Essential hospitals can lead a holistic approach to climate and health

Health care systems are on the front lines of the climate crisis — anchoring disaster response while coping with growing health impacts from heatwaves, wildfires and other weather-related threats. Hardest hit are America’s essential hospitals, which care for the nation’s most climate-vulnerable patients.

Within this challenge lies an opportunity. Given their stature in the most-impacted communities, essential hospitals could lead a holistic approach to climate and health. But in a time of strained resources and unrelenting demand, most lack the capacity to do so. With more federal funding, essential hospitals could improve health, equity and climate resilience in the most vulnerable communities.

The need for resilience is clear: climate change is impacting human and planetary health and the window of opportunity to secure a livable future is closing fast.

Extreme heat, the deadliest climate impact, exacerbates chronic conditions such as heart disease, respiratory illness and diabetes. Rising temperatures trigger other insidious effects on human health and well-being, including food-, water- and vector-borne illness, along with mental health impacts and more.

The health burdens of climate change are not borne equally.While all Americans are at risk, low-income communities and communities of color are particularly vulnerable.Worse, climate impacts are layered atop existing inequities. Low-income communities and communities of color already bear higher disease burdens and lower life expectancies than more affluent and white populations. In effect, climate change is a threat multiplier for factors that contribute to disease and widen inequality.

These challenges are felt most acutely by America’s essential hospitals, which care for patients regardless of their insured status or ability to pay. Essential hospitals provide a disproportionate share of the nation’s uncompensated care and typically operate with little or no profit margin. The patients who rely on essential hospitals are often economically disadvantaged, members of historically underrepresented racial and ethnic groups, often with complex clinical needs — all factors that put them at heightened risk from the health impacts of climate change.

Essential hospitals — and the health sector generally — have considerable power to effect change. Representing nearly 20 percent of U.S. GDP, the health sector can leverage its purchasing power to drive the transition to clean energy and a low-carbon supply chain. And essential hospitals serve as vital anchor institutions in the most-impacted communities, where they can address the factors that heighten vulnerability.

The health sector also plays a role in actually causing climate change. Despite its healing mission and commitment to “do no harm,” the health care industry is among the most carbon-intensive service sectors in the industrialized world, producing up to 4.6 percent of all greenhouse gas emissions. The U.S. health care system is responsible for about one-quarter of the global sector’s emissions — a larger share than any other nation.This outsized impact provides an important lever for change.

While the problems of climate change and inequity create a vicious cycle of harm, the solutions to these problems can create a “virtuous circle” of mutually reinforcing benefits. For example, emissions reductions that also cut air pollution can immediately mitigate suffering from asthma and other respiratory diseases. And less air pollution means lower health care costs and reduced pressure on overburdened hospitals.

The potential benefits are staggering. In the United States, eliminating fossil fuel pollution could save 100,000 lives and $880 billion annually. Over the long term, air quality improvements alone could substantially offset, or even exceed, the costs of climate change mitigation.

With the motive and the means to address climate change and inequity, health systems are taking action. For example, Washington state-based Providence hospital system is reducing waste, switching to renewable energy, purchasing local and sustainable foods and phasing out climate-changing anesthetic agents. Providence has cut emissions at its hospitals by nearly 12 percent and 26 of its facilities operate entirely on renewable energy.

And the Impact Purchasing Commitment, created by the Healthcare Anchor Network in partnership with Practice Greenhealth and Health Care Without Harm, directs health care purchasing toward industries that decrease their carbon footprint, produce safer products and services and grow economic opportunities for businesses owned by people of color and women.

Despite resource constraints, members of America’s essential hospitals are also taking steps to reduce their energy use and lower emissions. For example, Atrium Health in North Carolina cut energy use by 20 percent, winning the U.S. Environmental Protection Agency’s (EPA) “Energy Star Partner of the Year” award for three consecutive years. The resulting cost savings enabled Atrium to donate $10 million toward affordable housing in the communities it serves. 

Importantly, essential hospitals are working to build environmental and social resilience in the communities they serve. For example, Boston Medical Center — one of the largest essential hospital and level 1 trauma centers in New England — worked with local stakeholders to identify the top challenges facing its patient population: housing instability and food insecurity. In response, Boston Medical Center has invested nearly $7 million since 2017 to support community projects on housing and nutritional health.

These inspiring examples notwithstanding, relatively few essential hospitals have the capacity to mitigate and prepare for climate change.

That could change. Currently, there is unprecedented momentum at the intersection of climate, health and equity. In addition to issuing an executive order requiring federal agencies to decarbonize their facilities, the Biden administration created a new Office of Climate Change and Health Equity in the Department of Health and Human Services. This new office launched the Health Care Sector Climate Pledge, asking health care stakeholders to commit to halving their greenhouse gas emissions by 2030 and building more climate-resilient infrastructure. It’s a call to action that has already been met by 102 of the nation’s largest health systems.

President Biden also signed into law the Inflation Reduction Act, which will invest $369 billion to drive the growth of clean energy and cut the nation’s carbon footprint. It will deliver financial support to enable health systems to cut emissions, while helping overburdened communities reduce pollution and make zero-emission infrastructure more affordable.

Collectively, these initiatives create a unique opportunity for transformation in the health sector. To achieve the greatest impact, the federal government must prioritize investments in essential hospitals that serve communities on the front lines of climate change and health inequity. With more resources, essential hospitals can engage communities to define and implement just, equitable solutions to the great climate and health challenges of our time.

Kalpana Ramiah, DrPH, is vice president of innovations and director of Essential Hospitals Institute at America’s Essential Hospitals.

Gary Cohen is president of Health Care Without Harm and Practice Greenhealth.

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