Systemic Approach to the Environmental Sustainability of Mobile Health

Information and communication technologies play an increasingly important role in healthcare systems, through the development of technological ecosystems known as electronic health (eHealth) and mobile health (mHealth). While this digitalization of healthcare is often considered as a lever for reducing the environmental impacts of the sector, the systemic changes induced by these new technologies are often neglected. A systematic review of the scientific literature explores the considerations on environmental sustainability of mHealth technologies. The selection of relevant articles is performed according to the PRISMA methodology and an overview of the articles addressing this subject is provided. The considerations regarding environmental impacts are analyzed through a content analysis along three dimensions: the scope of the system whose impacts are considered, the direct or indirect nature of these impacts and the indicators used to characterize them. The results of this analysis highlight the limitations of the current environmental sustainability evaluations in the literature. They show that mHealth environmental sustainability literature is still in its early stages and barely addresses the specificities of mHealth devices. More importantly, the impacts of mHealth at the system level are only considered positively, either through the reduction of transportation or the optimization of care procedures, but overlook many potential indirect impacts. To address these limitations, the LES model of Hilty and Aebischer, originally from the field of ICT, is applied to mHealth systems in order to provide a broader approach. Examples inspired from the literature are used to illustrate the systemic environmental impacts of wearable devices