What happens when you move acute hospital care into the patient's own home? Maria Normann Larsen shares the results of Denmark's first hospital-at-home randomised trial.

About the guest: Maria Normann Larsen is a medical doctor and researcher at Herlev Hospital who recently completed her PhD on remote care. Her randomised trial, run at Nordsjaellands Hospital, tested whether acutely ill patients treated at home do better than those admitted to a conventional ward.

Three takeaways:

• Patients treated at home were measurably more physically active than those in hospital, which matters because the drop in activity during admission drives functional decline and slower recovery.
• - They were also more satisfied with their treatment, so the better-for-recovery option was also the one patients preferred.
• - Hospital at home is a complex intervention, not just a change of location. It only works when hospital teams, municipalities, patients and relatives are aligned, and a model proven in one department cannot simply be lifted onto the shelf elsewhere.

Timestamps:
00:00 - Intro and why remote care
02:00 - What is a care model, and the trial's goal
05:00 - The findings: more active, more satisfied
09:00 - Why it's a complex intervention
12:00 - Which patients it suits
17:00 - A first step for teams who want to try it

References:

• Hybrid Hospital at Home and Physical Activity RCT (JAMA Network Open): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2850565
• - Informal caregivers in a hybrid hospital-at-home model (BMC Health Services Research): https://research.regionh.dk/en/publications/caring-beyond-hospital-walls-informal-caregivers-experiences-in-a/
• - Nordsjaellands Hospital: https://www.nordsjaellandshospital.dk
• - Maria Normann Larsen on LinkedIn: [add link]

You might also enjoy:

• Telemedicine: Reaching Drawdown with a Decentralised Healthcare System (Ep 016)
• - The Transition From the Sick Care System to a Preventive Care System (Ep 008)

Hosts:
Joachim Almdal: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"It's not just a shift of location. It's more complex than that. Just because we showed we could do it at one hospital doesn't mean everyone else can take it off the shelf and implement it."

If we want to fix sustainability in healthcare, one of the most powerful levers sits at the gate where new health technologies get approved: Health Technology Assessment (HTA).

In this episode of the Sustainable Healthcare Podcast, Frederik Dam van Deurs speaks with Melissa Pegg, Senior Research Consultant in Environmental Sustainability in HTA at the York Health Economics Consortium (YHEC), University of York, and co-lead of the first HTAi Working Group on environmental sustainability in HTA.

Disclosure: All opinions are Melissa's own and not the opinions of York Health Economics Consortium (YHEC) and the National Institute for Health and Care Excellence (NICE).

About the guest: Melissa Pegg leads YHEC's environmental sustainability work, bringing environmental impact methods into HTA and health economics for the NHS, government bodies and industry. She holds a master's in HTA (University of Glasgow), spent 18 years in industry before academia, and was a fellow in sustainable surgery for the BMJ.

Three things you'll take away:

• HTA works as a "gatekeeper", and adding environmental impact alongside safety, efficacy and cost could reshape which technologies reach patients.
• - The "information conduit" and "parallel" approaches: getting environmental data into HTA now, reported alongside health-economic data, without waiting for agencies to build new capacity.
• - A real case study with the Scottish Health Technologies Group: reusable vs single-use endoscopes came out around 50% less environmentally impactful, with a more favourable budget impact and QALY, and still held up when the 3,000-use assumption was quartered under sensitivity analysis.

Timestamps:
00:00 Introduction
01:00 Life in York: yoga, two boys, philosophy
03:00 What HTA is, and why it's a gatekeeper
07:00 National vs global: WHO, NICE and the devolved-nation agencies
09:00 The "reference case" and how agencies differ
15:00 Adding the environmental and planetary-health perspective
17:00 Safety for whom? Bringing the environment into the safety domain
22:00 Can it work? The information-conduit approach
24:00 Case study: reusable vs single-use endoscopes with SHTG
30:00 The figures: around 50% lower impact, favourable budget and QALY
33:00 The "just transition" and the classic objections to reusables
39:00 Sensitivity analysis and the 3,000-use assumption
45:00 What makes Melissa hopeful

References mentioned:
Green Surgery report (UK Health Alliance on Climate Change, 2023): https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/
Cliff Goodman, HTA 101: Introduction to Health Technology Assessment: https://www.inahta.org/wp-content/uploads/2014/09/HTA-101_Goodman_2004.pdf
HTAi Environmental Sustainability in HTA (ESHTA) Working Group: https://htai.org/engage-with-us/working-groups/htai-eshta/
Toward including environmental sustainability in HTA (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/toward-including-environmental-sustainability-in-health-technology-assessment/2FF6BA84AC3E7FB280DA2DF3F17D6130
Environmental sustainability in diabetes (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/environmental-sustainability-in-diabetes-improving-the-quality-of-diabetes-management-through-hta-and-systemlevel-change/E9B3804A2EB373D31752F6A2587C084A
How Can HTA Shape a More Sustainable Future for Healthcare? (YHEC): https://www.yhec.co.uk/resource/how-can-hta-shape-healthcare-sustainability/
Scottish Health Technologies Group (SHTG): https://shtg.scot/
NICE: https://www.nice.org.uk/

Links:
Melissa Pegg on LinkedIn: https://www.linkedin.com/in/melissapegg1/
Melissa's email: [email protected]
Melissa's publications (YHEC Environmental Impact): https://www.yhec.co.uk/what-we-do/environmental-impact/
York Health Economics Consortium: https://www.yhec.co.uk/

You might also enjoy:
Episode 103, LCA in Surgery and Specialty-Level Carbon Literacy with Anna Roe Rasmussen: https://carepathwayconsulting.com/podcast/podcast-episode-103/

Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"HTA is a gatekeeper. The opportunity right now is to get environmental data into HTA and report it alongside everything else, without yet expecting agencies to act on it. That alone would be a huge step forward." - Melissa Pegg

How do you cut 40% of the carbon out of a clinical trial without changing the price? You rent the equipment instead of buying it.

In this episode of the Sustainable Healthcare Podcast, part of our mini-series with the Sustainable Healthcare Coalition's Community of Practice for Clinical Trials, Frederik Dam van Deurs speaks with Alejandra Medina, Chief Sustainability Officer at Quipment, the French, B Corp-certified provider of equipment solutions for clinical trials.

About the guest: Alejandra Medina is Chief Sustainability Officer at Quipment SAS, a Nancy-based company founded in 2010 that equips and maintains clinical trial sites across 110+ countries. She joined as quality director and led Quipment through its B Corp certification.

Three things you'll take away:

• An equipment-rental ("equipment-as-a-service") model is circular by design: returning, reprocessing and redeploying devices keeps them in near-constant use across the value chain.
• - Quipment's benchmark, built for B Corp certification, shows a 40% carbon-footprint reduction moving from a linear to a circular model, comparable to the saving the Sustainable Markets Initiative estimates from more digital trials.
• - The real bottleneck for circularity isn't the technology, it's convincing the actors in the trial supply chain that circular is just as safe, compliant and high-performance as linear.

Timestamps:
00:00 Introduction
02:00 Meet Alejandra: from Mexico to Nancy
03:00 What Quipment does: equipping and maintaining trial sites
05:00 The portfolio: ECGs, infusion pumps, data loggers and 3,000+ products
07:00 Becoming a B Corp: how the assessment revealed a circular model
09:00 Circular by design: rent, return, reprocess, redeploy
13:00 Where circularity breaks down in clinical trials
16:00 The cost question: services at the same price
18:00 Informing the choice: tools over mandates
19:00 The Quipment Carbon Compass: a comparator, not a calculator
20:00 40% carbon reduction, linear vs circular
23:00 The new seven-pillar B Corp standard
25:00 What gives Alejandra hope

References and links:
Sustainable Healthcare Coalition, Community of Practice for Clinical Trials: https://shcoalition.org/sustainable-clinical-trials-knowledge-hub/
B Corp certification (B Lab): https://www.bcorporation.net/
Quipment B Corp profile: https://www.bcorporation.net/en-us/find-a-b-corp/company/quipment-sas/
Alejandra Medina on LinkedIn: https://fr.linkedin.com/in/alejandra-medina-3315185
Quipment: https://www.quipment.com/

You might also enjoy:
Episode 102, Sustainable Clinical Trials (1): Convien & myoncare with Christian Hieronimi: https://carepathwayconsulting.com/podcast/podcast-episode-102/

Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"Quipment Carbon Compass isn't a calculator, it's a comparator. We didn't change anything; we just changed the way we explain our business. We were circular by design from the beginning." - Alejandra Medina

Structured Material Selection: Building Sustainable Medical Devices with Plastics
How do you make a medical device more sustainable without blowing up the business case? Lucas Pianegonda breaks down the structured way to choose plastics, and why the first win is usually deleting a requirement, not changing a material.


ABOUT THE GUEST
Lucas R. Pianegonda is founder and lead plastic expert at Gradical (Switzerland), a consultancy that helps medtech companies select materials that are technically sound, compliant, and lower-footprint. Material scientist by training, he also hosts the podcast now called MedTech Sustainability by Design.
KEY TAKEAWAYS
- Over-requirement is the biggest hidden source of cost and carbon. Challenge every "must be medical grade" before you reach for a greener material.
- The plastic pyramid: moving down from high-performance plastics (PEEK) to engineering or commodity grades, where the part allows, cuts footprint and cost at once. Twenty years ago we just called it optimising.
- You don't need a 50,000 euro LCA to decide. A rough Excel or OpenLCA estimate gets you within ~20-25%. The certified LCA is for making public claims, which the EU's Empowering Consumers Directive now requires you to back with data.
TIMESTAMPS (adjust to audio)
00:00 - Intro and Lucas's path into materials
04:00 - Four forces driving sustainability in medtech
12:00 - Why SME device makers struggle to specialise
18:00 - Structured material selection and the value analysis
24:00 - The plastic pyramid and downgrading
30:00 - Rough vs. certified LCA, and what an LCA really costs
38:00 - Selling sustainability: the commercial translation gap
REFERENCES
- OpenLCA, free life cycle assessment software: https://www.openlca.org
- Empowering Consumers for the Green Transition Directive, Directive (EU) 2024/825 (applies from 27 September 2026)
- Pharmapack Europe: https://www.pharmapackeurope.com
- Science Based Targets initiative (SBTi): https://sciencebasedtargets.org
- Lucas's podcast, MedTech Sustainability by Design: https://www.buzzsprout.com/2389989
LINKS
- Lucas R. Pianegonda on LinkedIn: https://www.linkedin.com/in/lucas-r-pianegonda-81142b110/
- Gradical: https://gradical.ch
YOU MIGHT ALSO ENJOY
- Episode 096 - Recycling pharmaceutical transport packaging, with Arne Kloke (SCHOTT Pharma)
- Episode 097 - Visualizing Circular Healthcare: A Taxonomy for Sustainable Medical Device Flows, with Tamara Hoveling (TU Delft)
HOSTED BY
- Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
- Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
- Care Pathway Consulting: https://carepathwayconsulting.com
"Sustainability can't be a strategic advantage if you can't sell the device." - Lucas Pianegonda

What if the plastic waste from a hospital's clinical areas could come back as the ID card holders every nurse and doctor wears every day? That is what SMALLrevolution is doing, and it is one of the more elegant circular economy stories I have come across in healthcare. About the guest: Arendse Ekegren Baggesen is the Founder of SMALLrevolution, a Danish design-to-manufacturing company that collects plastic waste from hospitals, municipalities, and companies, transforms it into recycled raw material, and produces furniture and functional products that go back to the original waste producer. Three key takeaways:

• According to Arendse, only 8-10% of plastic collected in Denmark is actually recycled. Sorting quality in the waste stream, not collection, is the primary bottleneck.
• SMALLrevolution's closed-loop model: they collect a facility's waste, produce products from it, and return those products to the same facility, along with full LCA and ESG data.
• According to Arendse, producing one kilo of virgin plastic requires two kilos of crude oil. Redirecting to recycled material reduces both CO2 emissions (around 30% vs. virgin plastic, based on SMALLrevolution's own LCAs) and crude oil demand.

Timestamps:

• 00:00 - Introduction and origins of SMALLrevolution
• 02:00 - Why recycled plastic for outdoor furniture?
• 05:00 - Finding the first factory willing to work with household plastic waste
• 07:00 - How COVID pivoted SMALLrevolution from B2C to B2B
• 08:00 - The closed-loop model: collect, produce, return
• 09:00 - LCAs and ESG data on every product
• 10:00 - What actually happens to plastic in the "normal" waste stream?
• 12:00 - Why sorting quality, not collection, is the real bottleneck
• 14:00 - How hospitals can get started: two live case studies
• 18:00 - The "not another bucket" problem in surgical theatres
• 21:00 - CO2 impact: around 30% reduction vs. virgin plastic (based on SMALLrevolution's own LCAs)
• 23:00 - According to Arendse: 2 kg of crude oil per 1 kg of plastic, and what that means for resource resilience

Pull quote: "All vases in the world should be produced in a recycled material. There is demand, and there is a lot of waste, so why not connect those two dots?" Contact Arendse:
Website: smallrevolution.dk
LinkedIn: Arendse Ekegren Baggesen You might also enjoy:
Episode 088: Circular Material Flow of Medication in the Intensive Care Unit (Nicole Hunfeld, Erasmus UMC)
Episode 074: The Future of Reprocessing in Healthcare (Lars Thording, Innovative Health)
Episode 096: Recycling Pharmaceutical Transport Packaging (Arne Kloke, SCHOTT Pharma)

What happens when a doctor applies the rigour of clinical research to the carbon footprint of surgery?

In this episode, Frederik speaks with Anna Roe Rasmussen, MD, MSc Health Policy — a scientific researcher at the Regional Unit for the Green Transition in Region Zealand.

Anna recently defended her PhD at the University of Copenhagen and the Technical University of Denmark, where she applied lifecycle assessment (LCA) to total hip replacement surgery, working towards the integration of environmental impact into clinical decision-making.

About Anna:
Anna has spent over a decade at the intersection of climate and health — as a co-founder of Doctors for Climate Denmark (Læger for Klimaet), as part of the working group that drafted the Danish Medical Association's climate and health policy (published 2022), and as a scientific researcher applying LCA methodology to surgical care pathways.

Three things you'll take away:

• Why the field needs to distinguish more clearly between carbon footprint screenings and full ISO-compliant LCAs — and what gets lost when clinicians can't tell the difference.
• Why specialty-level carbon literacy is the missing link between organisational sustainability targets and meaningful action on the ground in clinical departments.
• Why acting — finding someone to act with — is Anna's personal antidote to climate anxiety.

Timestamps:

• 00:00 — Introduction
• 03:00 — Anna's PhD: applying LCA to total hip replacement surgery
• 08:00 — From medical student at COP to co-founding Doctors for Climate Denmark
• 10:00 — The Danish Medical Association's 2022 climate and health policy
• 13:00 — A passionate but fragmented global movement of healthcare workers
• 17:00 — The publication explosion in healthcare LCA — and why quality must keep pace
• 21:00 — Carbon screening vs. ISO-compliant LCA: the precision vs. direction trade-off
• 27:00 — Specialty-level carbon literacy as the next step for healthcare decarbonisation
• 33:00 — Carbon budgets and financial budgets: an uncomfortable but necessary analogy
• 38:00 — The hard conversations healthcare systems avoid
• 41:00 — What makes Anna hopeful: engaged colleagues and the power of acting together

References and links mentioned:

• ISO 14040/14044 standards for lifecycle assessment (see iso.org)
• DTU Centre for Absolute Sustainability
• Doctors for Climate Denmark / Læger for Klimaet — Facebook [Joachim/Frederik: add official website if available]
• Danish Medical Association climate and health policy 2022 [Frederik: add direct link]
• International Federation of Medical Students' Associations: ifmsa.org

Guest links:

• Anna Roe Rasmussen on LinkedIn
• Sjællands Universitetshospital
• DTU Centre for Absolute Sustainability

You might also enjoy:

• Episode 097: Visualising Circular Healthcare — Tamara Hoveling (TU Delft) on LCA methodology in healthcare
• Episode 101: Sustainable Healthcare: Implementation and Hope — Maria Gaden
• Episode 088: Circular Material Flow in the ICU — Nicole Hunfeld (Erasmus UMC)

[Episode Spotify/platform links to be added by Frederik] Hosts:

• Joachim Almdal on LinkedIn
• Frederik van Deurs on LinkedIn
• Care Pathway Consulting

Pull quote: "If you want to do something — act. And find someone to do it with. That's always both more fun and more productive." — Anna Roe Rasmussen

The first episode of our Sustainable Clinical Trials mini-series, produced in partnership with the Sustainable Healthcare Coalition (SHC), following up on the Community of Practice conference in London on 4 November 2025. Each episode brings one of the CoP speakers back to share their story in long form.
 
GUEST
Christian Hieronimi, Founder & CEO of ONCARE (myoncare) and co-founder of Convien. A serial healthcare entrepreneur based in Munich, with previous exits to Elekta (Medical Intelligence) and Varian (humediq).
 
WHAT YOU WILL LEARN

• How Convien's meeting-point optimiser can cut around 30 to 35% of travel cost and 40% of the CO2 footprint of investigator meetings, by jointly optimising ticket price, travel time and carbon per kilogram.
• Why roughly half of corporate travel spend in international organisations is driven by meetings, not customer visits, and why that makes meetings the biggest under-addressed decarbonisation lever in clinical operations.
• How myoncare uses wearable data, symptom questionnaires and guideline-based thresholds to "fill the void" between doctor visits, and how the same platform can decentralise a trial by routing blood work, imaging and eligibility checks to local providers.

 
TIMESTAMPS
00:00 Introduction by Nathalie Preiswerk (Sustainable Healthcare Coalition) and series framing
02:00 Meet Christian: serial founder, robotics and oncology background
03:30 Convien origin story: Beijing vs. Barcelona, 2010
06:00 The three-variable optimisation: cost, time, carbon
10:00 How big is the meetings prize inside corporate travel
11:00 Applying Convien to investigator meetings and site selection
13:00 Introducing myoncare: a care orchestration platform
16:00 A chronic kidney disease use case, end to end
20:00 Decentralised trials: bringing the site to the patient
22:00 Bring-your-own-device and the International Patient Summary
25:00 Care pathways that trigger the next step automatically
 
REFERENCES MENTIONED

• Sustainable Healthcare Coalition Community of Practice conference (London, 4 Nov 2025): https://shcoalition.org/cop-conference/
• SHC Sustainable Clinical Trials Knowledge Hub: https://shcoalition.org/sustainable-clinical-trials-knowledge-hub/
• Convien Smart Meeting Location Planner: https://www.convien.com/
• myoncare Virtual coordinated care: https://www.myoncare.com/
• Convien Meeting Point Optimiser (Siemens partnership, Microsoft AppSource): https://marketplace.microsoft.com/en-us/product/office/wa200001588
• EU MDR 2017/745 (myoncare is classified as MDR Class IIa)
• International Patient Summary (ISO 27269)

 
CONNECT WITH THE GUEST

• Christian Hieronimi on LinkedIn: https://www.linkedin.com/in/christian-hieronimi-066a394/
• ONCARE / myoncare: https://www.myoncare.com/
• Convien GmbH: https://www.convien.com/

 
YOU MIGHT ALSO ENJOY

• 091 SHC: the Sustainable Healthcare Coalition (Fiona Adshead, Keith Moore, Nathalie Preiswerk), the backstory to this mini-series.
• 089 Koen Kas on transforming healthcare and clinical trials, another conversation on reimagining the trial operating model.
• 083 Sustainability requirements in public procurement, relevant if you are thinking about where the buy-side pressure lands.

 
HOSTS

• Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
• Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
• Care Pathway Consulting: https://carepathwayconsulting.com

 
PULL QUOTE
"In between two doctor's visits, nobody looks after the patient, because the patient's pretty much invisible. We are filling up that void." Christian Hieronimi
 
Produced in partnership with the Sustainable Healthcare Coalition.

Why do hospitals with good data, proven cases and clear economics still fail to implement sustainability solutions at scale?

That is the question Maria Gaden is spending three years answering.

Maria returns to the podcast as Chief of Development at Center for Sustainable Hospitals in Central Denmark Region, and as a public industrial PhD student at the University of Copenhagen's Globe Institute. Her research is in implementation science: what actually determines whether a sustainability intervention gets adopted across a whole hospital - not just one passionate department.

In this conversation, Frederik and Maria cover:

- Why the reusable surgical gown project has not yet launched and why she still calls it a success
- Moving from "heroes" to systems, and from passion to governance
- 38 hospital interviews across Denmark, a trip to Karolinska Institutet, and a visit to Singapore's Centre for Sustainable Medicine
- How to start if you work inside a hospital and how it differs if you sit inside pharma
- Why human irrationality is the real implementation barrier, and what to do about it

**Timestamps**
00:00  Welcome back
01:30 New title, new PhD
02:30 The reusable textiles project update
07:30 Heroes to systems, passion to governance
09:00 Why implementation science
13:30 The research: 38 interviews, four countries
17:30 Rationality is not the main driver
22:30 Advice for healthcare professionals
29:30 Advice for pharma and medtech
38:30 What gives Maria hope

**Pull quote (Maria):** *"We know the solutions. We have the data. So what is really hindering implementation right now? That is what I keep asking."*

**References and links from the episode**

- [Center for Sustainable Hospitals, Central Denmark Region](https://www.rm.dk/om-os/organisation/center-for-baeredygtige-hospitaler/) [URL to confirm]
- [Globe Institute, University of Copenhagen](https://globe.ku.dk/)
- [Global Green and Healthy Hospitals (GGHH)](https://greenhospitals.org/)  free to join; hosted by Health Care Without Harm
- [Health Care Without Harm  Europe](https://europe.noharm.org/)
- [Centre for Sustainable Medicine, NUS Singapore](https://medicine.nus.edu.sg/cosm/)
- [Karolinska Institutet](https://ki.se/en)
- [*Harry Potter and the Methods of Rationality* (free online)](https://hpmor.com/)  referenced by Frederik

**Connect with Maria**

- [Maria Gaden on LinkedIn](https://www.linkedin.com/in/mariagaden/)
- [Center for Sustainable Hospitals](https://www.rm.dk/om-os/organisation/center-for-baeredygtige-hospitaler/) [URL to confirm]

**You might also enjoy:**

- Episode 090 — *Data-Driven Decarbonisation of Danish Hospitals* (Rasmus & Thea, Region Midt)
- Episode 087/086 — *Sustainability insights from 290 nurses and clinicians* (Michael Maagaard, Region Midt)
- Episode 044 & 043 — Maria Gaden's previous appearances on the show

**Host links**

- [Joachim Almdal on LinkedIn](https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/)
- [Frederik van Deurs on LinkedIn](https://www.linkedin.com/in/frederikvandeurs/)
- [Care Pathway Consulting](https://carepathwayconsulting.com)

Liz Willetts has spent 20 years at the intersection of nature and health.

In this conversation, she explains why nearly 200 governments have been asking for integrated biodiversity-health indicators for over a decade, and why the scientific community still hasn't delivered them. About the guest: Liz Willetts is a science-policy expert on global governance of the health-environment nexus.

She has served as Planetary Health Policy Director at Harvard T.H. Chan School of Public Health, science-policy advisor to the Convention on Biological Diversity, and is a Team Leader, Editor and Writer at IISD's Earth Negotiations Bulletin. She is also a primary care clinician with experience in Micronesia, Central America, and the US. Key takeaways:

• 196 countries have called for biodiversity-health metrics through the Convention on Biological Diversity for decades, but the health and environmental science communities remain siloed, and integrated indicators still don't exist
• Even senior clinicians with 10+ years of experience may not know how to define "biodiversity", pointing to a fundamental gap in medical education
• The post-consumption lifecycle of pharmaceuticals, what happens when drugs exit patients and enter wastewater, represents a massive blind spot in both environmental monitoring and clinical training

Timestamps:
00:00 - Introduction and Liz's background
03:00 - How environmental decisions are public health decisions
08:00 - Air quality policy as a biodiversity example (Copenhagen low emission zones)
12:00 - The decade-long gap: governments asking for indicators nobody has built
18:00 - The grand rounds anecdote: a clinician who didn't know "biodiversity"
22:00 - Plant blindness and the siloing of scientific education
26:00 - Chronic kidney disease carbon footprint and biodiversity
30:00 - Practical advice for national biodiversity-health strategies
36:00 - Held v. State of Montana: climate litigation as a model for ecosystem values
42:00 - The nature footprint of healthcare: a blank canvas
46:00 - Pharmaceutical pollution and the end-of-life gap
50:00 - What gives Liz hope References mentioned:

• Liz Willetts, "Metrics for Biodiversity and Health Policy Integration," PLOS Global Public Health, 2025: PubMed
• Convention on Biological Diversity (CBD) and the Kunming-Montreal Global Biodiversity Framework (2022)
• Global Action Plan on Biodiversity and Health, adopted at CBD COP16 (2024)
• Held v. State of Montana: Climate Case Chart
• Plant blindness (academic concept): Literature review 1999-2024
• Pharma Pollution Hub / Kelly Thornber: pharmapollution.org
• Global Biodiversity Framework: https://www.cbd.int/gbf
• Global Action Plan on Biodiversity and Health:
  https://www.cbd.int/health/GAP.shtml

Links:

• Liz Willetts on LinkedIn: https://www.linkedin.com/in/liz-willetts-2336749/
• IISD Earth Negotiations Bulletin: https://enb.iisd.org/
• Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
• Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
• Care Pathway Consulting: https://carepathwayconsulting.com

You might also enjoy:

• Episode 092: Planetary Boundaries & Health with Mia Heide (WELA)
• Episode 098: Tackling Pharmaceutical Pollution: A Systems-Based Approach
• Episodes 023/024: The Biodiversity Crisis in Healthcare (two-parter)

Meeting Pharma's Rising Sustainability Demands:
Marwin Krull on Körber Pharma and the Alliance to Zero Marwin Krull is Sustainability Lead for the Pharma business area at Körber Pharma and Vice President of the Alliance to Zero. He explains how pharma customer requests have evolved from broad questions about EcoVadis scores and green electricity to specific demands around product carbon footprints, SBTi alignment, CDP thresholds, and ISO-based LCAs. Key takeaways:

• Pharma sustainability demands have matured fast - customers now ask for verified GHG inventories and product-level carbon footprints, not just policies
• Closing the gap between group sustainability strategy and day-to-day operations requires internal coordination, sales enablement, and e-learning - not just a target
• The Alliance to Zero (founded 2021) is driving practical collaboration across the autoinjector value chain, including a syringe packaging redesign and "green premium" transparency research with TU Hamburg

Timestamps:
00:00 - Customer sustainability pressure
00:37 - Meet Marwin Krull and his roles
03:35 - How customer demands evolved
07:13 - What Körber Pharma does
10:21 - Inside the sustainability role
14:58 - Sales enablement and training
18:05 - What is Alliance to Zero
21:30 - Collaboration wins and research
25:33 - Practical advice and wrap-up
Links: Marwin Krull on LinkedIn | Alliance to Zero | Körber Pharma Hosts: Joachim Almdal on LinkedIn | Frederik van Deurs on LinkedIn | Care Pathway Consulting "Customers went from asking 'do you have green electricity?' to asking for ISO-verified product carbon footprints in just a few years." - Marwin Krull