[Call for action: the health sector as a driver of societal transition towards Planetary Health]. / Een oproep tot verandering.

Humanity is facing existential challenges that require urgent action to address the triple planetary crises. Drawing on the principles of planetary health, the paper argues that health professionals and the health sector have historically been important drivers of societal change, and that time has come once again for the sector to take up such active roles in addressing the planetary-health challenges. The paper provides an overview of the current frontlines of planetary health in the Netherlands: in education, research, new governance and sustainable leadership, as well as in various movements for greater transformative connection and transdisciplinary collaboration. The paper concludes with a call to action: for health professionals to adopt a planetary health perspective, consider the impacts on health and the environment, and rearticulate commitment to social and intergenerational justice, and practically engage with the frontlines of planetary health to work towards a more resilient future.

Turning green: the impact of changing to more eco-friendly respiratory healthcare - a carbon and cost analysis of Dutch prescription data.

OBJECTIVES: Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO2 equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost. DESIGN: We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies. First, we calculated the number of patients with chronic obstructive pulmonary disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of pMDIs and NPIs including DPIs and soft mist inhalers, as well as the number of dispensed spacers per patient (2020). Third, we estimated the potential emission reduction in CO2 equivalents if 70% of patients would switch from using pMDIs to using NPIs. Fourth, we performed a budget impact analysis. SETTING: Dutch respiratory healthcare. PRIMARY AND SECONDARY OUTCOME MEASURES: The carbon footprint of current inhalation medication and the environmental and financial impact of replacing pMDIs with NPIs. RESULTS: In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 364 million defined daily doses from inhalers were dispensed of which 49.6% were dispensed through pMDIs. We estimated that this could be reduced by 70% which would lead to an annual reduction in greenhouse gas emission of 63 million kg.CO2 equivalents saving at best EUR 49.1 million per year. CONCLUSIONS: In the Netherlands, substitution of pMDIs to NPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing greenhouse gas emission by 63 million kg.CO2 equivalents on average and saving at best EUR 49.1 million per year. This study confirms the potential climate and economic benefit of delivering a more eco-friendly respiratory care.