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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.

Background Mass anthelmintic drug administration is recommended in developing countries to address infection by soil-transmitted helminthiases (STH). We quantified the public health benefit of treatment with mebendazole in eight million Vietnamese children aged 5–14 years from 2006 to 2011. This was compared to the environmental impact of the pharmaceutical supply chain of mebendazole, as the resource use and emissions associated with pharmaceutical production can be associated with a public health burden, e.g. through emissions of fine particulate matter. Methodology Through Markov modelling the disability due to STH was quantified for hookworm, Ascaris lumbricoides and Trichuris trichiura. For each worm type, four levels of intensity of infection were included: none, light, medium and heavy. The treatment effect on patients was quantified in Disability-Adjusted Life Years (DALYs). The public health burden induced by the pharmaceutical supply chain of mebendazole was quantified in DALYs through Life Cycle Assessment. Principal findings Compared to ‘no treatment’, the modelled results of five-year treatment averted 116,587 DALYs (68% reduction) for the three worms combined and largely driven by A. lumbricoides. The main change in DALYs occurred in the first year of treatment, after which the results stabilized. The public health burden associated with the pharmaceutical supply chain was 6 DALYs. Conclusions The public health benefit of the Mass Drug Administration (MDA) averted substantially more DALYs than those induced by the pharmaceutical supply chain. These results were verified in a sensitivity analysis. The starting prevalence for each worm was the most sensitive model parameter. This methodology is useful for policymakers interested in a holistic approach towards the public health performance of MDA programs, enveloping both the treatment benefit received by the patient and the public health burden associated with the resource consumption and environmental emissions of the pharmaceutical production and supply chain., Author summary Millions of children from developing countries are infected by soil-transmitted helminthiases (STH), an infection of intestinal worms that cause abdominal pain, bad absorption of nutrients from food and a decrease in the amount of red blood cells. This disease can be treated with anthelmintic medication, such as mebendazole, that decreases the intensity of infection and leads to a public health benefit. Because reinfection often occurs within months, regular treatment (every six months) is advised. Given the number of people that are infected with this disease, numerous tablets are required each year to facilitate treatment. However, the industrial production of these tablets can have a negative effect on global human health, e.g. through emissions of fine particulate matter, which should be considered as a public health burden. Our findings suggest that the public health benefit of treating STH with anthelmintic medication is 18,035 times larger than the public health burden associated with pharmaceutical production. However, the conclusion that the health benefits for the patients outweigh the health damage due to resource use and emission from industry may not hold for every medical treatment, therefore we propose a more holistic evaluation of health care programmes, including a broader approach towards human health.

Background Environmental impact assessments of pharmaceuticals typically consider only a part of the pharmaceutical supply chain, e.g. tablet formulation. While the environmental impact can be expressed in environmental Human Health burden due to resource use and emissions, the Human Health benefit of the pharmaceutical treatment of patients is currently not simultaneously taken into account. The study aims include a cradle-to-grave assessment of all Human Health impacts of the production, administration and disposal of two antipsychotics for the treatment of schizophrenia. This is complemented with the environmental impact of health care providers such as hospitals. The aim is to holistically quantify to what extent the environmental Human Health burden compares to the Human Health benefit associated with the treatment. Methods We applied an overall framework which included Life Cycle Assessment to model the environmental Human Health impacts of the pharmaceutical supply chain, administration and disposal of the drug and health care providers. To model the patient benefit, this was complemented with a Markov model with a 1-year time horizon. Three patient groups were modeled: medicine coverage of paliperidone palmitate for either one month (PP1M) or three months (PP3M) at a time, and compared to Treatment Interruption (TI) as a control group. Outcomes were quantified using Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life Years (DALY). Results The main environmental impacts were visits to the psychiatrist and psychiatric hospitals. The pharmaceutical supply chain had a limited impact. For 1000 patients for 1 year, PP1M and PP3M respectively avoided 0.38 and 0.49 environmental DALYs compared to TI. PP1M and PP3M further avoided 45.60 and 57.87 YLL and 23.31 and 29.91 YLD compared to TI. The main outcome was the sum of environmental DALYs, YLL and YLD, in which PP1M and PP3M respectively avoided 69.29 and 88.26 DALYs. Alternative analysis of Quality-Adjusted Life Years confirmed the results. Conclusions The overall environmental burden was lower for PP1M and PP3M treatment than Treatment Interruption because patients are kept more stable, which reduces the environmental burden due to hospitals. Moreover, the Human Health burden was outweighed by the Human Health benefit. Electronic supplementary material The online version of this article (10.1186/s12913-019-4247-2) contains supplementary material, which is available to authorized users.

The International Journal of Life Cycle Assessment, 18 (3), ISSN:0948-3349, ISSN:1614-7502

Purpose: In the context of progress of sustainability science, life cycle thinking and, in particular, life cycle sustainability assessment may play a crucial role. Environmental, economic and social implications of the whole supply chain of products, both goods and services, their use and waste management, i.e. their entire life cycle from "cradle to grave" have to be considered to achieve more sustainable production and consumption patterns. Progress toward sustainability requires enhancing the methodologies for integrated assessment and mainstreaming of life cycle thinking from product development to strategic policy support. Life cycle assessment (LCA), life cycle costing (LCC) and social LCA (sLCA) already attempt to cover sustainability pillars, notwithstanding different levels of methodological development. An increasing concern on how to deal with the complexity of sustainability has promoted the development of life cycle sustainability frameworks. As a contribution to the ongoing scientific debate after the Rio+20 conference, this paper aims to present and discuss the state of the art of life cycle sustainability assessment (LCSA), giving recommendations for its further development in line with ontological, epistemological and methodological aspects of sustainability science. Methods: Building on the review about the state of the art of sustainability science and sustainability assessment methods presented in part I, this paper discuss LCA, LCC, sLCA and LCSA against ontological, epistemological and methodological aspects of ongoing scientific debate on sustainability. Strengths and weaknesses of existing life cycle-based methodologies and methods are presented. Besides, existing frameworks for LCSA are evaluated against the criteria defined in part I in order to highlight coherence with sustainability science progress and to support better integration and mainstreaming of sustainability concepts. Conclusions and outlook: LCSA represents a promising approach for developing a transparent, robust and comprehensive assessment. Nevertheless, the ongoing developments should be in line with the most advanced scientific discussion on sustainability science, attempting to bridge the gaps between the current methods and methodologies for sustainability assessment. LCSA should develop so as to be hierarchically different from LCA, LCC and sLCA. It should represent the holistic approach which integrates (and not substitutes) the reductionist approach of the single part of the analysis. This implies maintaining the balance between analytical and descriptive approaches towards a goal and solution-oriented decision support methodology. © 2012 Springer-Verlag Berlin Heidelberg.