Quantifying the handprint—Footprint balance into a single score: The example of pharmaceuticals

Life Cycle Assessment typically focuses on the footprint of products and services, expressed on three Areas of Protection (AoP): Human Health, Ecosystems and Resources. While the handprint is often expressed qualitatively, quantified handprints have recently been compared directly to the footprint concerning one AoP: Human Health. We propose to take this one step further by simultaneously comparing the quantified handprint and footprint on all AoPs through normalization and weighting of the results towards a single score. We discuss two example cases of a pharmaceutical treatment: mebendazole to treat soil-transmitted helminthiases and paliperidone palmitate to treat schizophrenia. Each time, treatment is compared to ‘no treatment’. The footprint of health care is compared to the handprint of improved patient health. The handprint and footprint were normalized separately. To include sensitivity in the normalization step we applied four sets of external normalization factors for both handprint (Global Burden of Disease) and footprint (ReCiPe and PROSUITE). At the weighting step we applied 26 sets of panel weighting factors from three sources. We propose the Relative Sustainability Benefit Rate (RSBR) as a new metric to quantify the relative difference in combined handprint and footprint single score between two alternatives. When only considering the footprint, the first case study is associated with an increased single score burden of treatment compared to ‘no treatment’, while in the second case study treatment reduces the single score burden by 41.1% compared to ‘no treatment’. Also including the handprint provided new insights for the first case study, now showing a decrease of 56.4% in single score burden for treatment compared to ‘no treatment’. For the second case study the reduction of single score burden was confirmed as the handprint burden was also decreased because of treatment by 9.9%, reinforcing the findings.

[1]  Massimo Pizzol,et al.  Normalisation and weighting in life cycle assessment: quo vadis? , 2017, The International Journal of Life Cycle Assessment.

[2]  L. London Climate Change and Human Health. Risks and Responses , 2008 .

[3]  Charlotte Glümer,et al.  Health Impact Assessment of increased cycling to place of work or education in Copenhagen , 2012, BMJ Open.

[4]  Hans-Jörg Althaus,et al.  The ecoinvent Database: Overview and Methodological Framework (7 pp) , 2005 .

[5]  M J Nieuwenhuijsen,et al.  Health impact assessment of increasing public transport and cycling use in Barcelona: a morbidity and burden of disease approach. , 2013, Preventive medicine.

[6]  Steven De Meester,et al.  The recyclability benefit rate of closed-loop and open-loop systems: a case study on plastic recycling in Flanders , 2015 .

[7]  Serenella Sala,et al.  Uncertainty and sensitivity analysis of normalization factors to methodological assumptions , 2016, The International Journal of Life Cycle Assessment.

[8]  James Woodcock,et al.  The Carbon Savings and Health Co-Benefits from the Introduction of Mass Rapid Transit System in Greater Kuala Lumpur, Malaysia , 2017 .

[9]  Bo Pedersen Weidema,et al.  Multi-user test of the data quality matrix for product life cycle inventory data , 1998 .

[10]  Koji Tokimatsu,et al.  Development of weighting factors for G20 countries—explore the difference in environmental awareness between developed and emerging countries , 2018, The International Journal of Life Cycle Assessment.

[11]  T. Tinh,et al.  Elimination of Iron Deficiency Anemia and Soil Transmitted Helminth Infection: Evidence from a Fifty-four Month Iron-Folic Acid and De-worming Program , 2013, PLoS neglected tropical diseases.

[12]  Alan D. Lopez,et al.  The Global Burden of Disease Study , 2003 .

[13]  J. Dewulf,et al.  The public health benefit and burden of mass drug administration programs in Vietnamese schoolchildren: Impact of mebendazole , 2018, PLoS neglected tropical diseases.

[14]  L. Moja,et al.  Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups : guideline , 2017 .

[15]  J. Sermon,et al.  Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study , 2017, PloS one.

[16]  Colin Mathers,et al.  Comparative Quantification of Mortality and Burden of Disease Attributable to Selected Risk Factors , 2006 .

[17]  Mirjam Kretzschmar,et al.  Disability weights for the Global Burden of Disease 2013 study. , 2015, The Lancet. Global health.

[18]  Serenella Sala,et al.  Positive impacts in social life cycle assessment: state of the art and the way forward , 2018, The International Journal of Life Cycle Assessment.

[19]  Hong-Chao Zhang,et al.  Loss and Benefit Caused by a Diesel Engine: From the Perspective of Human Health , 2017 .

[20]  Thomas P. Seager,et al.  Normalization in Comparative Life Cycle Assessment to Support Environmental Decision Making , 2017 .

[21]  T. Seager,et al.  Stochastic multi-attribute analysis (SMAA) as an interpretation method for comparative life-cycle assessment (LCA) , 2014, The International Journal of Life Cycle Assessment.

[22]  T. Brady,et al.  Mineral resources in life cycle impact assessment—defining the path forward , 2015, The International Journal of Life Cycle Assessment.

[23]  J. Lawson Comparative Quantification of Health Risks. Global and Regional Burden of Disease Attributable to Selected Major Risk Factors , 2006 .

[24]  Rana Pant,et al.  A distance-to-target weighting method for Europe 2020 , 2016, The International Journal of Life Cycle Assessment.

[25]  K. Marsh,et al.  Expanding Health Technology Assessments to Include Effects on the Environment. , 2016, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[26]  B. Weidema,et al.  Monetary valuation in Life Cycle Assessment: a review , 2015 .

[27]  An M. De Schryver,et al.  The influence of value choices in life cycle impact assessment of stressors causing human health damage , 2011, The International Journal of Life Cycle Assessment.

[28]  Martin Kumar Patel,et al.  A Novel Methodology for the Sustainability Impact Assessment of New Technologies , 2013 .

[29]  Henrikke Baumann,et al.  A method for human health impact assessment in social LCA: lessons from three case studies , 2018, The International Journal of Life Cycle Assessment.

[30]  B. Steen A Systematic Approach to Environmental Priority Strategies in Product Development (EPS) Version 2000- Models and data of the default method , 1999 .

[31]  M. Huijbregts,et al.  Human-Toxicological Effect and Damage Factors of Carcinogenic and Noncarcinogenic Chemicals for Life Cycle Impact Assessment , 2005, Integrated environmental assessment and management.

[32]  G. Norris Social Impacts in Product Life Cycles - Towards Life Cycle Attribute Assessment , 2006 .

[33]  Huppes Gjalt,et al.  Evaluation of weighting methods for measuring the EU-27 overall environmental impact , 2011 .

[34]  J. Peuskens,et al.  Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis , 2012, PharmacoEconomics.

[35]  Reinout Heijungs,et al.  Bias in normalization: Causes, consequences, detection and remedies , 2007 .

[36]  Ahmed Busnaina,et al.  Life cycle impacts and benefits of a carbon nanotube-enabled chemical gas sensor. , 2014, Environmental science & technology.

[37]  Cecília M.V.B. Almeida,et al.  Assessing the replacement of lead in solders: effects on resource use and human health , 2013 .

[38]  Alan D. Lopez,et al.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020. , 1996 .

[39]  Ashutosh Kumar Singh,et al.  Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016, Lancet.

[40]  Ying Zhang,et al.  Traffic-related air pollution and health co-benefits of alternative transport in Adelaide, South Australia. , 2015, Environment international.

[41]  T. Nemecek,et al.  Overview and methodology: Data quality guideline for the ecoinvent database version 3 , 2013 .

[42]  Serenella Sala,et al.  Hotspots analysis and critical interpretation of food life cycle assessment studies for selecting eco-innovation options and for policy support , 2017 .

[43]  C. Corvalan,et al.  Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks , 2016 .

[44]  P. Scarborough,et al.  The Eatwell Guide: Modelling the Health Implications of Incorporating New Sugar and Fibre Guidelines , 2016, PloS one.

[45]  M. Goedkoop,et al.  The Eco-indicator 99, A damage oriented method for Life Cycle Impact Assessment , 1999 .

[46]  D. Owens,et al.  State-transition modeling: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--3. , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[47]  J. McCarthy,et al.  Assessment of Anthelmintic Efficacy of Mebendazole in School Children in Six Countries Where Soil-Transmitted Helminths Are Endemic , 2011, PLoS neglected tropical diseases.

[48]  K. Marsh,et al.  INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL , 2016, International Journal of Technology Assessment in Health Care.

[49]  S. Saha,et al.  A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? , 2007, Archives of general psychiatry.

[50]  S. Dursun,et al.  Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation , 2008, Health and quality of life outcomes.

[51]  J. Dewulf,et al.  Human health benefit and burden of the schizophrenia health care pathway in Belgium: paliperidone palmitate long-acting injections , 2019, BMC Health Services Research.

[52]  D. Fryback,et al.  HALYS and QALYS and DALYS, Oh My: similarities and differences in summary measures of population Health. , 2002, Annual review of public health.

[53]  G. Tiwari,et al.  Land use, transport, and population health: estimating the health benefits of compact cities , 2016, The Lancet.

[54]  J. S. Pandey,et al.  Carbon footprint: current methods of estimation , 2011, Environmental monitoring and assessment.

[55]  Nam Lethanh,et al.  Markov Model Predicts Changes in STH Prevalence during Control Activities Even with a Reduced Amount of Baseline Information , 2016, PLoS neglected tropical diseases.

[56]  B. Moldan,et al.  How to understand and measure environmental sustainability: Indicators and targets , 2012 .

[57]  G. Brundtland World summit on sustainable development , 2002, BMJ : British Medical Journal.

[58]  S. Hellweg,et al.  Emerging approaches, challenges and opportunities in life cycle assessment , 2014, Science.

[59]  D. Jolley,et al.  Anemia, iron deficiency, meat consumption, and hookworm infection in women of reproductive age in northwest Vietnam. , 2008, The American journal of tropical medicine and hygiene.

[60]  Sala Serenella,et al.  Development of a weighting approach for the Environmental Footprint , 2017 .

[61]  J. Stoddard,et al.  Antipsychotic Adherence and Rehospitalization in Schizophrenia Patients Receiving Oral Versus Long-Acting Injectable Antipsychotics Following Hospital Discharge. , 2015, Journal of managed care & specialty pharmacy.

[62]  A. Inaba,et al.  Weighting across safeguard subjects for LCIA through the application of conjoint analysis , 2004 .

[63]  A. McAlearney,et al.  Quality-adjusted life-years and other health indices: a comparative analysis. , 1999, Clinical therapeutics.

[64]  G Bertanza,et al.  How green are environmental technologies? A new approach for a global evaluation: the case of WWTP effluents ozonation. , 2013, Water research.

[65]  M. Givoni,et al.  Health Impact Modelling of Active Travel Visions for England and Wales Using an Integrated Transport and Health Impact Modelling Tool (ITHIM) , 2013, PloS one.

[66]  B. Weidema,et al.  carbon footprint , 2020, Catalysis from A to Z.

[67]  C. Murray,et al.  Global burden of disease , 1997, The Lancet.

[68]  John T Harvey,et al.  Pavement Life-Cycle Assessment : Proceedings of the Symposium on Life-Cycle Assessment of Pavements (Pavement LCA 2017), April 12-13, 2017, Champaign, Illinois, USA , 2017 .

[69]  Patrick Hofstetter,et al.  Selecting Human Health Metrics for Environmental Decision‐Support Tools , 2002, Risk analysis : an official publication of the Society for Risk Analysis.

[70]  B. Weidema,et al.  Carbon Footprint , 2008 .

[71]  J. Vercruysse,et al.  Soil-transmitted helminthiasis: the relationship between prevalence and classes of intensity of infection. , 2015, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[72]  Tam V. Nguyen,et al.  Risk factors for anemia in Vietnam. , 2006, The Southeast Asian journal of tropical medicine and public health.

[73]  Katerina S. Stylianou,et al.  A life cycle assessment framework combining nutritional and environmental health impacts of diet: a case study on milk , 2016, The International Journal of Life Cycle Assessment.

[74]  J. Dewulf,et al.  Human health benefits and burdens of a pharmaceutical treatment: Discussion of a conceptual integrated approach. , 2016, Environmental research.

[75]  Mark A. J. Huijbregts,et al.  Framework for modelling data uncertainty in life cycle inventories , 2001 .

[76]  O. Phillips,et al.  Extinction risk from climate change , 2004, Nature.

[77]  J. Vanderhaegen,et al.  Assessment of the priority target group of mental health service networks within a nation-wide reform of adult psychiatry in Belgium , 2016, BMC Health Services Research.

[78]  Huppes Gjalt,et al.  Background review of existing weighting approaches in Life Cycle Impact Assessment (LCIA) , 2011 .

[79]  Thomas Dyllick,et al.  Towards true product sustainability , 2017 .

[80]  Jon Biemer,et al.  Our environmental handprint: The good we do , 2013, 2013 1st IEEE Conference on Technologies for Sustainability (SusTech).

[81]  S. Gopal,et al.  Paliperidone palmitate maintenance treatment in delaying the time-to-relapse in patients with schizophrenia: A randomized, double-blind, placebo-controlled study , 2010, Schizophrenia Research.

[82]  Mark A. J. Huijbregts,et al.  USEtox—the UNEP-SETAC toxicity model: recommended characterisation factors for human toxicity and freshwater ecotoxicity in life cycle impact assessment , 2008 .

[83]  W. Fleischhacker,et al.  Efficacy and Safety of Paliperidone Palmitate 3-Month Formulation for Patients with Schizophrenia: A Randomized, Multicenter, Double-Blind, Noninferiority Study , 2016, The international journal of neuropsychopharmacology.

[84]  Benedetto Rugani,et al.  A Revision of What Life Cycle Sustainability Assessment Should Entail: Towards Modeling the Net Impact on Human Well‐Being , 2017 .

[85]  T. Vos,et al.  Global, regional, and national incidence and prevalence, and years lived with disability for 328 diseases and injuries in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017 .

[86]  G. Munda Social Multi-Criteria Evaluation for a Sustainable Economy , 2007 .

[87]  S. Brooker,et al.  Global numbers of infection and disease burden of soil transmitted helminth infections in 2010 , 2014, Parasites & Vectors.

[88]  M. Goldacre,et al.  Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006 , 2011, BMJ : British Medical Journal.

[89]  T. Tinh,et al.  Markov model to forecast the change in prevalence of soil-transmitted helminths during a control programme: a case study in Vietnam. , 2013, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[90]  E. Hertwich,et al.  Carbon footprint of nations: a global, trade-linked analysis. , 2009, Environmental science & technology.

[91]  F. Gueyffier,et al.  Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials , 2011, BMJ : British Medical Journal.

[92]  Hans-Jürgen Dr. Klüppel,et al.  The Revision of ISO Standards 14040-3 - ISO 14040: Environmental management – Life cycle assessment – Principles and framework - ISO 14044: Environmental management – Life cycle assessment – Requirements and guidelines , 2005 .

[93]  Rana Pant,et al.  Integrated assessment of environmental impact of Europe in 2010: data sources and extrapolation strategies for calculating normalisation factors , 2015, The International Journal of Life Cycle Assessment.

[94]  Stefanie Hellweg,et al.  LCIA framework and cross-cutting issues guidance within the UNEP-SETAC Life Cycle Initiative. , 2017, Journal of cleaner production.