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ESGO Survey on Environmental Sustainability

Dear ESGO Members,

We invite you to participate in the inaugural ESGO Survey on Environmental Sustainability. The World Health Organization defines environmental sustainability in healthcare as ‘a strategy to improve, maintain or restore health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations’. This survey aims to investigate your attitudes, expectations, awareness and commitment regarding environmental sustainability in your clinical work, as well as to gather suggestions on how ESGO can support environmental sustainability in its activities.

Your insights are invaluable in shaping future initiatives and policies to promote sustainable practices in gynaecologic oncology. The results of the survey are planned to be published and discussed further during the next ESGO congress.

Your participation in this survey is voluntary. If you choose to participate, your responses will be kept confidential. The information collected during this survey will be used for research and organisational purposes. Only the research team and authorised personnel will have access to the data. Data will be stored securely and will be retained until the publication of the anonymised data analysis in a peer-reviewed journal. By proceeding with the survey, you indicate that you have read the information provided, understood the purpose and procedures, and voluntarily agree to participate. You may print a copy of this page for your records.

If you have any questions or concerns about the survey, please contact the ESGO Office at adminoffice@esgo.org.

We thank you for your participation in this initiative.

Sincerely,
ESGO Environment and Sustainability Working Group
Part I: General information
1.Country of residence:(Required.)
2.Age:(Required.)
3.Gender:(Required.)
4.Do you implement sustainable measures in your private life?(Required.)
5.Main place of work:
(please choose all that apply)(Required.)
6.Level of education/experience:
(please choose all that apply)(Required.)
7.Years of professional experience after completion of medical degree:(Required.)
8.Current academic position or current academic level:(Required.)
9.Main focus of your daily work:
(please choose up to two answers)(Required.)
10.Number of new patients with a primary gynaecological malignancy treated in your centre in 2024:(Required.)
11.Do you work in an ESGO accredited centre for training?(Required.)
12.Is your department performing robotic-assisted laparoscopic procedures?(Required.)
Part II: Attitude of ESGO members towards environmental sustainability in daily clinical practice
13.How much are you concerned about the consequences of climate change?(Required.)
14.How well do you feel informed about the carbon footprint of your daily work:(Required.)
15.To what extent do you agree with the following statement: "Sustainable practices should be a priority in gynaecologic oncology."(Required.)
16.How important do you think sustainability is in your everyday clinical work (e.g. commuting to work, energy use, waste reduction)?(Required.)
17.Which three of the following do you consider the most important for reducing the carbon footprint in clinical work?
(Please choose three most important answers)(Required.)
18.Are you currently advocating for sustainable practices within your institution?(Required.)
Part III: Willingness and obstacles of ESGO members to engage in sustainable solutions
19.Which of the following measures are you currently doing or willing to do to decrease your and your institution’s carbon footprint?
(Please select all that apply)(Required.)
20.Can you identify any barriers in increasing sustainability in gynaecologic oncology?
(Please select up to three most important answers)(Required.)
21.What resources or support would you need for a stronger engagement in sustainable practices?
(Please select up to three most important answers)(Required.)
Part IV: Expectations from ESGO regarding sustainability
22.Do you think that ESGO should increase their engagement in sustainability?(Required.)
23.Which of the following measures do you think ESGO should engage in?
(Please choose all that apply)(Required.)
24.Do you think ESGO congresses are sustainable enough?(Required.)
25.Do you have any comments or suggestions to increase the environmental sustainability of ESGO events?
26.Do you think that ESGO should always offer the possibility to attend the congress virtually?(Required.)
27.Which factors, besides the scientific program, do you consider as the most important when deciding to attend the ESGO congress?
(Please select up to three)(Required.)
28.If you are attending the ESGO congress, do you pay attention to the following sustainable practices?
(Please select all that apply)(Required.)
29.Would you agree to participate in a further part of ESGO’s study on environmental sustainability in gynaecological oncology? If yes, please share your contact details (name, surname, e-mail address, institution):
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Here is a short summary of what we are doing to prioritise sustainability at ESGO Congress, more detail can be found at https://congress.esgo.org/resources/sustainability/

• Paperless programme
• Easily accessible and sustainable venue and city
• Carbon offset donation
• Elimination of plastics
• Waste control and recycling
• Donation of leftovers


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Additional educational materials for respondents:

The World Health Organization defines environmental sustainability in healthcare as a strategy to improve, maintain or restore health, while minimizing negative impacts on the environment and leveraging opportunities to restore and improve it, to the benefit of the health and well-being of current and future generations.

Healthcare systems are responsible for 4-7% of the carbon footprint and 40% of public sector emissions. The biggest CO2 emissions in healthcare (together responsible for 80%) are energy use of the buildings (38%), travel of healthcare providers and patients (22%) and (preparation of) medication (18%).

CO2 emissions in healthcare by category:

· Energy supply of buildings: 38%
· Travel of patients and healthcare workers: 22%
· Medicines: 18%
· Other (transport, fuels, chemicals, food and catering, water and sanitation): 11%
· Medical equipment and instruments: 6%
· Paper: 3%
· Management activities: 3%
Source: The Dutch National Institute for Public Health and Environment
Total and relative CO2 emissions for 13 health-care expenditure categories:

· Public hospitals: 34%
· All pharmaceuticals: 19%
· Private hospitals: 10%
· Capital expenditure: 8%
· Specialist medical services: 6%
· Community or public health: 6%
· General practice: 4%
· Dentistry: 3%
· Aids and appliances: 3%
· Other health practitioners: 2%
· Research: 2%
· Administration: 2%

The Operating Room causes the most emissions inside the hospital, for the following three reasons:

1. Single use instruments
Devices with a plug have a larger footprint than loose materials, which means that throwing away these instruments generates unnecessary emissions.

2. Clean air
Replacing the air in an operating room 20 times per hour, 24 hours a day, 7 days a week, is equivalent to 90% of the total energy consumption of the operating room and therefore also of a very large part of the hospital’s energy consumption.

3. Jacket on, jacket off
Surgical gowns are often made for single use. Every time a surgeon puts on a jacket for an operation but leaves the room to look up something or for a short break, the jacket is taken off and a new one is put on when the surgeon returns.
References:

1. World Health Organization. "Environmentally sustainable health systems: a strategic document." Environmentally sustainable health systems: a strategic document. 2017.
2. Malik, Arunima, et al. "The carbon footprint of Australian health care." The Lancet Planetary Health 2.1 (2018): e27-e35.
3. https://www.health.org.uk/reports-and-analysis/briefings/net-zero-care-what-will-it-take
4. Information collected by the Dutch National Institute for Public Health and Environment
5. De Bruin, J, Houwert, T, and Merkus, K. Een stuur voor de transitie naar duurzame gezondheidszorg: Kwantificering van de CO2-uitstoot en maatregelen voor verduurzaming. Amsterdam: Gupta Strategists (2019).
6. Malik, Arunima, et al. "The carbon footprint of Australian health care." The Lancet Planetary Health 2.1 (2018): e27-e35.
7. Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG. 2024 Apr;131(5):555-567. doi: 10.1111/1471-0528.17637. Epub 2023 Aug 21. PMID: 37604701.