Key Actions to Reduce Greenhouse Gas Emissions by U.S. Hospitals and Health Systems
Climate change is increasingly affecting people鈥檚 health, which has direct consequences for the health care system听[1]. At the same time, the health care system is contributing to climate change. In the U.S., health care accounts for nearly 20% of GDP, making it a major consumer of resources, and as a result, a major producer of waste and greenhouse gases. In fact, the U.S. health sector is responsible for approximately 8.5% of U.S. carbon emissions听[2]. These emissions stem from:
- Operations of health care facilities (classified as 鈥渟cope 1鈥 emissions)
- Purchased sources of energy, heating and cooling (鈥渟cope 2鈥)
- Supply chain of health care services and goods, as well as the value chain and investments within the health care sector (鈥渟cope 3鈥) [3]
Compared to other health care systems globally, the U.S. is among the top emitters of carbon, and is responsible for 25% of global health sector emissions, which is the greatest proportion among all global health sectors听[4].
To address these impacts, the听探花app Climate Collaborative听Health Care Delivery Working Group developed a shortlist of key actions for hospitals and health systems to reduce their greenhouse gas emissions. The following actions could be utilized by any hospitals or health systems starting their journey to reach decarbonization goals.
View additional key actions for health professionals to advance sustainable health care.听Any questions can be directed to听[email protected].
Key Actions Shortlist
The following list provides specific actions that hospitals and health systems can take to set and meet goals to reduce greenhouse gas emissions.
Step I: Start Your Decarbonization Journey
01
Establish an executive-level sustainability team
听with broad representation across operational and clinical lines. Engage staff, leaders, clinicians, boards, and patients to achieve goals.
02
Perform a greenhouse gas (GHG) inventory
for Scope 1 and 2 emissions, and actionable Scope 3 emissions (e.g., business travel, employee commuting, waste), with an aim for whole organization accounting.
03
Establish specific decarbonization goals.
For example, this may include a goal of 10% GHG reduction annually across all operations, aiming to achieve 50% reduction by 2030 and net zero by 2050 or sooner听[5][6][7].
04
Develop an implementation plan for your decarbonization goals with documented milestones and deliverables to measure and track progress.
Step II: Implement High Impact Interventions to Reach Your Decarbonization Goals and Track Progress
01
Reduce building emissions.
Potential actions include [8][9]:听
- Set a goal to reduce building emissions, for example, by 10% per year.
- Improve energy efficiency and electrification听[10].
- Increase the amount of electricity supply derived from renewable sources.
- For new buildings, implement energy efficient strategies into design and construction.
02
Reduce emissions from anesthetic gases and pressurized metered dose inhalers.
Potential actions include:
- Set a goal of reducing anesthetic gas emissions and pressurized metered dose inhaler emissions, for example, by 50% by 2024听[11][12].
- Minimize use of desflurane by removing or limiting desflurane vaporizers in select clinical situations.
- Decommission centrally piped nitrous oxide and substitute portable e-cylinders.
- Substitute nebulizers, dry-powder inhaler (DPI), and soft-mist inhaler (SMI) where pressurized metered dose inhalers are not essential听[13][14].
03
Reduce physical waste and single use plastics.
Potential actions include:
- Assess waste streams and identify reduction opportunities (reuse, recycle听[15],听compost) by analyzing and tracking data on invoices, including volume and cost.
- Reduce single-use plastics, for example, by 10% per year.
- Switch from disposable to reusable products such as reusable isolation gowns, dishware, linens, surgical supplies
- Optimize reprocessing as allowed per FDA regulations.
- Reduce waste from Operating Rooms and other procedure areas.
04
Reduce emissions from food services.
Potential actions include:
- Determine baseline for carbon emissions per meal served听[16]听and reduce this each year by specific activities, such as limiting purchase of beef and other animal products and substituting with plant-based menu items.
- Implement systems and processes to reduce food waste during preparation.
- Provide post-consumer composting.
- Reduce use of single-use, disposable food packaging.
05
Reduce transportation emissions.
Potential actions include [17]:
- Set a goal to reduce transportation emissions, for example, by 10% per year.
- Reduce fleet vehicle emissions (e.g., replace with EVs, reduce miles traveled) and optimize product delivery (e.g., reduce frequency of just-in-time deliverables).
- Reduce business travel emissions (e.g., flights, rental cars) through maximizing virtual meeting participation.
- Provide EV charging infrastructure and commuting incentives that promote use of public transportation, carpooling, and active transportation.
References
- Romanello, M., et al. 2022. The 2022 report of the Lancet Countdown on health and climate change: Health at the mercy of fossil fuels.听Lancet听400(10363):5-11.听.
- Eckelman, M. J., et al. 2020. Health care pollution and public health damage in the United States: An update.听Health Affairs听39(12).听.
- Ibid.
- Ibid.
- Agency for Healthcare Research & Quality. n.d.听Reducing healthcare carbon emissions: A primer on measures and actions for healthcare organizations to mitigate climate change.听听(accessed May 17, 2023).
- Intergovernmental Panel on Climate Change. n.d.听Special report: Global warming of 1.5 C.听听(accessed May 17, 2023).
- The White House. 2021.听Executive order on catalyzing clean energy industries and jobs through federal sustainability.听听(accessed May 17, 2023).
- Office of the Federal Chief Sustainability Officer. n.d.听Net-zero emissions buildings by 2045, including a 50% reduction by 2032.听听(accessed May 17, 2023).
- n.d.听ASHRAE task force for building decarbonization.听听(accessed May 17, 2023).
- ENERGY STAR. n.d.听ENERGY STAR nextgen certification for commercial buildings.听听(accessed May 17, 2023).
- Devlin-Hegedus, J.A., et al. 2022. Action guidance for addressing pollution from inhalational anaesthetics.听Journal of the Association of Anaesthetists听77:9 (1023-1029). DOI:听听(accessed May 25, 2023).
- American Society of Anaethesiologists. 2023. 鈥溾婭nhaled Anesthetic 2023 Challenge.鈥澨(accessed May 25, 2023).
- Woodcock, A., et al. 2022. The environmental impact of inhaled therapy: Making informed treatment choices.听European Respiratory Journal听60:2102106. DOI:听10.1183/13993003.02106-2021.
- Janson, C., et al. 2019. Carbon footprint impact of the choice of inhalers for asthma and COPD.听Thorax听75(1).听.
- Environmental Protection Agency. n.d.听Reduce, reuse, recycle.听听(accessed May 17, 2023).
- n.d.听The Coolfood pledge.听听(accessed May 17, 2023).
- Environmental Protection Agency. n.d.听Routes to lower greenhouse gas emissions transportation future.听听(accessed May 17, 2023).
The funding support extended by the 探花app Climate Grand Challenge鈥檚 sponsors makes work like the Key Action shortlist possible.听See full list of sponsors.
Disclaimer:听This document was prepared by听Kathy Gerwig听(Health Care Without Harm),听Hardeep Singh听(Michael E. DeBakey VA Medical Center and Baylor College of Medicine),听Jodi Sherman听(Yale School of Medicine, Yale Center on Climate Change and Health, and Yale-New Haven Health System),听Walt Vernon听(Mazzetti), and听Beth Schenk听(Providence St. Joseph Health), who are members of the Health Care Delivery Working Group of the 探花app Action Collaborative on Decarbonizing the Health Care Sector; and reviewed by members of the Action Collaborative. Statements in this document do not necessarily reflect the views of all members of the Action Collaborative; the 探花app; or the National Academies of Sciences, Engineering, and Medicine (NASEM). The document is intended to help inform and stimulate discussion. It is not a report of the 探花app or the NASEM. Copyright by the 探花app. All rights reserved.
