COVID-19 has upended our healthcare systems in extraordinary ways. From enacting surge capacity plans to rapidly developing treatment protocols, those who staff our hospitals have battled this disease head-on, despite all the uncertainties. Just as healthcare workers and administrators have worked tirelessly to adapt their hospitals to the pandemic, so too must they lead the charge against another crisis: climate change.
Climate change has become a public health emergency. It is worsening chronic diseases like asthma and increasing the frequency of infectious diseases like COVID-19. According to the World Health Organization, climate change will cause an additional 250,000 deaths per year between 2030 and 2050 without significant reductions in greenhouse gas emissions.
In many ways, our healthcare systems are on the front line of the climate crisis. They provide medical care to an increasing number of patients whose diseases are exacerbated by climate change. However, these efforts may be upended when these systems are hit from a structural and financial standpoint with more frequent extreme weather events. One example is the impact of Hurricane Maria. Due to the severe damage wrought on Puerto Rico and to IV bag manufacturing plants, doctors and nurses across the country were unable to administer IV fluids and medications.
While they provide medical care to patients who suffer from conditions worsened by the climate crisis, healthcare systems are also inadvertently contributing to the issue. Currently, the U.S. healthcare system accounts for a quarter of all healthcare greenhouse gas emissions worldwide — more than the healthcare system of any other nation.
Fortunately, healthcare systems are beginning to recognize their role in addressing climate change and its impact on the health of communities. Energy efficiency, transportation, and food sustainability are all potential areas of intervention.
Hospitals can lessen their energy use with both big and small changes. Cleveland Clinic is an excellent example of how these types of changes can be incorporated into healthcare systems. The organization underwent a major light fixture retrofit by switching from fluorescent lights to LEDs, and in the process saved 28 million kilowatt hours and over $2 million annually. Recognizing that their computers were another large energy drain, they invested in software that put 40,000 non-critical computers and monitors in sleep mode when not in use, saving the system $400,000 per year.
In addition to these smaller changes, Cleveland Clinic also tackled the greatest energy user in their hospitals: the heating, ventilation, and air conditioning (HVAC) system. By adjusting the air changes per hour to meet guidelines rather than exceeding them, the organization saved $250,000 per year. The organization also began operating room (OR) setbacks, or reducing the number of air exchanges when ORs were not in use, which generated savings of $2 million per year. These adjustments had no negative impact on patient care. Like Cleveland Clinic, Kaiser Permanente has also sought to reach carbon neutrality by establishing long-term power purchase agreements in wind and solar. These agreements would provide clean power for 27 out of 39 hospitals, build utility-scale wind and solar farms, and establish a large battery storage system.
Transportation is another major source of emissions for hospitals, as 60% of transportation emissions in the U.S. come from the 76% of workers who drive alone or who operate light duty vehicles. A number of healthcare systems are trying to tackle this challenge by encouraging alternative means of commuting and partnering with their cities and local organizations. At Seattle Children’s Hospital, staff members can take advantage of its on-site bicycle center, which offers free maintenance and discounted cycling gear. This effort moves the hospital toward its goal of cutting the percentage of staff driving alone to 30% by 2030 while also encouraging employee physical wellness. It also helps to address Seattle’s significant traffic congestion problem and allows for greater patient capacity.
Like Seattle Children’s Hospital, the University of California San Francisco (UCSF) looked to lessen its carbon footprint through its multipronged transportation initiative. The system reduced its percentage of single occupancy vehicles to 25% by encouraging vanpools and carpools, offering pre-tax commuter benefits to lower the cost of public transport, and installing bike racks with showering stations throughout the hospital campuses. Currently, 23% of staff drive hybrid or electric vehicles with an end-goal of 50% by 2025. UCSF also operates 15 electric buses and has installed multiple electric vehicle charging stations in its parking lots.
Food consumption and waste have also become critical components of sustainability efforts across industries. By substituting plant-based foods for 50% of animal products, we could prevent 1.6 billion tons of greenhouse gas emissions by 2030. While agriculture contributes to 24% of greenhouse gas pollution worldwide, regenerative agriculture could reduce carbon dioxide by 23.2 gigatons and generate $ 1.2 trillion by 2050. Fortunately, some hospitals have recognized the importance of food not only in regards to the health of our bodies, but also the health of our planet. At Boston Medical Center, the over 2,000-square-foot rooftop farm provides fresh produce to patients and the local community while lessening the hospital’s carbon footprint. This is because the carbon-breathing plants help reduce the building’s heating and cooling costs and shift transport of food to in-house production. The rooftop farm’s water use is controlled through a smart phone app, which shuts down water based on weather forecasts, and it also addresses combined sewer overflows by slowing the flow of rainwater into sewage.
At this moment, climate change demands our action from the individual level to the organizational level. Without serious efforts to engage in sustainable interventions, healthcare systems’ carbon footprint will continue to rise and add to disease burden. Fortunately, healthcare organizations across our nation have shown they are willing to take the steps to help reverse climate change. By investing in our planet, healthcare systems are also investing in our collective health and future.
Christine James, MD, is an allergist-immunologist and a member of Climate Health Now, a California-based healthcare professional organization that recognizes climate change as a public health emergency, and the Public Health Advisory Committee of Climate Action Campaign.
Sweta Chakraborty, PhD, is behavioral scientist, author, and regular television news commentator. She is the U.S. representative for We Don’t Have Time and is also on the leadership council for EcoHealth Alliance.