U.S. healthcare System working to be Part of Global Change

The US Healthcare system is a substantial contributor to climate change, responsible for about 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants. If the global health sector were a country, it would be the 5th largest emitter on the planet. Fortunately, there are a growing number of cutting-edge Wisconsin and national health care facilities that have made significant progress by voluntarily incorporating sustainability into their work.

Gundersen Hospital in La Crosse leads Wisconsin’s pioneers. In 2008, then CEO Jeff Thompson, MD recognized “we are the problem,” noting that Gundersen was putting 465,000 pounds of particulate matter per year in the atmosphere. As part of a robust energy conservation program, they set a goal of switching to 100% renewable energy which significantly reduced pollutants and has already saved them more than $28 million in energy bills. Since that time, they have implemented nearly a dozen more renewable energy projects.

Another Wisconsin trailblazer is Edgerton Hospital and Health Services, which is the first hospital in the State of Wisconsin, as well as the first critical access hospital in the United States, to build a geothermal heating and cooling system. Edgerton also incorporated a high-performance electrical system, onsite construction recycling, green roofs, water efficient landscaping and zero volatile organic building materials. Not only are these efforts paying off for the environment, but they recouped the cost of the $850,000 geothermal system within a surprisingly short time, only 5 years, and have saved nearly $15,000/month in energy costs.

Both Advocate Aurora Health and UW Health have addressed the impact of anesthesia gases as part of their sustainability goals. While all anesthetic agents are potent greenhouse gases (GHGs), their impact depends on the agent chosen and the way it is delivered. For example, desflurane has 26 times the global warming potential of sevoflurane. Switching from desflurane to sevoflurane when clinically equivalent, significantly reduces GHG emissions from the operating room. Since sevoflurane is also more affordable, hospitals can reduce emissions and costs simultaneously.

Reducing energy usage and hospital GHG emissions is essential, yet 60-80% of health system emissions are embedded in the supply chain, including pharmaceuticals and chemicals, investments, medical equipment, food, and purchased services, presenting complex challenges. In comparison, recycling reduces emissions by only 1%, but is “low hanging fruit” for emerging sustainability programs.

Healthcare organizations can focus on “climate-smart health care” by encompassing emission reduction and resilience strategies into a sustainability framework. Resilience strategies include building and landscape design, healthcare delivery during extreme weather events, and disaster preparedness. The work done during the early COVID-19 pandemic exemplifies how hospitals can improve their resiliency by demonstrating a flexibility to pivot as challenges arise. Similar strategic approaches are necessary for climate change resilience.

For example, the California Hospital Association held a disaster preparedness conference in 2019 to include the health effects of climate change at their annual meeting, a first for them and perhaps a first for the nation’s hospital associations. California’s deadly fires and heat waves were the impetus to address this critical problem. Current evidence shows that the majority of health professionals view climate change as an important and growing cause of health harm but lack time to engage their health systems to act.  Hospital associations could fill this role by implementing education on local human health challenges of climate change as well as mitigation and resilience strategies.

On the other hand, many state medical societies and departments of health support climate health education as well as resilience and adaptation policies. The Wisconsin State Medical Society adopted a climate change policy supporting education, mitigation, climate change research and transitioning to renewable energy. The Wisconsin Department of Health Services uses the Building Resilience Against Climate Effects (BRACE) framework to guide its strategies and has launched development of a mapping tool to pinpoint and assist communities that are most vulnerable to the impacts of climate change.

However, if hospitals don’t act voluntarily to “kick the carbon habit”, the government may soon hold them accountable. Recently the Biden administration launched the Office of Climate Change and Health Equity within the Department of Health and Human Services to reduce the disproportionate effects of climate change on poor communities and vulnerable populations. Their goal is to ensure hospitals meet Biden’s goal to reduce GHG emissions by 50% by 2030 and net zero emissions by 2050. Meanwhile, many governmental entities have issued requests for information on climate change and the health care sector, including  the Ways and Means Committee, the Agency for Healthcare Research and Quality, the Centers of Medicare and Medicaid Services, and others.

Healthcare facilities like Gundersen, Edgerton, Advocate Aurora, and UW Health, did not voluntarily incorporate sustainability practices by accident. Strong leadership was key. Practice Greenhealth, a sustainability resource for healthcare systems, notes that 90% of the top-performing institutions in sustainability work have an executive level champion. Dr. Victor Dzau, president of the National Academy of Medicine (NAM), is one of those torchbearers. With Dr. Dzau at the helm, NAM launched the Grand Challenge on Climate Change, Human Health and Equity in October of 2020 with four strategic objectives including to “catalyze the health sector to reduce its climate footprint and ensure its resilience”.

Bold national and international efforts are none too soon as the latest IPCC report has been coined by UN Secretary-General Antonio Guterres as “code red for humanity.” With alarm bells sounding and 2030 right around the corner, it is crucial for healthcare executives and hospitals to become anchors for sustainability and lead the global movement for environmental health and justice.

Abby Novinska-Lois (She/her/hers)

Executive Director

Wisconsin Health Professionals for Climate Action