The Lancet Planetary Health, April 2025

A kilo for a tonne: the unmet need to address underuse in health care in a climate crisis

Climate change is the greatest threat to human health in the 21st century and the health-care system is a substantial contributor, being responsible for about 5% of worldwide carbon emissions. Every health-care investigation and intervention has a carbon footprint, and evidence exists for the overuse of unnecessary, low-value care in health systems worldwide. The sustainable health-care community has therefore leveraged Choosing Wisely concepts of so-called do-not-do lists and social prescribing (eg, nature, exercise, and diet) to address overuse in health care.

However, whether all physicians can further reduce the diagnostic tests and treatments they order remains unclear. Research has shown substantial variation in physician ordering practices, with some favouring a maximalist approach (which should be targeted by resource stewardship campaigns) and some adopting a more minimalist attitude. Addressing the minimalist approach—which could lead to underuse of high-value investigations and interventions that decrease the need for future care and the subsequent health-care carbon footprint— is rarely discussed.