Do No Harm: The obligation for healthcare to lead against climate change

April 22 marked the 52nd anniversary of Earth Day, the birth of the modern environmental movement when people first rallied together and demanded action to protect the planet. While now recognized around the world by over a billion people, this holiday comes amid a barrage of bad news and daunting projections: Earth is on track to be “unlivable.” Climate change is leading to new disease outbreaks. There’s a risk for “cataclysmic” marine extinction. Heat waves are months long. 

President Biden released a statement in honor of Earth Day from the White House, connecting the importance of action on climate change to health. “For the future of our planet, for our health, and for our children and grandchildren, we must act now.”

Health Effects of Climate Change

The impacts of climate change on health are vast, including expanded geographic distributions of infectious diseases, increased respiratory and cardiovascular disease, severe weather events resulting in increased injury and premature death, and, adverse effects on mental health. These impacts will not be felt equally. President Biden emphasized that “environmental injustices continue to exact a toll on the health of communities of color, low-income communities and Tribal and Indigenous communities.”

The health impacts of climate change tend to progress slowly, making them harder to attribute the cause. However, new studies are quantifying the toll of climate change on human lives and the numbers are not small—globally, 5 million deaths a year are attributed to “non-optimal temperatures.”

What is at stake in the healthcare system?

Healthcare systems and leaders have a role to play in addressing climate change. They care for patients with a variety of health conditions caused by climate change. Climate change also threatens the ability of these systems to sustain operations, evidenced by hospital shutdowns during increasingly frequent hurricanes such as Sandy, Ida, Irma, Florence, Harvey, Michael, and more.

However, the industry is also a large emitter. Globally, the healthcare industry accounts for roughly 4.4% of emissions. In the United States, this figure is much higher at 10% of emissions. There are three classifications of emissions. Scope 1 emissions are those produced directly by a health system’s building or fleet of vehicles and the associated fuel consumption (17% of healthcare emissions globally). Scope 2 emissions include purchased electricity, heat, and steam (12% globally). Scope 3 emissions are the hardest to quantify but make up the bulk of healthcare emissions (71% globally). Examples in this category include emissions caused by pharmaceuticals, food, devices and equipment, investments, and waste from operations.

Scope 1 and 2 emissions are easiest to tackle, as they are more accurately measured. Additionally, solutions are predominantly at the discretion of the system. With that, they are often the target for many hospitals. For example, here in Boston, Massachusetts General Hospital aims to achieve carbon neutrality in Scope 1 and 2 greenhouse gas emissions through energy efficiency measures, changes in equipment, and carbon offsets by 2021.

Healthcare Systems Taking the Lead

The National Health System in England is a leader in green healthcare provision. Through their goal of achieving Net Zero emissions, they approach emissions in both the traditional “Scope” schematic but they also separate their approach into two buckets—emissions we control directly and emissions we can influence—with goals of net zero by 2040 and 2045 respectively.

In Boston, Harvard Medical Teaching and Affiliate Hospitals committed to decarbonizing, or reducing greenhouse gases. Similarly, Boston Medical Center (BMC) has reduced their square footage and their energy consumption. They have installed a cogeneration plant that pairs electricity production on-site with heating, improving efficiency by 35%. This type of on-site energy production has multifaceted advantages. It reduces emissions and enables the hospital to be self-sufficient in the event of a large storm that could disconnect the hospital from the traditional energy grid. BMC combats aspects of climate change by planting trees and a community roof garden that counters the urban island effect in which temperatures are much warmer in cities. BMC has outsourced Scope 3 emissions, such as food, to more local and sustainable options. They partner with a local fishing association in Boston and have switched from frozen to fresh, local, sustainable varieties of fish to be used in hospital meals.

A Call to Action

More healthcare systems should identify and act upon emissions they directly control and emissions they can influence. Through the oath of “do no harm,” healthcare entities must assume responsibility for contributing to a just and habitable planet for generations to come. Green initiatives have the potential to create system resilience, increase efficiencies leading to cost savings, and improve the health of patients, the surrounding community, and world.

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