Image perception and interpretation of abnormalities; can we believe our eyes? Can we do something about it?

The radiologist's visual impression of the image is communicated to the clinician through non-visual means (reports). There are several complex steps between the radiologist's perception of the image and the clinician's understanding of that impression. In such a complex process, it is not surprising that errors in perception, cognition, interpretation, communication, and understanding are very common. This paper outlines the process of perception and error occurrence, as well as possible strategies to minimize them.

Introduction

Humans rely on their eyes more than any other sense to grasp the world around them. Even when we sleep, we "see" dreams. With this familiarity comes a sense of trust, and for most people, "seeing is believing."

As medical imaging diagnosticians, it is our job to "see correctly." What we see and report has a huge impact on the patient's well-being. If we make a wrong judgment, the impact can extend to harm to the patient, loss of personal self-esteem, risk to life, and even freedom.

Errors in medical images have been of interest since the dawn of radiology, when they were first reported by Garland [1] in 1959. The degree of "alarming" inaccuracies, first reported more than 50 years ago, continues to this day and seems unchanged. Chest X-rays have a 20-50% "miss rate" [2], while mammograms have a "miss rate" of up to 75% [3]. If radiologists are given only "positive" images as comments, an error rate of 30% occurs, but many researchers agree that if normal and abnormal cases, which correspond to usual clinical practice, are mixed, the error rate drops to about 4% [4].

The process of "seeing" is complex, and the chain has anatomical, physiological, neuropsychological, and psychoemotional components. It is not surprising that in a process as complex as "seeing," there are many opportunities to make mistakes.

First, let's briefly review the process.

The input, anatomy and physiology that make seeing difficult

The "see" process starts with your eyes. Helmholtz, the inventor of an optical instructor, concluded that the optical system was quite poor. [5] Eyes are elegan t-designed organs to quickly get information about daytime hunting and large objects, but is not the best design for detailed analysis. The retina surface where all processes begin is curved, the image is projected upside down, and the image is flat (depth perception is mainly different from both eyes, thre e-dimensional view, and the appearance of different distances. It is obtained by using a secondary clue such as the difference in size). More importantly, of the entire surface of the retina (25 cm2), only a 1. 5 mm size fossa has an appropriate type of receptor (pyramida), of which 0. 3 mm fossa is capillaries. Since there is no and there is no rod, detailed color vision is possible. [6] Therefore, the eyeballs perform rapid and awkward exercises called sackdones, scanning the scene, and bringing various areas of the scene on the fossa. This movement is performed up to four times per second, reaching up to 400 degrees per second. Eye balls are basically blind during the Sackard exercise. The orbital visual acuity that depends on the cone can handle 3 to 4 hig h-quality color images per second, but the peripheral visual acuity that uses the rod is low and is not sensitive to color, but 90 per second. You can process image information of the sheet.

For this reason, the input is basically an unscrupulous and awkward image, a blurred image is projected during the operation, and when it is stationary, the image of the stationary high resolution is reflected in a short time, so there are many noise. The stream of the data varies not only in the quality of the resolution but also in the frame rate. With such input, we can see the world of color, depth and movement. < SPAN> Watching process starts with your eyes. Helmholtz, the inventor of an optical instructor, concluded that the optical system was quite poor. [5] Eyes are elegan t-designed organs to quickly get information about daytime hunting and large objects, but is not the best design for detailed analysis. The retina surface where all processes begin is curved, the image is projected upside down, and the image is flat (depth perception is mainly different from both eyes, thre e-dimensional view, and the appearance of different distances. It is obtained by using a secondary clue such as the difference in size). More importantly, of the entire surface of the retina (25 cm2), only a 1. 5 mm size fossa has an appropriate type of receptor (pyramida), of which 0. 3 mm fossa is capillaries. Since there is no and there is no rod, detailed color vision is possible. [6] Therefore, the eyeballs perform rapid and awkward exercises called sackdones, scanning the scene, and bringing various areas of the scene on the fossa. This movement is performed up to four times per second, reaching up to 400 degrees per second. Eye balls are basically blind during the Sackard exercise. The orbital visual acuity that depends on the cone can handle 3 to 4 hig h-quality color images per second, but the peripheral visual acuity that uses the rod is low and is not sensitive to color, but 90 per second. You can process image information of the sheet.

The processing; the neurology that makes seeing difficult

For this reason, the input is basically an unscrupulous and awkward image, a blurred image is projected during the operation, and when it is stationary, the image of the stationary high resolution is reflected in a short time, so there are many noise. The stream of the data varies not only in the quality of the resolution but also in the frame rate. With such input, we can see the world of color, depth and movement. The "see" process starts with your eyes. Helmholtz, the inventor of an optical instructor, concluded that the optical system was quite poor. [5] Eyes are elegan t-designed organs to quickly get information about daytime hunting and large objects, but is not the best design for detailed analysis. The retina surface where all processes begin is curved, the image is projected upside down, and the image is flat (depth perception is mainly different from both eyes, thre e-dimensional view, and the appearance of different distances. It is obtained by using a secondary clue such as the difference in size). More importantly, of the entire surface of the retina (25 cm2), only a 1. 5 mm size fossa has an appropriate type of receptor (pyramida), of which 0. 3 mm fossa is capillaries. Since there is no and there is no rod, detailed color vision is possible. [6] Therefore, the eyeballs perform rapid and awkward exercises called sackdones, scanning the scene, and bringing various areas of the scene on the fossa. This movement is performed up to four times per second, reaching up to 400 degrees per second. Eye balls are basically blind during the Sackard exercise. The orbital visual acuity that depends on the cone can handle 3 to 4 hig h-quality color images per second, but the peripheral visual acuity that uses the rod is low and is not sensitive to color, but 90 per second. You can process image information of the sheet.

For this reason, the input is basically an unscrupulous and awkward image, a blurred image is projected during the operation, and when it is stationary, the image of the stationary high resolution is reflected in a short time, so there are many noise. The stream of the data varies not only in the quality of the resolution but also in the frame rate. With such input, we can see the world of color, depth and movement.

The world around us is moving, and we need to react quickly. The brain gets around this problem by using shortcuts, the most important of which is to resort to a process similar to the Fourier analysis of images [8]. Fourier analysis is a process that divides information (in this case, visual information) into frequency components that contain progressively more detail. The brain first analyzes the least detailed frequency components, and then, if time permits and if interested, the higher frequency components. Obviously, less time is needed for a small amount of information, and this trick allows us to quickly assess a visual situation and respond appropriately. This ability is what allows us to recognize a caricature that consists of only a few lines and contains no detail, or to recognize a shadow or a familiar person under low light that hides details (Figure 1). While this is useful for most purposes and allows us to respond quickly and appropriately, it can also cause the brain to jump to the wrong conclusions (Figure 2). This sequential processing of visual information is accepted as the most useful model of how we gradually understand visual details [9]. Figure 1

Fair pathways to net-zero healthcare

Fourier analysis allows us to recognize silhouettes with few details.

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Main

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Not only is the medical department exposed to the risk of climate change, but also the recognition of 1, one of the main polluters, which accounts for 5. 2%of the world's emissions, has spread, and international grassroots movement seeking low carbon medical care. It is active. Time is rapidly approaching to reduce the temperature of the world in accordance with the Paris Agreement, which is an interpretation of the Paris, which is an interconnection agreement that suppresses the temperature rise to less than 1. 5 to 2 ° C. Even with the upper limit of 2 ° C, it is necessary to decrease 5 % of this year's emissions, which is the same as the impact on the emissions of the 2020 Coronavirus infection 2019 (COVID-19). , It will rise to 17 % a year by 2050 (Figure 1). On the other hand, in order to maintain the possibility of lowering the lower limit of 1. 5 ° C even in on e-half, it is necessary to reduce the emissions by 2030 and reach the net zero by 2050 (reference). Letters 2). It is now widely understood that in order to achieve this goal, it is necessary for all sectors and all organizations to play that role.

Figure 1: Annual carbon emissions for keeping the world temperature of less than 2 ° C.

This highlights the importance of early action to alleviate carbon emissions. The thick black line indicates the actual emission of the past. Dashing lines indicate the orbit of the past and future to control global warming to 2 ° C. Each curve reflects that the probability of staying below 2 ° C or less is 66%or more, using the carbon balance of IPCC SR15 report 60. This figure by Robbie Andrew is licensed by CC by 4. 0 (reference 61). < SPAN> Not only is the medical department exposed to the risks of climate change, but it is also an international recognition that the main recognition of 5. 2%of the world's emissions has been widespread, and it is an internationally seeking lo w-carbon medical care. The grassroots movement is becoming active. Time is rapidly approaching to reduce the temperature of the world in accordance with the Paris Agreement, which is an interpretation of the Paris, which is an interconnection agreement that suppresses the temperature rise to less than 1. 5 to 2 ° C. Even with the upper limit of 2 ° C, it is necessary to decrease 5 % of this year's emissions, which is the same as the impact on the emissions of the 2020 Coronavirus infection 2019 (COVID-19). , It will rise to 17 % a year by 2050 (Figure 1). On the other hand, in order to maintain the possibility of lowering the lower limit of 1. 5 ° C even in on e-half, it is necessary to reduce the emissions by 2030 and reach the net zero by 2050 (reference). Letters 2). It is now widely understood that in order to achieve this goal, it is necessary for all sectors and all organizations to play that role.

Figure 1: Annual carbon emissions for keeping the world temperature of less than 2 ° C.

This highlights the importance of early action to alleviate carbon emissions. The thick black line indicates the actual emission of the past. Dashing lines indicate the orbit of the past and future to control global warming to 2 ° C. Each curve reflects that the probability of staying below 2 ° C or less is 66%or more, using the carbon balance of IPCC SR15 report 60. This figure by Robbie Andrew is licensed by CC by 4. 0 (reference 61). Not only is the medical department exposed to the risk of climate change, but also the recognition of 1, one of the main polluters, which accounts for 5. 2%of the world's emissions, has spread, and international grassroots movement seeking low carbon medical care. It is active. Time is rapidly approaching to reduce the temperature of the world in accordance with the Paris Agreement, which is an interpretation of the Paris, which is an interconnection agreement that suppresses the temperature rise to less than 1. 5 to 2 ° C. Even with the upper limit of 2 ° C, it is necessary to decrease 5 % of this year's emissions, which is the same as the impact on the emissions of the 2020 Coronavirus infection 2019 (COVID-19). , It will rise to 17 % a year by 2050 (Figure 1). On the other hand, in order to maintain the possibility of lowering the lower limit of 1. 5 ° C even in on e-half, it is necessary to reduce the emissions by 2030 and reach the net zero by 2050 (reference). Letters 2). It is now widely understood that in order to achieve this goal, it is necessary for all sectors and all organizations to play that role.

International and intranational justice

International justice

Figure 1: Annual carbon emissions for keeping the world temperature of less than 2 ° C.

This highlights the importance of early action to alleviate carbon emissions. The thick black line indicates the actual emission of the past. Dashing lines indicate the orbit of the past and future to control global warming to 2 ° C. Each curve reflects that the probability of staying below 2 ° C or less is 66%or more, using the carbon balance of IPCC SR15 report 60. This figure by Robbie Andrew is licensed by CC by 4. 0 (reference 61).

At the global level, under the World Health Organization (WHO) COP26 Health Program (Reference 3), which was launched at the COP26 Climate Summit in November 2021, the recalculion of health sector is currently being adjusted, and its implementation is. It has been supported by the recently established Alliance (ATACH) 4, "ATACH). To date, 58 countries have been committed to the development of a sustainable lo w-carbon medical system from all regions and income groups in the world, of which 22 countries have set a specific date to achieve the Internet. 。 Net Zero Medical Care is a common goal, but the challenges facing policy devices are very different around the world. In hig h-income countries, the carbon emissions and expenditures of medical care have already been separated 6, which is supported by the bulk of society as a whole. In England, emissions decreased to on e-quarter between 1990 and 2019, while medical budgets were tripled, service was doubled, and the population increased to on e-fifth. In contrast, in lo w-income and middl e-income countries, emissions are increasing as medical expenses, medical services, and population increase. Net Zero Healthcare Agenda has previously raised a new issue to a medical system that has previously focused on health outcomes, cost suppression, service scope, and has hardly paid attention to the climate.

Healthcare carbon footprints mainly reflect the use of healthcare in that country, access, quality, especially secondary medical care, and domestic energy systems and medical expenses. The largest percentage of emissions is global supply chains, highlighting the problem of carbon footprint management, along with the potential of international cooperation. Medical carbon emissions are less than 0. 1 tons per person in most lo w-income countries, whereas in the United States, nearly 2 tons per capita (this is equivalent to 25 % of medical carbon emissions) 10, 11. And various. If you share it evenly throughout the world as a whole, it will almost exceed the total discharge per person required to keep 1. 5 ° C or less by 2030 by 2030 (Reference 12). ) < SPAN> At the global level, the carbohydrate of the health sector has been adjusted under the World Health Organization (WHO) COP26 health program (Reference 3), which was established at the COP26 Climate Summit in November 2021. The implementation has been supported by the recently established "ATACH" 4 for transformational behavior on climate and health. To date, 58 countries have been committed to the development of a sustainable lo w-carbon medical system from all regions and income groups in the world, of which 22 countries have set a specific date to achieve the Internet. 。 Net Zero Medical Care is a common goal, but the challenges facing policy devices are very different around the world. In hig h-income countries, the carbon emissions and expenditures of medical care have already been separated 6, which is supported by the bulk of society as a whole. In England, emissions decreased to on e-quarter between 1990 and 2019, while medical budgets were tripled, service was doubled, and the population increased to on e-fifth. In contrast, in lo w-income and middl e-income countries, emissions are increasing as medical expenses, medical services, and population increase. Net Zero Healthcare Agenda has previously raised a new issue to a medical system that has previously focused on health outcomes, cost suppression, service scope, and has hardly paid attention to the climate.

Healthcare carbon footprints mainly reflect the use of healthcare in that country, access, quality, especially secondary medical care, and domestic energy systems and medical expenses. The largest percentage of emissions is global supply chains, highlighting the problem of carbon footprint management, along with the potential of international cooperation. Medical carbon emissions are less than 0. 1 tons per person per person in most lo w-income countries, while nearly 2 tons per capita (this is equivalent to 25 % of medical world carbon emissions) 10, 11. And various. If you share it evenly throughout the world as a whole, it will almost exceed the total discharge per person required to keep 1. 5 ° C or less by 2030 by 2030 (Reference 12). ) At the global level, under the World Health Organization (WHO) COP26 Health Program (Reference 3), which was launched at the COP26 Climate Summit in November 2021, the recalculion of health sector is currently being adjusted, and its implementation is. It has been supported by the recently established Alliance (ATACH) 4, "ATACH). To date, 58 countries have been committed to the development of a sustainable lo w-carbon medical system from all regions and income groups in the world, of which 22 countries have set a specific date to achieve the Internet. 。 Net Zero Medical Care is a common goal, but the challenges facing policy devices are very different around the world. In hig h-income countries, the carbon emissions and expenditures of medical care have already been separated 6, which is supported by the bulk of society as a whole. In England, emissions decreased to on e-quarter between 1990 and 2019, while medical budgets were tripled, service was doubled, and the population increased to on e-fifth. In contrast, in lo w-income and middl e-income countries, emissions are increasing as medical expenses, medical services, and population increase. Net Zero Healthcare Agenda has previously raised a new issue to a medical system that has previously focused on health outcomes, cost suppression, service scope, and has hardly paid attention to the climate.

Healthcare carbon footprints mainly reflect the use of healthcare in that country, access, quality, especially secondary medical care, and domestic energy systems and medical expenses. The largest percentage of emissions is global supply chains, highlighting the problem of carbon footprint management, along with the potential of international cooperation. Medical carbon emissions are less than 0. 1 tons per person per person in most lo w-income countries, while nearly 2 tons per capita (this is equivalent to 25 % of medical world carbon emissions) 10, 11. And various. If you share it fairly throughout the world, it will almost exceed the total emissions required to keep 1. 5 ° C or less by 2030 by 2030 (Reference 12 (Reference 12) )

The principle of fair distribution of emissions is in principle consensus, but has not actually been executed. Currently, nations that have scored high scores on the social scale of human happiness supporting sustainable development goals have also violated more important global support systems, including stable climate. Thus, an important issue for health policy creators is to identify ways to reduce emissions while expanding access to hig h-quality healthcare. Specifically, given the major differences between healthcare emissions and services around the world, what is a fair path to lo w-carbon healthcare?

Intranational justice

Since the establishment of an international panel (IPCC) on climate change in 1988, fair responsibilities to reduce emissions have been set at the center of global negotiations. However, the annual emissions are halved by the unequal world. The 50 % of the world's smallest emissions are 16 % of this increase, and 1 % of the highest emissions are 21 % of this increase. The climate change also enlarges the inequality of the world economy independently, and even the most optimistic climate change easing scenario 16 has a significant energy necessary to achieve the appropriate standard of living and health for everyone. It is increasing. However, in consideration of existing inequality, effective climate change relief policy can have unfair consequences. For example, paying a polluter pays a carbon discharge (in other words, "carbon pricing"), if there is no gradual fiscal redistribution, it is possible to drive 50 million more poverty by 2030. There is (Reference 17). Political and public consensus 18 on the need for effective and fair climate change measures has spread, and the emissions have recently recovered to a record high despite the "better recovery" after COVID-19 pandemic. did. You need to change this. The principle of fair allocation of < SPAN> emissions has been consensus in principle, but has not actually been executed. Currently, nations that have scored high scores on the social scale of human happiness supporting sustainable development goals have also violated more important global support systems, including stable climate. Thus, an important issue for health policy creators is to identify ways to reduce emissions while expanding access to hig h-quality healthcare. Specifically, given the major differences between healthcare emissions and services around the world, what is a fair path to lo w-carbon healthcare?

Since the establishment of an international panel (IPCC) on climate change in 1988, fair responsibilities to reduce emissions have been set at the center of global negotiations. However, the annual emissions are halved by the unequal world. The 50 % of the world's smallest emissions are 16 % of this increase, and 1 % of the highest emissions are 21 % of this increase. The climate change also enlarges the inequality of the world economy independently, and even the most optimistic climate change easing scenario 16 has a significant energy necessary to achieve the appropriate standard of living and health for everyone. It is increasing. However, in consideration of existing inequality, effective climate change relief policy can have unfair consequences. For example, paying a polluter pays a carbon discharge (in other words, "carbon pricing"), if there is no gradual fiscal redistribution, it is possible to drive 50 million more poverty by 2030. There is (Reference 17). Political and public consensus 18 on the need for effective and fair climate change measures has spread, and the emissions have recently recovered to a record high despite the "better recovery" after COVID-19 pandemic. did. You need to change this. The principle of fair distribution of emissions is in principle consensus, but has not actually been executed. Currently, nations that have scored high scores on the social scale of human happiness supporting sustainable development goals have also violated more important global support systems, including stable climate. Thus, an important issue for health policy creators is to identify ways to reduce emissions while expanding access to hig h-quality healthcare. Specifically, given the major differences between healthcare emissions and services around the world, what is a fair path to lo w-carbon healthcare?

Since the establishment of an international panel (IPCC) on climate change in 1988, fair responsibilities to reduce emissions have been set at the center of global negotiations. However, the annual emissions are halved by the unequal world. The 50 % of the world's smallest emissions are 16 % of this increase, and 1 % of the highest emissions are 21 % of this increase. The climate change also enlarges the inequality of the world economy independently, and even the most optimistic climate change easing scenario 16 has a significant energy necessary to achieve the appropriate standard of living and health for everyone. It is increasing. However, in consideration of existing inequality, effective climate change relief policy can have unfair consequences. For example, paying a polluter pays a carbon discharge (in other words, "carbon pricing"), if there is no gradual fiscal redistribution, it is possible to drive 50 million more poverty by 2030. There is (Reference 17). Political and public consensus 18 on the need for effective and fair climate change measures has spread, and the emissions have recently recovered to a record high despite the "better recovery" after COVID-19 pandemic. did. You need to change this.

For countries, companies, and (including healthcare) sector, carbon vajet (cumulative carbon emissions corresponding to a certain temperature rise) are useful concepts for climate change measures. However, there is still room for discussions on how to allocate the remaining carbon balance between countries fairly. Various approaches for reducing emissions that IPCC are considering is a strategy that takes into account past emissions, the concept of "per capita", the ability to reduce emissions, and these three combinations. As IPCC states, how to balance costs and benefits is eventually an ethics problem 22.

The general practices (known as the "glandfathering") that set goals based on the current or past emission levels are emissions that meet the current emissions and to meet the future development needs. 23, which implicitly eliminates the role of the amount and the need to consider the historical responsibilities of pollution. This is a realistic but unfair approach 24. Equal concept (or "emission equality") is an approach based on rights in a finite carbon budget, from the premise that no one else claims to emission. 。 In many cases, it is considered as a transactionable permit so that profits are gradually distributed from the wealthy to the poor. This idea solves many concerns pointed out in Grand Fazing, but is difficult to implement politically. The focus here, the Caucable Approach, aims to harmonize unequal social and economic conditions and global common interests. This approach is specified in the United Nations Conditions and Paris Agreement, which was born from the United Nations Conditions Convention and the Paris Agreement, under the principle of "common but different responsibilities and abilities of each" (CBDR-RC). In fact, the CBDR-RC has no clear operation definition, so each country has implemented this principle in the most suitable way to its own interests, and the internationally agreed goal has been impaired. For < SPAN> countries, companies, and (including healthcare) sector, carbon vajet (cumulative carbon emissions corresponding to a certain temperature rise) are useful concepts for climate change measures. However, there is still room for discussions on how to allocate the remaining carbon balance between countries fairly. Various approaches for reducing emissions that IPCC are considering is a strategy that takes into account past emissions, the concept of "per capita", the ability to reduce emissions, and these three combinations. As IPCC states, how to balance costs and benefits is eventually an ethics problem 22.

Priority setting and net-zero healthcare

The general practices (known as the "glandfathering") that set goals based on the current or past emission levels are emissions that meet the current emissions and to meet the future development needs. 23, which implicitly eliminates the role of the amount and the need to consider the historical responsibilities of pollution. This is a realistic but unfair approach 24. Equal concept (or "emission equality") is an approach based on rights in a finite carbon budget, from the premise that no one else claims to emission. 。 In many cases, it is considered as a transactionable permit so that profits are gradually distributed from the wealthy to the poor. This idea solves many concerns pointed out in Grand Fazing, but is difficult to implement politically. The focus here, the Caucable Approach, aims to harmonize unequal social and economic conditions and global common interests. This approach is specified in the United Nations Conditions and Paris Agreement, which was born from the United Nations Conditions Convention and the Paris Agreement, under the principle of "common but different responsibilities and abilities of each" (CBDR-RC). In fact, the CBDR-RC has no clear operation definition, so each country has implemented this principle in the most suitable way to its own interests, and the internationally agreed goal has been impaired. For countries, companies, and (including healthcare) sector, carbon vajet (cumulative carbon emissions corresponding to a certain temperature rise) are useful concepts for climate change measures. However, there is still room for discussions on how to allocate the remaining carbon balance between countries fairly. Various approaches for reducing emissions that IPCC are considering is a strategy that takes into account past emissions, the concept of "per capita", the ability to reduce emissions, and these three combinations. As IPCC states, how to balance costs and benefits is eventually an ethics problem 22.

The general practice (known as the "glandfathering") that sets goals based on the current or past emission level is emissions that meet the current emissions and to meet the future development needs. 23, which implicitly eliminates the role of the amount and the need to consider the historical responsibilities of pollution. This is a realistic but unfair approach 24. Equal concept (or "emission equality") is an approach based on rights in a finite carbon budget, from the premise that no one else claims to emission. 。 In many cases, it is considered as a transactionable permit so that profits are gradually distributed from the wealthy to the poor. This idea solves many concerns pointed out in Grand Fazing, but is difficult to implement politically. The focus here, the Caucable Approach, aims to harmonize unequal social and economic conditions and global common interests. This approach is specified in the United Nations Conditions and Paris Agreement, which was born from the United Nations Conditions Convention and the Paris Agreement, under the principle of "common but different responsibilities and abilities of each" (CBDR-RC). In fact, there is no clear operation definition of CBDR-RC, so each country has implemented this principle in the most suitable way to its own interests, and the internationally agreed goal has been damaged 24.

Equitable burden sharing is a new conceptual challenge for the health sector. As shown in Figure 2, the carbon footprint of health care is disproportionately high in wealthy countries, and the health impacts of climate change are concentrated in the poorest countries. At the same time, low- and middle-income countries, despite their relatively low share of the world population, also contribute significantly to the global health care footprint. Considered within the broader context of improving living standards, life satisfaction, and opportunities for all13, 15, it is clear that to achieve net zero health spending worldwide, the trends of high-income as well as middle-income countries are important, and equity is a crucial concern.

Figure 2: Health care carbon footprint and vulnerability to climate change.

This shows that countries with lower health care carbon footprints (y-axis) are more vulnerable to climate change impacts (x-axis). The width of the circles reflects the share of global health emissions in each income group (orange) and the share of global population (green). Healthcare carbon footprint data were obtained from Lenzen et al. 8, climate vulnerability data from the Notre Dame Global Adaptation Initiative62, and population and income data from the World Bank data portal (https://data. worldbank. org/).

In other words, while emissions reductions are a global benefit, the direct benefits of emissions reductions to the health system itself may be relatively small. This reflects the tension between ethical and political responsibility. The nature of climate change as a moral issue challenges basic ethical principles28.

Country comparison is a beneficial analysis frame in considering the fair path to the Internet Zero, but in a world that is clearly different from the time the IPCC was established, domestic comparison also played an important role. I'm doing it. In 1990, the average citizens of hig h-income countries had much more emissions than those in lo w-income and middl e-income countries, but today, tw o-thirds of the global emissions are ineque. Is due to inequality in domestic emissions, not between countries. As shown in Fig. 3, the U. S. has the lowest emissions of 50 % of the discharge of 40 % in East Asia and Europe, and the top 10 % in South Asia and Southeast Asia. This highlights the limitations of the orbit of the Internet, zero healthcare, based on 30 gross domestic production (GDP) per capita (GDP).

Box 1 Fair pathways to a ‘Green UHC’

Figure 3: Inequality of emissions between the world and regions.

This indicates that there is a significant inequality in the per capita carbon emissions (the top 10%, the medium 40%, the bottom 50%). In addition, the high emissions in the region are driven by the top 10 % of the top 10 %, while the lower 50 % of the su b-exhausts in all regions, including North America and Europe, are currently per capita that matches the 2 ° C passway. It indicates that it is before or after or less than the emission amount. The width of the circle corresponds to the ratio of global emissions in the population income groups in each region. The 2 ° C integrated passway is based on the UN emission gap report 12. This figure is quoted from World INEQUALITY Report 2022 and is licensed under CC by 4. 0 (Reference 14).₂Healthcare emissions are expected to show the same pattern as carbon footprint in the area shown in Fig. 3. This is especially noticeable in areas where hig h-quality medical care is ineque, especially in the United States and other wealthy countries and tw o-thirds of the poor in the world. In countries with universal insurance systems, which are covered by public funds, this inequality is more indirectly reflected in the relative contribution of medical care in personal carbon footprints. For example, in the United Kingdom, the poorest is estimated to be on e-fifth of healthcare, while on e-fifth of the individual carbon footprint is estimated to be on e-50th. < SPAN> Country comparison is a beneficial analysis frame for considering the fair path to the net and zero, but in a world that is clearly different from the time when IPCC was established, domestic comparison is also important. It is fulfilled. In 1990, the average citizens of hig h-income countries had much more emissions than those in lo w-income and middl e-income countries, but today, tw o-thirds of the global emissions are ineque. Is due to inequality in domestic emissions, not between countries. As shown in Fig. 3, the U. S. has the lowest emissions of 50 % of the discharge of 40 % in East Asia and Europe, and the top 10 % in South Asia and Southeast Asia. This highlights the limitations of the orbit of the Internet, zero healthcare, based on 30 gross domestic production (GDP) per capita (GDP).₂Figure 3: Inequality of emissions between the world and regions.₂This indicates that there is a significant inequality in the per capita carbon emissions (the top 10%, the medium 40%, the bottom 50%). In addition, the high emissions in the region are driven by the top 10 % of the top 10 %, while the lower 50 % of the su b-exhausts in all regions, including North America and Europe, are currently per capita that matches the 2 ° C passway. It indicates that it is before or after or less than the emission amount. The width of the circle corresponds to the ratio of global emissions in the population income groups in each region. The 2 ° C integrated passway is based on the UN emission gap report 12. This figure is quoted from World INEQUALITY Report 2022 and is licensed under CC by 4. 0 (Reference 14).₂Healthcare emissions are expected to show the same pattern as carbon footprint in the area shown in Fig. 3. This is especially noticeable in areas where hig h-quality medical care is ineque, especially in the United States and other wealthy countries and tw o-thirds of the poor in the world. In countries with universal insurance systems, which are covered by public funds, this inequality is more indirectly reflected in the relative contribution of medical care in personal carbon footprints. For example, in the United Kingdom, the poorest is estimated to be on e-fifth of healthcare, while on e-fifth of the individual carbon footprint is estimated to be on e-50th. Country comparison is a beneficial analysis frame in considering the fair path to the Internet Zero, but in a world that is clearly different from the time the IPCC was established, domestic comparison also played an important role. I'm doing it. In 1990, the average citizens of hig h-income countries had much more emissions than those in lo w-income and middl e-income countries, but today, tw o-thirds of the global emissions are ineque. Is due to inequality in domestic emissions, not between countries. As shown in Fig. 3, the U. S. has the lowest emissions of 50 % of the discharge of 40 % in East Asia and Europe, and the top 10 % in South Asia and Southeast Asia. This highlights the limitations of the orbit of the Internet, zero healthcare, based on 30 gross domestic production (GDP) per capita (GDP).

Moving toward net-zero healthcare

Figure 3: Inequality of emissions between the world and regions.

This indicates that there is a significant inequality in the per capita carbon emissions (the top 10%, the medium 40%, the bottom 50%). In addition, the high emissions in the region are driven by the top 10 % of the top 10 %, while the lower 50 % of the su b-exhausts in all regions, including North America and Europe, are currently per capita that matches the 2 ° C passway. It indicates that it is before or after or less than the emission amount. The width of the circle corresponds to the ratio of global emissions in the population income groups in each region. The 2 ° C integrated passway is based on the UN emission gap report 12. This figure is quoted from World INEQUALITY Report 2022 and is licensed under CC by 4. 0 (Reference 14).

Healthcare emissions are expected to show the same pattern as carbon footprint in the area shown in Fig. 3. This is especially noticeable in areas where hig h-quality medical care is ineque, especially in the United States and other wealthy countries and tw o-thirds of the poor in the world. In countries with universal insurance systems, which are covered by public funds, this inequality is more indirectly reflected in the relative contribution of medical care in personal carbon footprints. For example, in the United Kingdom, the poorest is estimated to be on e-fifth of healthcare, while on e-fifth of the individual carbon footprint is estimated to be on e-50th.

Box 2 Implications for policymakers

1. Low-carbon healthcare is not just a matter of international justice, but also of domestic justice. The immediate challenge facing healthcare policymakers, administrators, clinicians, and ultimately patients is how to prioritize the achievement of net-zero ambitions in the face of many other competing interests, and share the burdens and benefits fairly in the process. Priority setting in healthcare is a process that aims to achieve established targets in an efficient and equitable manner, and it provides a useful framework for considering pathways to net-zero healthcare. Key ideas that underpin priority setting are: (1) scarcity – i. e., the demand for a good (e. g., health services) exceeds the supply; and (2) opportunity cost – i. e., choosing one option means losing another option. Ethical decision-making aims to help policymakers balance the competing interests (‘trade-offs’) they face, such as meeting healthcare needs, reducing out-of-pocket costs, and allocating costs and benefits fairly in a way that expresses the values ​​of individuals and society as a whole. 33 Priority setting is widely used in health care, both in high-, middle-, and low-income settings33. Given growing commitments to low-carbon health systems, including ATACH and parallel commitments by G7 health ministers34, 35, an increasingly pressing question for health policymakers is how to value carbon emission reductions in decision-making. There are three fundamental arguments in addressing this issue.
2. First, emissions harm others, and that harm needs to be justified and ideally compensated. Based on Bressler's mortality cost of carbon analysis35, cutting health care carbon dioxide emissions in half this year could avert 226, 000 heat-related deaths alone between 2020 and 2100. These deaths are a small fraction of the climate-related excess deaths from all causes, concentrated in low- and lower-middle-income countries. As the IPCC has argued, climate change harms may be partially compensated for by providing adequate climate adaptation financing to affected people.
3. Second, not all emissions are equal, and who benefits matters. For example, alleviating poverty increases the mitigation efforts needed to stay below 1. 5-2 °C (ref. 36), which directly benefits the world's poor. Mitigating climate change while eradicating poverty is enshrined in the Paris Agreement. 37 Philosopher Henry Hsu distinguishes between "subsistence emissions," which are necessary to ensure basic life and should not be sacrificed, and "luxury emissions," which are above this level and should not be sacrificed. 38 Even if it is a health benefit, it does not mean that it is a subsistence source. Even medical interventions with relatively small health benefits can have a very large carbon footprint, especially in high-income settings. 39 Third, the remaining carbon budget is "zero-sum." Although an approach to reducing emissions that focuses on efficiency gains may seem objective and politically attractive, this approach runs the risk of resulting in the same level of emission reductions at lower costs, rather than increasing emission reductions at the same cost. A fair share does not infringe on the shares of others, and polluters’ costs are a relevant but secondary issue. The Paris Agreement is, after all, a commitment to reduce emissions, not without sacrifice. Because there are many different ways to carve up the carbon budget and no set rulebook on how to do so, there is always a risk that a self-declared “fair and ambitious” pathway will in fact be neither 42, 43 . A net-zero health care strategy would help make ambitions and timelines transparent and open to external scrutiny.
4. Such issues highlight the importance of a pathway to net-zero health care that takes full account of allocation issues, historical responsibilities, and geography. This also applies to efforts to incorporate carbon emissions into various health resource allocation processes, such as health technology assessment 44, 45 , procurement and commissioning 46 , and clinical service design 47 . From a priority setting perspective, a net-zero health care agenda must consider opportunity costs and how to manage the trade-offs of protecting health while reducing emissions 39 .
5. One option is to incorporate carbon emissions into existing health resource allocation processes. This can theoretically be achieved by placing a value on carbon emission reductions and evaluating them alongside other relevant outcomes. If the prices and health outcomes of two options are comparable, emissions can be a straightforward decision driver. This is less clear when there is a disparity between costs and health outcomes. Whether carbon emissions are incorporated into a multi-criteria decision analysis (to rank alternatives) or directly monetized using the social cost of carbon (in economic evaluation), their weighting is subject to value judgments. If the value of emission reductions is too low, they may have little impact on resource allocation. 48 Incorporating emissions directly into resource allocation processes has the advantage of clarifying trade-offs in certain decisions, but is more limited when considering the carbon footprint of the entire health care system, including supply chains, procurement, transportation, and facilities. An alternative approach is to explicitly treat the goal of decarbonizing health care as an ethical concern, rather than one that directly competes with health outcomes and fiscal budgets, by optimizing health within a constant “carbon budget.”29 For example, the UK’s National Health Service (NHS) recommends a minimum 10% “net-zero and social value” weighting in its procurement process, 49 and has specific carbon reduction targets at national and state level. 50 Given that the carbon balance for the rest of the world is zero-sum and that emissions cause harm, the question of how to value emissions reductions requires a full consideration of both. We explore this issue in more depth through a case study of universal health coverage (UHC; Box 1).

Conclusion

Between 2020 and 2050, the current population of high-income countries is expected to decline by one-fifth, while the world population is expected to increase by 2 billion, and Africa's population is expected to almost triple by the end of the century63, 64. A real challenge facing policymakers is how to ensure equitable and efficient resource allocation while realizing the UHC agenda3, 65. UHC, a comprehensive program that expands timely access to quality health care with financial risk protection to the half of the world's population currently lacking such services, could save 100 million lives by 2030 (ref. 66) and is a cornerstone of the 2015 UN Sustainable Development Goals to end poverty, reduce inequalities, and protect the planet. Clearly, emissions associated with the implementation of UHC imply a progressive use of the remaining carbon budget. Building on the work of Rasheed et al. 65, we compare the average emission intensity (kg CO

References

1. e/$) per dollar spent on health systems in low-income countries (0. 3kg CO
2. e/$), lower-middle income (1. 44kg CO
3. e/$), and upper-middle income (0. 87kg CO
4. e/$) with estimates of the cost of achieving UHC from the WHO, Disease Control Priorities, and the Institute for Health Metrics and Evaluation57, 67, 68. We estimate the “carbon cost” of achieving UHC in four scenarios, as shown in the figure below. This suggests that achieving UHC could increase global carbon emissions from health care by 10-50%, with differences between scenarios mainly reflecting the scope and population coverage of the intervention packages included. Unless net-zero is a specific policy goal backed by adequate funding, achieving UHC is likely to increase the carbon footprint of health care faster than reductions elsewhere. Efforts to decarbonize health should be integrated with broader efforts to improve health for all. Between 2020 and 2050, the current population of high-income countries is expected to fall by one-fifth, while the world population is expected to grow by 2 billion, and Africa's population is expected to nearly triple by the end of the century. 63, 64 A real challenge facing policymakers is how to ensure equitable and efficient resource allocation while realizing the UHC agenda. 3, 65 UHC, a comprehensive program that expands timely access to quality health care with financial risk protection to the half of the world's population that currently does not receive such services, could save 100 million lives by 2030 (ref. 66) and is a cornerstone of the 2015 UN Sustainable Development Goals to end poverty, reduce inequalities, and protect the planet. Emissions associated with the implementation of UHC clearly imply a progressive use of the remaining carbon budget. Building on the work of Rasheed et al. 65, we compare the average emission intensity (kg CO
5. e/$) per dollar spent on health systems in low-income countries (0. 3kg CO
6. e/$), lower-middle income (1. 44kg CO
7. e/$), and upper-middle income (0. 87kg CO
8. e/$) with estimates of the cost of achieving UHC from the WHO, Disease Control Priorities, and the Institute for Health Metrics and Evaluation57, 67, 68. We estimate the “carbon cost” of achieving UHC in four scenarios, as shown in the figure below. This suggests that achieving UHC could increase global carbon emissions from health care by 10-50%, with differences between scenarios mainly reflecting the scope and population coverage of the intervention packages included. Unless net-zero is a specific policy goal backed by adequate funding, achieving UHC is likely to increase the carbon footprint of health care faster than reductions elsewhere. Efforts to decarbonize health should be integrated with broader efforts to improve health for all. Between 2020 and 2050, the current population of high-income countries is expected to fall by one-fifth, while the world population is projected to grow by 2 billion, and Africa’s population is expected to nearly triple by the end of the century63, 64. A real challenge facing policymakers is how to ensure equitable and efficient resource allocation while realizing the UHC agenda3, 65. UHC, a comprehensive program that expands timely access to quality health care with financial risk protection to half of the world’s population currently lacking such services, could save 100 million lives by 2030 (ref. 66) and is a cornerstone of the 2015 UN Sustainable Development Goals to end poverty, reduce inequalities, and protect the planet. Clearly, emissions associated with the implementation of UHC imply a progressive use of the remaining carbon budget. Building on the work of Rasheed et al. 65, we compare the average emission intensity (kg CO
9. e/$) per dollar spent on health systems in low-income countries (0. 3kg CO
10. e/$), lower-middle income (1. 44kg CO
11. e/$), and upper-middle income (0. 87kg CO
12. e/$) with estimates of the cost of achieving UHC from the WHO, Disease Control Priorities, and the Institute for Health Metrics and Evaluation57, 67, 68. We estimate the “carbon cost” of achieving UHC in four scenarios, as shown in the figure below. This suggests that achieving UHC could increase global carbon emissions from health care by 10-50%, with differences between scenarios mainly reflecting the scope and population coverage of the intervention packages included. Unless net-zero is a specific policy goal backed by adequate funding, achieving UHC is likely to increase the carbon footprint of health care faster than reductions elsewhere. Efforts to decarbonize health care should be integrated with broader efforts to improve health for all.
13. As shown in the COP26 health program, the rapid development of lo w-carbon healthcare is that each country adapts the effects of climate change, is tied to carbo n-intensive services, and later requires a hig h-cost renovation solution. Useful for avoiding. Calculation of healthcare has a promising sign of quickly bringing returns to investment. England NHS states that the cost associated with 80 % reduction in emissions can be collected in three and a half years. Agan Khan Health Service states that it can be collected in five years in response to an effort to reduce emissions from businesses in Tanzania, Pakistan, and Kenya by 60 % (reference 52). All research 53, 54 is all about medical care, to make the investment earnings more completely quantified, incorporate carbon emissions into medical resources distribution, and better understand the barriers facing all levels of medical systems. It will help accelerate the agenda of carbon caloral.
14. Adjusting the priority of policy to support investment in lo w-carbon medical care is particularly important for low and mediu m-income health policies. For example, in Africa, south of Sahara, there are only 28%of medical facilities that can use reliable electricity, and there are no medical facilities in the world that provide 1 billion services in the world. This not only enhances the dependence on generators with inefficient, expensive and highly contaminated generators, but also related to various adverse effects on health. In COP27, international organizations promised 100, 000 medical facilities electrified by 2030, but this is an important step, but the 415, 000 new locations estimated that WHO is necessary to realize UHC Agenda. 57, only a half of medical facilities. The Green UHC must be more than carrels and include climate resilience (preparing for climate change, dealing with climate change, recovery from climate change). In addition, climate change must also include the enormous impact on the environment, society, and health. It is urgently necessary to define the Green UHC and integrate sustainability and UHC issues. As shown in the < SPAN> COP26 health program, the rapid development of lo w-carbon healthcare is indicated by countries, tied to carbo n-intensive services, and needs expensive renovation solutions later. It helps to avoid being. Calculation of healthcare has a promising sign of quickly bringing returns to investment. England NHS states that the cost associated with 80 % reduction in emissions can be collected in three and a half years. Agan Khan Health Service states that it can be collected in five years in response to an effort to reduce emissions from businesses in Tanzania, Pakistan, and Kenya by 60 % (reference 52). All research 53, 54 is all about medical care, to make the investment earnings more completely quantified, incorporate carbon emissions into medical resources distribution, and better understand the barriers facing all levels of medical systems. It will help accelerate the agenda of carbon caloral.
15. Adjusting the priority of policy to support investment in lo w-carbon medical care is particularly important for low and mediu m-income health policies. For example, in Africa, south of Sahara, there are only 28%of medical facilities that can use reliable electricity, and there are no medical facilities in the world that provide 1 billion services in the world. This not only enhances the dependence on generators with inefficient, expensive and highly contaminated generators, but also related to various adverse effects on health. In COP27, international organizations promised 100, 000 medical facilities electrified by 2030, but this is an important step, but the 415, 000 new locations estimated that WHO is necessary to realize UHC Agenda. 57, only a half of medical facilities. The Green UHC must be more than carrels and include climate resilience (preparing for climate change, dealing with climate change, recovery from climate change). In addition, climate change must also include the enormous impact on the environment, society, and health. It is urgently necessary to define the Green UHC and integrate sustainability and UHC issues. As shown in the COP26 health program, the rapid development of lo w-carbon healthcare is that each country adapts the effects of climate change, is tied to carbo n-intensive services, and later requires a hig h-cost renovation solution. Useful for avoiding. Calculation of healthcare has a promising sign of quickly bringing returns to investment. England NHS states that the cost associated with 80 % reduction in emissions can be collected in three and a half years. Agan Khan Health Service states that it can be collected in five years in response to an effort to reduce emissions from businesses in Tanzania, Pakistan, and Kenya by 60 % (reference 52). All research 53, 54 is all about medical care, to make the investment earnings more completely quantified, incorporate carbon emissions into medical resources distribution, and better understand the barriers facing all levels of medical systems. It will help accelerate the agenda of carbon caloral.
16. Adjusting the priority of policy to support investment in lo w-carbon medical care is particularly important for low and mediu m-income health policies. For example, in Africa, south of Sahara, there are only 28%of medical facilities that can use reliable electricity, and there are no medical facilities in the world that provide 1 billion services in the world. This not only enhances the dependence on generators with inefficient, expensive and highly contaminated generators, but also related to various adverse effects on health. In COP27, international organizations promised 100, 000 medical facilities electrified by 2030, but this is an important step, but the 415, 000 new locations estimated that WHO is necessary to realize UHC Agenda. 57, only a half of medical facilities. The Green UHC must be more than carrels and include climate resilience (preparing for climate change, dealing with climate change, recovery from climate change). In addition, climate change must also include the enormous impact on the environment, society, and health. It is urgently necessary to define the Green UHC and integrate sustainability and UHC issues.
17. High-income countries need to take the lead in decarbonizing health care, as they have the most polluting health systems, are responsible for the majority of past emissions, and will continue to be the largest emitters in the future. The participation of major polluting countries in the COP26 health program is an important first step58, 59. But middle-income countries also have an increasingly important role to play in curbing health care carbon emissions globally. With severely constrained health budgets and less access to financial capital, decarbonizing health care in low- and middle-income countries has opportunity costs that need to be considered. At the intersection of climate change and health, new domestic and international financing mechanisms that support the development of high-quality, low-carbon, climate-resilient health systems will be critical. Policymakers at all levels will face difficult choices in the coming years.
18. 1. The drive to decarbonize health care presents new challenges to improve health within planetary limits.
19. 2. With rapidly diminishing "zero-sum" carbon budgets, a fair path to net-zero health care would ensure that wealthy countries do not accelerate their decarbonization efforts and encroach on other countries' fair share.
20. 3. Curbing emissions in middle-income countries while realizing the UHC agenda is central to achieving net-zero health care worldwide.
21. 4. Close alignment of national and international health financing with the climate policy agenda is necessary to achieve “green UHC.”
22. 5. Accelerating the carbon-free health care agenda could not only reduce health care’s climate impact but also spur the societal actions needed to achieve the Paris Agreement.
23. The global drive to decarbonize healthcare presents new challenges and opportunities for healthcare policymakers. Although future temperature trajectories are becoming more predictable, how to fairly allocate the declining carbon budget remains a value judgment across countries and sectors. Allowing the biggest polluters to reach net zero quickly, taking into account demographic change and basic needs, can leave room for others. Accelerating the net-zero healthcare agenda has the potential not only to reduce healthcare’s climate impact but also to spur the societal transformation urgently needed to achieve the Paris Agreement. In this crucial decade for climate action, the healthcare sector must play its part.
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Authors and Affiliations

1. Mortimer, F., ISHERWOOD, J., A. & Amp; Vaux, E. Sustainability in Quality: Redefining Value. 2018). ArticlePubmedpubmed CentralGoogle Schoolar
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1. British Federation Fund. https://www. commonwealthFUND. ORG/podcast/podcast/2022/jan/getting-to-net-ne-Health-System-fights-climate-change (2022) Achievement to Zero: Climate change One health system that fights with