But shifting to greener practices does require upfront investment, as well as cultural shifts: rethinking how, when and where all sorts of tasks are done. In numerous interviews, doctors, nurses and environmental officers made clear that change was not always easy, particularly with physicians who had been doing certain things in certain ways ever since their training.
Sustainability efforts are largely voluntary, although more of the health industry is engaging. Both new bottom-up organizations like Medical Students for a Sustainable Future as well as pillars of the medical establishment, like the accrediting body known as the Joint Commission, are undertaking the work.
One reason: It’s become harder to ignore how extreme climate events and pollution endanger human health, with poor people, minority groups and elderly people particularly vulnerable. Extreme weather exacerbates heart, lung and kidney disease; it makes asthma worse. Mental health deteriorates. Heat waves kill people — directly, or by aggravating chronic conditions. Power outages in patient homes mean no refrigeration for insulin or electricity to keep oxygen tanks flowing.
Indeed, many hospitals are making a related, but distinct, effort to become more resilient to the fallout from climate change. Resiliency enables hospitals to withstand the impact of worsening hurricanes, floods, wildfires or heat domes. Decarbonization and efforts to bolster sustainability aim at combatting climate change itself.
“What excites me is that health professionals are starting to connect the reason why they’re there in the first place, which is to take care of patients, with the health impacts that are happening because of climate [which] their health systems are contributing to,” said Shanda Demorest, a nurse who is associate director for climate engagement and education at Health Care Without Harm, which along with its Practice Greenhealth arm, is a major force in pushing for new health and climate work.
Early in the Biden administration, officials took some real steps, both practical and symbolic, to make combatting climate change a greater focus in American health care.
The Department of Health and Human Services signaled the issue was a new, formal priority through the creation of the Office of Climate Change and Health Equity, though it’s running on a patchwork of staff borrowed from other offices and agencies since Congress hasn’t funded it. In May of last year, HHS Secretary Xavier Becerra added the Office of Environmental Justice to address the disproportionate harm pollution and climate change inflict on low-income and minority communities.
The Veterans Administration and the Indian Health Service, which deliver health care to millions of people across the country, have been directed to reduce emissions and energy use as part of the Biden White House’s overall government climate policy.
For the rest of the health care system, HHS unveiled a Climate Pledge on Earth Day 2022 to spur more action. It was originally a one-time opportunity to create a vanguard for change. But hearing that more organizations were ready to come on board, HHS recently decided more hospitals can sign on, with public lists being updated twice a year — coinciding with the U.N. International Climate Conference in the fall, and Earth Day in the spring. About 116 health organizations, representing 872 hospitals as well as other health care sectors, have signed on. Along with the federal health systems, that represents about 15 percent of U.S. hospitals, HHS officials said.