Healthcare is responsible for 5% of global carbon emissions, which is higher than the aviation industry.
In the U.S., healthcare accounts for 10% of the nation’s CO2 emissions. During the 2021 United Nations Climate Change Conference, COP26, climate change was framed as a public health issue for the first time, with the World Health Organization even sponsoring a health pavilion. Experts have increasingly warned that climate change represents one of the greatest threats to public health.
Fierce Healthcare spoke to industry leaders to understand the challenges of addressing climate change, and the solutions.
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Sick planet, sick people
Behind much of the healthcare movement at COP26 was Health Care Without Harm, an environmental advocacy group. It sponsored a health program in partnership with the United Nations that 52 countries, including the U.S., signed onto ahead of the summit. It also advocated for the Biden administration to establish the Office of Climate Change and Health Equity, the group told Fierce Healthcare.
The organization began in 1996 to help inform the healthcare sector on its role in climate change and steer it in a better direction, president Gary Cohen told Fierce Healthcare. “The sector that's committed to healing is in fact poisoning people—not out of malice, but out of ignorance,” he said. Because of the industry’s ethical framework – the Hippocratic Oath—building a movement felt especially meaningful.
“You can’t have healthy people on a sick planet,” Cohen said.
“We could strive to cure cancer through precision medicine, and at the same time we’re burning fossil fuels to run our research center,” echoed Gail Lee, sustainability director at the University of California, San Francisco.
Health Care Without Harm has built a coalition of nearly two dozen health systems representing 600 hospitals to lead climate solutions in the sector through the Health Care Climate Council. The Council invites hospitals to join its Health Care Climate Challenge, which commits to mitigation (watching one’s carbon footprint), resilience (preemptive interventions, like solar power) and leadership (advocating for environmentally-conscious policies). When hospitals advocate for their patients, “they’re not just islands in their communities, they’re actually anchors,” Cohen said.
Yet organizations may not realize the full benefits of operating with environmental goals. “One of the biggest impediments here is the lack of integrated thinking,” Cohen said. A reduction in fossil fuels, for example, creates a healthier environment, more jobs and improved public health and safety.
A lack of technology has posed an even bigger challenge for UCSF, according to Lee. For instance, while the system feels the best alternative to natural gas is hydrogen, there is limited supply and no infrastructure in place to deliver or handle it.
In the meantime, Lee said, the system has maintained its strategy of improving energy efficiency in buildings and operations and investing in renewable energy. Read more about the university's system-wide strategy here.
Lessons in waste
Desflurane, one of the most common inhaled anesthetics with the highest environmental impact, was invented at UCSF in the 1990s. Over time, recognizing the gas’s harmful potential, the system wanted to move away from it. Under the direction of associate clinical professor Seema Gandhi, M.D., the system made the gas less accessible to clinicians, Lee explained. Instead of storing it in the operating room, it was instead put in a storeroom. Clinicians did not bother going to get it and used alternatives instead. Eventually, desflurane was removed from the stock room altogether, Lee said.
Another intervention implemented by multiple UC systems involved washable gowns. UCLA piloted using washable gowns in 2012, transitioning fully to washable gowns over four years and saving more than $1 million in the process. When the pandemic hit and disposable hospital isolation gowns, which are worse for the environment, quickly became inaccessible, UCSF also transitioned away from them.
“Why waste something that you don’t need to waste?” Lee said. Gowns were not the only item UCSF repurposed. The harmonic scalpel, a surgical tool, cost the system $1,000 a pop and was discarded after one use. But one company reprocessed the tools and sold them back at half the price. For years, up until 2019, UCSF saved $3 million annually on repurchasing the refurbished scalpels, Lee noted. (Since then, however, the original manufacturers of the tools have implemented contract restrictions on this tactic, she said.)
UCSF is a member of Practice Greenhealth, which offers environmental solutions across 11 categories to health systems and hospitals.
Moving forward sustainably
With the pandemic taking up most health organizations’ resources, going forward, training, funding and technical assistance are needed to get them back on track with sustainability goals, Cohen said. This is especially true of safety-net hospitals that serve patients most impacted by climate change. Cohen is hopeful the Biden administration appears receptive to calls for funding increases dedicated to the sector addressing climate change.
In the meantime, health systems can implement “low-hanging fruit” interventions that save money, like improving energy efficiency and reducing waste. Cost-saving items of action always appeal to leadership, Lee agreed.
Looking ahead, the Health Care Climate Council intends to focus on transforming the healthcare supply chain. Since it involves big players with a lot of market share, it’s important to aggregate their purchasing power for maximum impact, Cohen explained. “The message to the supply chain is if you’ve got those toxic chemicals in your products, you’re not going to get contracts,” he said.
Healthcare IT and medical device company Philips, perhaps once known best for its everyday household electronics, is also focusing on engaging the healthcare supply chain. The tech company recently achieved carbon neutrality in its global operations and 100% electricity from renewable sources and is now urging its suppliers to commit to carbon reduction targets.
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But in order to drive meaningful innovation, an organization needs to understand where its impact is, said Robert Metzke, Philips’ global head of sustainability. Philips has developed metrics to measure its progress. “The difference between success and failure is getting the ‘how’ right,” Metzke said.
As part of the company’s ongoing transformation strategy, it has focused on creating a mission everyone can connect to—to improve people’s lives. Market leaders across various countries at the company collected input from their staff on the localized ways they thought the company could best achieve that goal. Together, they determined their targets for 2021, specific to their individual ambitions and communities.
Like UCSF’s efforts to repurpose supplies, Philips offers refurbished medical devices through its Diamond Select program as a way of honoring circularity, based on the principles of waste elimination and recycling. According to the Ellen MacArthur Foundation, “a circular economy decouples economic activity from the consumption of finite resources.”
Metzke encourages systems to embed sustainability into their core corporate structure. “Try not to do it as a Friday afternoon activity,” he said. When it’s treated as an afterthought, it becomes expensive, he added. To help with funding, Metzke recommends letting investors be a part of the conversation.
“It’s often perceived as a dilemma, but it doesn’t need to be,” he said, as investors want to support companies undertaking these efforts. “Companies doing the right thing will have a competitive edge in the market.” Read Philips’ latest environmental and other commitments here.