Carbon footprint of China's healthcare system from a global perspective: A multi-dimensional hotspot assessment

Healthcare systems are energy-intensive and contribute significantly to carbon emissions, making each country's understanding of its own emissions crucial for advancing climate and health agendas. However, existing estimates of China vary widely due to inconsistent boundaries, outdated data, and limited subnational resolution. This study developed a top-down framework using an environmentally extended multi-regional input–output model to assess China's healthcare-related carbon footprint from 2010 to 2019. It was also the first to compare different accounting scopes and methods, and identify multidimensional hotspots by region and disease. Our results show that China's healthcare carbon footprint reached 638 Mt. CO₂e in 2019, with the domestic share rising to 4.3 % of the nation's total carbon emissions. Electricity was the dominant source of healthcare carbon footprints across the supply chain. Geographically, Scope 1 and 2 emissions increased most in the Northwest (+33 %) and Southwest (+30 %), while Scope 3 increases came mainly from Central Coastal and Central provinces. Healthcare carbon footprint also varied by disease type, with cerebral infarction exhibiting the highest total footprint among major inpatient diseases (∼8 Mt. CO₂e), while coronary artery bypass grafting had the highest per-case footprint (∼11 t CO₂e) in 2017. These results point to the need for targeted measures that are region- and disease-specific, to promote a low-carbon transition and support the high-quality development of China's healthcare system.