Hospitals connect climate change to health and health equity

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Seema Wadhwa is executive director for environmental stewardship for Kaiser Permanente. The title is relatively unique in healthcare, but not the concept. Increasingly hospitals are making green efforts as part of an overall strategy that acknowledges climate change as linked to health and health equity.

"We're connecting this work to the work around equity," Wadhwa said. "Those that are most impacted by climate change are already socially disadvantaged. It's impacting those communities the hardest."

Kaiser Permanente helped build a green space in Santa Rosa, California, that addresses both climate change and health equity. Hardscaping in the green space made the area more fire resistant, Wadhwa said.

The managed care organization, which operates in eight states and the District of Columbia, has a long history of environmental stewardship going back at least 20 years, according to Wadhwa. In 2020, it became the first health system in the country to achieve carbon neutrality, she said. 

Kaiser Permanente did this in steps, focusing on greenhouse gasses and renewable energy in 2012 and 2013. It is now a large producer of wind and solar energy. ROI has been realized from these investments in renewable energy. Kaiser Permanente entered into power purchase agreements in the mid-2000s that allowed it to lock in pricing and avoid the current volatility in the energy market.

Carbon neutrality does not include waste. The American Hospital Association estimates that hospital waste totals about 5.9 million tons of garbage annually. About 85% of hospital waste is noninfectious and is recyclable, yet most of these materials are either put in a landfill or are burned, according to Waste 360.

Wadhwa said there are efforts at Kaiser hospitals for recycling and composting.

Among the company's most ambitious goals is in purchasing, Wadhwa said.

"We partner with suppliers," she said, "and introduced a supplier scorecard."

An estimated 35% of hospitals switched suppliers for better eco-friendly and sustainability actions, such as changing out plastic straws in favor of paper, according to Healthcare Facilities Today.

Kaiser works with a variety of consultants and vendors on environmental goals, Wadhwa said.

"I'm very excited to see how many different players are coming to the table," she said.

One is Deloitte. Dr. Elizabeth Baca is a specialist leader for Health Care and Life Science Strategy at the company. Baca sees strategies in three main categories: Tracking and mitigation, resilience and adaptation, and new business model creation.

Mitigation steps include switching a fleet of vehicles from gas-powered to electric, changing regular light bulbs to LED, or installing solar energy.

Resilience is thinking about care models to ensure operations continue to support the patient, Baca said.

New models can leverage data and technology to build automated systems to perform functions such as monitoring electricity use. AI and machine learning can help implement programs such as the hospital at home model, which, among its other advantages, can save hospitals energy overhead. 

Early trials of the Hospital at Home model, introduced by Johns Hopkins Medicine in 1994, found the total cost of at-home care was 32% less than traditional hospital care mainly by eliminating the fixed costs associated with a brick-and-mortar hospital, according to the Commonwealth Fund. Outcomes also improved, with no difference found in rates of subsequent use of medical services or readmissions. 

Once health systems recognize climate change as a health and therefore healthcare issue, it's easy to make the connection to the mission, Wadhwa said. "This is part of our mission."

Health systems that are working on sustainability don't see it as a separate policy add-on, Baca said. 

"Some of the places we've seen really taken action, this is part of their mission," Baca said. "A big part of it is the recognition of how much this is related to health equity. Hospitals do a lot of work around health inequity. Leaders see this as inseparable."

WHY THIS MATTERS

Various funding mechanisms are available at the state level, according to Baca.

At the federal level, there are tax incentives to implement environmental, social and governance strategies, according to Alicia Janisch, a partner at Deloitte.

"As more and more health systems recognize how the health of their patients and the planet are inextricably linked, the greater their focus on ESG strategies," Janisch said. "Whether they are a for-profit or nonprofit healthcare system, there are tax incentives and tax credits that can help fund these initiatives."

Janisch recommends an evaluation of current and pending government regulations such as Build Back Better.

The Department of Health and Human Services last year launched the Office of Climate Change and Health Equity. The first installment of a new public information series through that office is the Climate and Health Outlook, which serves as a resource on climate-related hazards such as extreme heat, wildfires, hurricanes, droughts and vector-borne diseases.

The federal government's latest effort is a call to action for healthcare stakeholders to commit to tackling the climate crisis through a new initiative aimed at reducing emissions across the sector. Hospitals, health systems, suppliers, pharmaceutical companies and other industry stakeholders are invited to submit pledges to reduce greenhouse gas emissions and increase their climate resilience on a pledge form due by June 3. The voluntary pledge asks signees to, at a minimum, commit to: reducing their organization's emissions by 50% by 2030, and to net zero by 2050, and publicly reporting their progress; completing an inventory of supply chain emissions; and developing climate resilience plans for their facilities and communities.

Rick Pollack, president and CEO of the American Hospital Association, said by statement, "America's hospitals and health systems see the public health effects of climate change first-hand, from buildings damaged during natural disasters to increases in asthma and other chronic conditions due to poor air quality. The social and structural factors that influence health, access to health insurance, exposure to pollution and other factors also result in some communities bearing a disproportionate burden from extreme climate-related events. That is why the AHA and our professional membership groups are already taking steps to help hospitals reduce the carbon footprints of facilities."

THE LARGER TREND

A climate resiliency report published by Deloitte in April shows that climate change is expected to increase the total cost of healthcare services and delivery. The healthcare industry is estimated to be the fifth-largest greenhouse gas emitter in the world. Globally, the sector contributes to 5% of worldwide emissions.

In the United States, the healthcare industry's contribution to emissions is even more pronounced, the report said, adding an estimated 8–9.8% to the total national emissions. 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com