute (ZIN) advises the Dutch Minister of Health on the basic benefit package using Health Technology Assessment (HTA), focusing on necessity, clinical effectiveness, cost-effectiveness, and feasibility. Despite the huge environmental impact of the healthcare sector, this impact is not taken into consideration. Several methodological approaches to integrate the environmental impact into HTA have been proposed, including information conduit, integrated evaluation, parallel evaluation, and environment-focused evaluation. There is significant uncertainty as to which approach is the most appropriate. Therefore, it is important to understand stakeholders’ perspectives on these approaches.

To explore Dutch stakeholders’ perspectives on integrating environmental impacts into HTA and assess preferred methods and challenges.

A qualitative study using a focus group with members from ZIN (n = 7) and individual interviews (n = 7) with experts in HTA, market access, and reimbursement. Interviews were transcribed and analyzed thematically.

Stakeholders highlighted the importance of addressing environmental impacts such as pharmaceutical pollution, greenhouse gas emissions, and waste. Integrated and parallel evaluations were preferred, but barriers such as data gaps, methodological complexity, and lack of guidelines were noted.

Incorporating environmental impacts into HTA is crucial but requires clear guidelines, better data, and stakeholder collaboration to support sustainable healthcare practices.

While associations of ultra-processed food (UPF) consumption with adverse health outcomes are accruing, its environmental and food biodiversity impacts remain underexplored. This study examines associations between UPF consumption and dietary greenhouse gas emissions (GHGe), land use and food biodiversity.

Prospective cohort study. Linear mixed models estimated associations between UPF intake (g/d and kcal/d) and GHGe (kg CO2-equivalents/day), land use (m2/d) and dietary species richness (DSR). Substitution analyses assessed the impact of replacing UPF with unprocessed or minimally processed foods.

368 733 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Europe.

Stronger associations were found for UPF consumption in relation with GHGe and land use compared with unprocessed or minimally processed food consumption. Substituting UPF with unprocessed or minimally processed foods was associated with lower GHGe (8·9 %; 95 % CI: –9·0, –8·9) and land use (9·3 %; –9·5; –9·2) when considering consumption by gram per day and higher GHGe (2·6 %; 95 % CI: 2·5, 2·6) and land use (1·2 %; 1·0; 1·3) when considering consumption in kilocalories per day. Substituting UPF by unprocessed or minimally processed foods led to negligible differences in DSR, both for consumption in grams (–0·1 %; –0·2; –0·1) and kilocalories (1·0 %; 1·0; 1·1).

UPF consumption was strongly associated with GHGe and land use as compared with unprocessed or minimally processed food consumption, while associations with food biodiversity were marginal. Substituting UPF with unprocessed or minimally processed foods resulted in differing directions of associations with environmental impacts, depending on whether substitutions were weight or energy based.

Dietary environmental impact in a Norwegian adult population was estimated for six environmental impact categories. Moreover, environmental benefits of scenario diets complying with the Norwegian Food-Based Dietary Guidelines (FBDG) and the EAT-Lancet reference diet were assessed.

The current diet of Norwegian adults was estimated according to 24-h dietary recall data from a national dietary surveillance survey (Norkost 3). Scenario diets were modelled to represent the Norwegian FBDG and the EAT-Lancet healthy reference diet. Dietary environmental impact in terms of global warming potential, freshwater and marine eutrophication, terrestrial acidification, water use and transformation and use of land was estimated for the current and scenario diets using environmental impact data representative of the Norwegian market. Significant associations between impact and gender/educational attainment were assessed at P < 0·05.

Norway.

Adults (n=1787) aged 18–70 years who participated in the Norkost 3 survey (2010–2011).

Environmental impact varied significantly by gender and educational attainment. The food groups contributing most to environmental impact of Norwegian diets were meat, dairy, beverages, grains and composite dishes. Compared with the current Norwegian diet, the FBDG scenario reduced impacts from 2 % (freshwater eutrophication) to 32 % (water use), while the EAT-Lancet scenario reduced impacts from 7 % (marine eutrophication) to 61 % (land use). The EAT-Lancet scenario resulted in 3–48 % larger reductions in impact than the FBDG scenario.

The Norwegian FBDG, while not as environmentally friendly as the EAT-Lancet reference diet, can still be an important tool in lessening environmental burden of Norwegian diets.

To characterise nutritionally adequate, climate-friendly diets that are culturally acceptable across socio-demographic groups. To identify potential equity issues linked to more climate-friendly and nutritionally adequate dietary changes.

An optimisation model minimises distance from observed diets subject to nutritional, greenhouse gas emissions (GHGE) and food-habit constraints. It is calibrated to socio-demographic groups differentiated by sex, education and income levels using dietary intake data. The environmental coefficients are derived from life cycle analysis and an environmentally extended input–output model.

Finland.

Adult population.

Across all population groups, we find large synergies between improvements in nutritional adequacy and reductions in GHGE, set at one-third or half of the current level. Those reductions result mainly from the substitution of meat with cereals, potatoes and roots and the intra-category substitution of foods, such as beef with poultry in the meat category. The simulated more climate-friendly diets are thus flexitarian. Moving towards reduced-impact diets would not create major inadequacies related to protein and fatty acid intakes, but Fe could be an issue for pre-menopausal females. The initial socio-economic gradient in the GHGE of diets is small, and the patterns of adjustments to more climate-friendly diets are similar across socio-demographic groups.

A one-third reduction in GHGE of diets is achievable through moderate behavioural adjustments, but achieving larger reductions may be difficult. The required changes are similar across socio-demographic groups and do not raise equity issues. A population-wide policy to promote behavioural change for diet sustainability would be appropriate.

To measure the effects of health-related food taxes on the environmental impact of consumer food purchases in a virtual supermarket.

This is a secondary analysis of data from a randomised controlled trial in which participants were randomly assigned to a control condition with regular food prices (n 152), an experimental condition with a sugar-sweetened beverage (SSB) tax (n 131) or an experimental condition with a nutrient profiling tax based on Nutri-Score (n 112). Participants were instructed to undertake their typical weekly grocery shopping for their households. Primary outcome measures were three environmental impact indicators: greenhouse gas (GHG) emissions, land use and blue water use per household per week. Data were analysed using linear regression analyses.

Three-dimensional virtual supermarket.

Dutch adults (≥ 18 years) who were responsible for grocery shopping in their household (n 395).

GHG emissions (–7·6 kg CO2-eq; 95 % CI –12·7, –2·5) and land use (–3·9 m2/year; 95 % CI –7·7, –0·2) were lower for the food purchases of participants in the nutrient profiling tax condition than for those in the control condition. Blue water use was not affected by the nutrient profiling tax. Moreover, the SSB tax had no significant effect on any of the environmental impact indicators.

A nutrient profiling tax based on Nutri-Score reduced the environmental impact of consumer food purchases. An SSB tax did not affect the environmental impact in this study.