Treffer: Priority setting for environmentally sustainable health care: emerging approaches to fair resource allocation.

Priority setting in health care is a research and practice area at the intersection of medicine, ethics, and economics, which aims to systematically and transparently evaluate the value for money of health services to support fair resource allocation. Three widely accepted principles for fair priority setting are cost-effectiveness, priority to the worse off, and financial risk protection, with a wide range of other contested criteria. Conceptualising and navigating potential synergies and trade-offs between competing goals, and clearly communicating the values at stake, are the central tasks of priority setting. It is now increasingly clear that health care systems have substantial environmental effects that have been largely overlooked, and that the growing movement towards high-quality, low-polluting, and climate-resilient health systems has potentially far-reaching implications for resource allocation. This Personal View explores how priority setting tools can facilitate the transition to environmentally sustainable health care. We outline the key principles of priority setting in health care and explore how environmental sustainability can be incorporated into resource allocation tools, such as health technology assessment and multicriteria decision analysis, as well as budgetary processes, such as programme budgeting and marginal analysis. We conclude with some implications for wider health system transformation.
(Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Declaration of interests MH reports receiving honoraria for lectures and educational events from the University of Bayreuth, Novartis Brazil, Pluralist Economics Network, and Torrens University in collaboration with Modern Money Lab; travel support from the Preventing Overdiagnosis Conference, the Lancet Commission on Sustainable Health care, and the London School of Hygiene & Tropical Medicine; and leadership roles with the South Australian Health Performance Council (paid), Glenview Community Services (paid), and the WHO Technical Advisory Group on the Economics of Environment, Climate and Health (unpaid). AM reports institutional support from the University of British Columbia and the Canadian Medical Association for personnel related to the manuscript, grants from the University of British Columbia Faculty of Medicine Strategic Investment Fund, Vancouver Coastal Health Research Institute, British Columbia Cancer Foundation, and Environment and Climate Change Canada, and honoraria for speaking engagements from the University of Calgary, Dalhousie University, and the Society of American Endoscopic and Gastrointestinal Surgeons. JS reports receiving grants from the Commonwealth Fund, Emergency Care Research Institute, Institute for Health care Improvement, Canadian Institutes for Health Research, and the Yale University Planetary Solutions Initiative; royalties from UptoDate; honoraria for lectures and educational events from Johns Hopkins School of Medicine, Centre for Sustainable Health Systems (CASCADES), University of British Columbia Department of Surgery, George Washington University, Columbia University, Weil Cornell Medical College Department of Anesthesiology, Health care Information and Management Systems Society, Project Echo, and University of Southern California Department of Anesthesiology and Department of Population Health; travel support from multiple organisations including WHO, American Hospital Pharmacists Association, Galien Forum, National Academy of Medicine, European Society of Anaesthesiology and Intensive Care, British Journal of Anaesthesiology, World Federation of Societies of Anaesthesiologists, American Society of Anaesthesiologists, Johns Hopkins School of Nursing, Society for Paediatric Anaesthesiology in New Zealand and Australia, Centre for Sustainable Health care University of Toronto, Endocrine Society, American Thoracic Society, and the International Forum on Perioperative Safety and Quality; and leadership roles as Chair of the American Society of Anaesthesiologists Committee on Environmental Health and Chair of the World Federation of Societies of Anaesthesiologists Sustainability Committee. OFN reports institutional funding from the Research Council of Norway Centre of Excellence Grant related to the manuscript. CM and AB declare no competing interests.