title: Making a case for telehealth: measuring the carbon cost of health-related travel.
abstract: BACKGROUND
  Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions.
  
  
  METHODS
  A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e).
  
  
  RESULTS
  Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time.
  
  
  CONCLUSIONS
  Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.
authors.affiliation: School of Nursing and Midwifery, University of Tasmania, Burnie, Tasmania, Australia. isabelle.ellis@utas.edu.au.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ellis
authors.forename: Colleen
authors.initials: C
authors.lastname: Cheek
authors.forename: Linda
authors.initials: L
authors.lastname: Jaffray
authors.forename: Timothy
authors.initials: T
authors.lastname: Skinner
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000009:adverse effects / Q000191:economics*; D002648:Child; D017281:Cost of Illness; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005579:Fossil Fuels; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D013648:Tasmania; D017216:Telemedicine; D014186:Transportation / Q000379:methods; D014195:Travel / Q000191:economics / Q000523:psychology*; D001335:Vehicle Emissions; D014739:Victoria; D055815:Young Adult
chemical_list: D005579:Fossil Fuels; D001335:Vehicle Emissions; D002245:Carbon Dioxide