Cleaner Health Care: Hospital Emissions Mitigation

Climate change’s toll on human health is undisputed: Cardiovascular diseases, respiratory illnesses, liver diseases, diabetes, preterm births, and behavioral health issues have all been associated with the presence of extreme temperatures.^{[i],[ii],[iii],[iv],[v],[vi],[vii],[viii]} Children, older Americans, and low-income communities remain especially vulnerable.^{[ix],[x],[xi],[xii],[xiii],[xiv],[xv],[xvi]}

The nation’s health care sector has an important role to play in reducing the greenhouse gas (GHG) emissions that are contributing to a warming planet. The United States remains the top emitter of health care GHG emissions globally, accounting for 27% of Earth’s total health care emissions.^[xvii] Hospitals generate the most emissions in the U.S. health care sector at 36%, followed by physician and clinical services at 12%, and prescription drugs at 10%.^[xviii]

This report focuses on the immediate actions that hospitals can take, but BPC recognizes that the GHG emissions originating from health care supply chains must be addressed as well, given that they account for nearly 80% of U.S. health care emissions.^[xix] Although the problem extends well beyond the health care system, addressing the unique features of the health care system’s supply chain—such as the development and manufacturing of health care goods and services (e.g., pharmaceutical drugs and medical devices)—is also essential to lowering emissions and will require input from a much larger set of stakeholders.

Promisingly, experts and policymakers at all levels of government increasingly acknowledge the need to reduce the GHGs emitted by the health care system, starting with the nation’s hospitals.^{[xx],[xxi],[xxii]} Indeed, many hospitals and health care entities have already begun to act.

And now is a propitious time to act: The 2022 Inflation Reduction Act (P.L. 117-169) and the 2021 Infrastructure Investment and Jobs Act (P.L. 117-58) both offer significant incentives for hospitals and health care systems to lower their greenhouse gas emissions.

To help hospitals reduce their emissions in a way that is consistent with both the effects of a changing climate on human health and the nation’s larger transition to clean energy, the Bipartisan Policy Center recommends the following federal actions:

• At least every three years, the Centers for Medicare and Medicaid Services (CMS) should publicly post on its website a report (1) detailing whether CMS deems any building code changes to be “significant” as they relate to the potential for reducing GHG emissions, and (2) describing how hospitals are utilizing categorical and noncategorical waivers granted since the previous report, including whether GHG emissions reductions have resulted.
• The National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC)—in coordination with the National Institute of Environmental Health Sciences (NIEHS) at the National Institutes of Health (NIH)—should research ventilation strategies in hospitals to determine ways to use the lowest energy ventilation while balancing risk reduction from infectious aerosols, given that ventilation technologies represent a significant portion of energy usage within hospitals. NIOSH should publish and promote this research utilizing its existing processes.
• CMS, via the Hospital Inpatient Quality Reporting Program, should require hospitals to report whether they utilize ENERGY STAR Portfolio Manager or a similar measuring tool.
• The Government Accountability Office (GAO) should issue a report detailing the various clean energy workforce development programs within the Departments of Energy, Labor, Agriculture, and Health and Human Services (HHS), and provide recommendations, if warranted, on where programs could be adjusted or developed to strengthen workforce expertise specific to health care settings. A member of Congress will likely need to request that GAO complete this report.

These recommendations are designed for immediate action and implementation, primarily by utilizing existing statutory and regulatory authorities, except for two areas that might require more congressional engagement—(1) at least one member of Congress will need to request a GAO report; and (2) Congress might need to act to provide CMS with the authority to collect information regarding hospital utilization of ENERGY STAR Portfolio Manager or a similar measuring tool.

Given the current congressional environment—and to make it more likely for Congress to act, if necessary—BPC’s recommendation related to ENERGY STAR Portfolio Manager is narrowly tailored and represents simply a first step—that is, only requesting that hospitals report if they are utilizing an energy and emissions measuring tool.

BPC also offers the following best practices for hospitals to begin reducing their GHG emissions:

• Hospitals should leverage federal funding opportunities, including those created by the Inflation Reduction Act. To do so, hospitals are encouraged to follow real-time updates from the HHS Office of Climate Change and Health Equity (OCCHE).
• Hospitals should employ C-suite personnel and, to the extent needed, contract out for additional services dedicated to driving and supporting organization-wide efforts to reduce GHG emissions.
• Hospitals should reduce their GHG emissions from anesthetic gases by gradually reducing, with the goal of eliminating, the use of desflurane gas and nitrous oxide—both of which are particularly potent greenhouse gases. They should also work to reduce their GHG gas emissions from anesthesia-related sources overall.
• Hospitals should reduce their GHG emissions from food waste by:
  • devoting resources to sourcing more locally grown, healthier, and fresher fruits and vegetables options;
  • providing more tailored meal options to patients;
  • taking immediate advantage of opportunities for composting or otherwise repurposing food waste and unused food products.

BPC developed these recommendations through expert and stakeholder interviews and reviews of relevant literature. For hospitals to achieve success, and in addition to supportive federal policies, they will need significant support from their C-suites and other leaders.

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[i] M.C. Sarofim, S. Saha, et al., “Chapter 2: Temperature-Related Deaths and Illness, The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment,” U.S. Global Change Research Program, 2016. Available at: https://health2016.globalchange.gov/low/ClimateHealth2016_02_Temperature_small.pdf.

[ii] M.C. Donnelly, W. Stableforth, et al., “The Negative Bidirectional Interaction Between Climate Change and the Prevalence and Care of Liver Disease: A Joint BSG, BASL, EASL, and AASLD Commentary,” Gastroenterology, March 21, 2022. Available at: https://www.gastrojournal.org/article/S0016-5085(22)00149-4/fulltext#%20.

[iii] A. Gasparrini, Y. Gui, et al., “Mortality risk attributable to high and low ambient temperature: a multicountry observational study,” The Lancet, May 20, 2015. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62114-0/fulltext.

[iv] A. Mandavilli, “Heat Singes the Mind, Not Just the Body,” The New York Times, August 10, 2023. Available at: https://www.nytimes.com/2023/08/10/health/heat-mental-health.html?campaign_id=9&emc=edit_nn_20230810&instance_id=99712&nl=the-morning&regi_id=62189971&segment_id=141604&te=1&user_id=c5d96583470c4db8f99aee2d666d53a7.

[v] U.S. Environmental Protection Agency, Climate Change and Social Vulnerability in the United States: A Focus on Six Impacts, September 2021. Available at: https://www.epa.gov/system/files/documents/2021-09/climate-vulnerability_september-2021_508.pdf.

[vi] K.L. Ebi and J.J. Hess, “Health Risks Due To Climate Change: Inequity In Causes and Consequences,” Health Affairs, December 2020. Available at: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2020.01125.

[vii] X. Qui, L. Shi, and L.D. Kubzansky, “Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US,” JAMA Network, February 10, 2023. Available at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801241.

[viii] H. Pörtner, D.C. Roberts, et al., “Climate Change 2022: Impacts, Adaptation and Vulnerability,” Intergovernmental Panel on Climate Change, 2023. Available at: https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_FullReport.pdf.

[ix] K.L. Ebi, J.M. Balbus, et al., Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II, U.S. Global Change Research Program, 2018. Available at: https://nca2018.globalchange.gov/downloads/NCA4_Ch14_Human-Health_Full.pdf.

[x] J. Berko, D.D. Ingram, et al., “Deaths attributed to heat, cold, and other weather events in the United States, 2006-2010,” National Health Statistics Reports, July 30, 2014. Available at: https://pubmed.ncbi.nlm.nih.gov/25073563/.

[xi] U.S. Environmental Protection Agency, Climate Change and Social Vulnerability in the United States: A Focus on Six Impacts, September 2021. Available at: https://www.epa.gov/system/files/documents/2021-09/climate-vulnerability_september-2021_508.pdf.

[xii] U.S. Department of Health and Human Services, Office of Minority Health, “Asthma and Hispanic Americans,” February 11, 2021. Available at: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=60#:~:text=Hispanics%20are%20twice%20as%20likely,compared%20to%20non%2DHispanic%20whites.

[xiii] J.R. Grunwell, C. Opolka, et al., “Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Life-Threatening Asthma,” Journal of Allergy and Clinical Immunology: In Practice, April 2022. Available at: https://www.sciencedirect.com/science/article/abs/pii/S2213219821012563.

[xiv] UNICEF, “The coldest year of the rest of their lives: Protecting children from the escalating impacts of heatwaves,” October 2022. Available at: https://www.unicef.org/media/129506/file/UNICEF-coldest-year-heatwaves-and-children-EN.pdf.

[xv] G.T. Wodtke, K. Ard, et al., “Concentrated poverty, ambient air pollution, and child cognitive development,” Science Advances, November 30, 2022. Available at: https://www.science.org/doi/10.1126/sciadv.add0285.

[xvi] J.D. Stowell, Y. Sun, et al., “Warm-season temperatures and emergency department visits among children with health insurance,” Environmental Research Health, November 1, 2022. Available at: https://iopscience.iop.org/article/10.1088/2752-5309/ac78fa/pdf.

[xvii] Health Care Without Harm, “Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action,” September 2019. Available at: https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_090619.pdf.

[xviii] M.J. Eckelman and J. Sherman, “Environmental Impacts of the U.S. Health Care System and Effects on Public Health,” PLOS ONE, June 9, 2016. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014.

[xix] The Commonwealth Fund, “How the U.S. Health Care System Contributes to Climate Change,” April 19, 2022. Available at: https://www.commonwealthfund.org/publications/explainer/2022/apr/how-us-health-care-system-contributes-climate-change.

[xx] L. Atwoli, A.H. Baqui, et al., “Call for emergency action to limit global temperature increases, restore biodiversity, and protect health,” The Lancet, September 4, 2021. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01915-2/fulltext#%20.

[xxi] R.N. Salas, T.H. Friend, et al., “Adding A Climate Lens To Health Policy In The United States,” Health Affairs, December 2020. Available at: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01352.

[xxii] Ways and Means Committee Democrats, “Health Care and the Climate Crisis: Preparing America’s Health Care Infrastructure,” March 2022. Available at: https://democrats-waysandmeans.house.gov/health-care-and-climate-crisis-preparing-americas-health-care-infrastructure.