The Much-Ignored Emissions Costs of Health Care

Health-care professionals have brought much-needed attention to the harm that climate change can cause on human health. But the very system that has helped bring attention to climate change is also driving it.
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Delegates from over 200 nations met in Katowice, Poland, this month, to discuss strategies on further reducing greenhouse gases. Much of the discussion centered around reductions in industries like mining and manufacturing. Little, if any, mention was made of the health-care industry—despite the fact that it's among the planet's more significant polluters.

While the causal link between health care and climate change isn't much discussed, the causal relationship between climate change and health is. The World Health Organization has long warned about the perilous effects, of climate change on human beings—poor air quality, for example, is linked to lung disease, food shortages, increases in malnutrition disease, and increases in vector-borne illnesses. And this is a problem that's only predicted to grow in severity: WHO projects that, between the years 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year.

Nurses and doctors are no strangers to patients whose lungs and heart conditions have been exacerbated by poor air quality and unseasonable heat. In fact, the American Nurses Association and the American Medical Association have both recognized the impact climate change will have on public health, and both organizations have encouraged nurses and physicians to join initiatives that support environmental sustainability. Health-care professionals have developed groups, such as the Alliance of Nurses for a Healthy Environment, to help educate and advocate for practices that will help protect the environment.

In these ways, health-care professionals have brought much-needed attention to the harm that climate change can cause on human health. The very system that has helped bring attention to climate change is also driving it, however. In a recent study, published by the American Journal of Public Health, researchers reported that the health-care system in the United States was responsible for between 9 and 10 percent of greenhouse gas emissions in 2013. The study also projected that these annual greenhouse gas emissions would cause between 123,000 and 381,000 disability-adjusted life-years in future health damages, with malnutrition being the largest damage category. The Commonwealth Fund, an organization committed to non-partisan and independent research of health-care issues, reported that the health-care system is the seventh-largest producer of carbon dioxide. In addition to polluting the air, the health-care system is a major contributor to waste. According to the Sustainability Roadmap for Hospitals, 7,000 tons of waste are produced every day by the health-care system.

There are some players within the health-care field who have recognized their contribution to climate change and are acting to minimize their carbon footprint. George Washington University Hospital, for example, uses solar energy to provide 50 percent of its electrical usage. Philadelphia's Thomas Jefferson University and Hospital made the decision to obtain a portion of their energy from a wind farm. Avoiding the use of fossil fuels for energy can significantly reduce greenhouse gas emissions, especially when you consider the very large energy demands of a health-care system.

Hospitals that are expanding can lessen their environmental impact by choosing building practices that are sustainable. For example, in 2012, Rush University Medical Center was awarded a gold LEED certification for its new tower. This certification is a symbol of sustainability achievement for new construction projects. Advocate Good Samaritan Hospital, in Downers Grove, Illinois, received Practice GreenHealth's Top 25 Environmental Excellence Award, for the fifth consecutive year. This award recognizes hospitals that are leading the industry in sustainability.

Some hospitals employ a sustainability officer whose sole purpose is to identify ways to reduce waste and energy use. Other hospital staff can be mobilized through committee work to reduce the footprint their organization leaves on the environment. For example, at the Cleveland Clinic, a "Green the OR committee" was started to reduce waste and save energy costs. Some of the committee's interventions included turning off air conditioning in the operating room when it wasn't in use and replacing single-use items with products that could be sterilized and reused. One of the easiest ways hospitals can reduce their carbon footprint is recycling. It is estimated that between 20 and 25 percent of all waste from a hospital is plastic that can be recycled. There are resources to drive these initiatives such as Practice GreenHealth, a non-profit organization that is committed to the environmental stewardship of hospitals.

The task at hand may seem insurmountable, but those in health care regularly face the impossible. They transplant organs, help premature infants survive outside the wombs, and even bring some people back to life. They can be found solving complex problems and creating order in dire situations. Take the example of Allyn Pierce, the nurse who, during California's fatal Camp Fire, risked his life to evacuate patients from his hospital; or the nurses and physicians during Hurricane Katrina, who had the seemingly impossible task of evacuating patients and deciding who lived and who died.

Climate change is happening, and health-care systems across the U.S. may be wise to mobilize and create organizational changes that will mitigate its effects. The care of the patient drives health care. It is time to include the environment in that care.