First, do no harm: That directive is drilled into caregivers from their first days in medical school. But when it comes to the planet's health, hospitals, medical equipment makers and pharmaceutical manufacturers cause a considerable deal of harm through climate pollution.
"If you're consuming or burning fossil fuels, I think it's pretty scientifically proven at this point you're impacting the health of people," Keith Edgerton with the nonprofit group Health Care Without Harm told Newsweek. Edgerton is U.S. director of climate solutions for the group, which works with thousands of hospitals, health systems and clinics around the world to find ways to reduce their surprisingly large emissions of greenhouse gases.
The global health sector collectively accounts for almost 5 percent of all man-made greenhouse gas emissions. If it were a country, the health industry would be the world's fifth-biggest source of greenhouse gases.
The U.S. health industry is by far the biggest source, contributing a little more than a quarter of global health-sector emissions. About 8.5 percent of total U.S. carbon emissions come from the health sector, far more than other high-profile polluting sectors, such as aviation.
"I was surprised as to how large it was," Stanford Health Care Vice President for Facilities and Sustainability Helen Wilmot told Newsweek. Stanford Health Care is one of several hospitals on Newsweek's ranking of the World's Best Hospitals 2024 that are taking the lead on cutting greenhouse gas emissions.
Wilmot is among the health-system officials charged with bringing down emissions while keeping quality of care high. That means tackling energy efficiency and rooting out dirty energy sources, reducing single-use and disposable products, and even rethinking the use of the gases that put patients under during medical procedures.
The flip side of working in a sector with a big carbon footprint, Wilmot said, is the opportunity it presents. "It's kind of exciting, because it means that you actually can have impact."
Steps to Increase Hospitals' Energy Efficiency
"Health care is an incredibly energy-intensive sector," Edgerton explained.
Sprawling health facilities typically run 24/7 and must maintain high standards for ventilation, heating, cooling and other indoor environmental measures. Hospitals operate food services and laundries and frequently have fleets of vehicles and even aircraft. All that energy consumption typically accounts for a big chunk of a health facility's CO2 output.
But many hospitals are finding ways to cut their carbon pollution. In the decade from 2012 to 2022, Stanford Health Care cut greenhouse gas emissions by almost 35 percent.
Stanford's Wilmot said a team approach can produce more energy-efficient operations when the hospital's clinical and infection prevention teams work alongside energy engineers.
"These smart people would love to understand how they can make the building more efficient, they've just never been invited into the conversation," she said. The hospital makes use of clean sources for steam and electricity from Stanford University campus facilities and the city of Palo Alto's renewable energy purchases.
Other hospital systems are building efficiency into the design of new facilities under construction. In Irvine, California, UCI Health is constructing a 144-bed hospital that it says will be the nation's first all-electric medical center when it opens in 2025.
In Ann Arbor, Michigan, University of Michigan Health has a 12-story hospital under construction that is designed to meet LEED Platinum certification, the U.S. Green Building Council's highest level of design that conserves energy and water, reduces waste and improves indoor environmental quality.
Tony Denton is senior vice president and chief ESG officer for University of Michigan Health, which is also on Newsweek's ranking of top hospitals. He said sustainability became a bigger part of hospital planning about 25 years ago when the hospital eliminated its medical waste incinerator. That triggered a more holistic approach to dealing with waste, and sustainability is now an integral part of leadership decision making.
"It has to be viewed as part of what we do and part of the culture," Denton told Newsweek. "We are committed to health care without harm, and so to the extent that we believe that, then we have to make the investment necessary."
Cutting Waste in Daily Operations
Energy consumption isn't the only source of medical greenhouse gases. Many anesthetic agents commonly used during surgery and other medical procedures, such as halogenated ethers and nitrous oxide, are also powerful greenhouse gases.
Research from the National Institutes of Health warns that the global warming potential of a halogenated anesthetic can be up to 2,000 times greater than CO2.
In England, the National Health Service found that such anesthetics were responsible for about 2 percent of the health sector's greenhouse gases. The NHS is phasing out the use of one such gas, desflurane, this year.
Wilmot said the centralized tank farm at Stanford Health Care is typical of how hospitals deliver anesthetic gases and is an example of how the gases escape.
"When the pressure gets too high or the attachment points might be a bit loose, you can lose 90 percent of it into the air before it ever gets delivered," she said.
Switching to portable gas cylinders, she said, can help reduce loss of the gas. But any change in long-standing practices in hospitals can take a lot of time and effort.
"Probably the biggest challenge in sustainability is the amount of education you have to do," Wilmot said.
That's especially true when it comes to reducing waste from single-use plastic equipment and replacing disposable materials such as medical gowns with reusable ones, she said.
"People look at you like, 'What? We're going to use a cloth gown? Oh my God, that's like the 1960s, we can't do that!'" Wilmot said with a laugh.
Disposable materials and equipment have become deeply ingrained not just in medical practice but in consumer culture. But through data-driven communication and careful analysis of how tools are used in medical settings, Wilmot said, she has been able to get doctors and nurses to cut waste.
At U-M Health, Denton said, about a third of hospital waste comes from the disposable or plastic-wrapped equipment used in operating rooms. He's collaborated with a company to better separate the plastic packaging waste from other materials that become contaminated, making it easier to gather recyclables.
Nick Thorp directs the Global Green and Healthy Hospitals Network at Health Care Without Harm. He said hospitals around the world are finding creative ways to reduce waste throughout their operations.
"As complex as the issue is, and the variety of sources where hospitals have an impact, there's an equal amount of innovation," Thorp told Newsweek.
In Taiwan, he said, Dalin Tzu Chi Hospital found ways to leverage its food service to promote healthier diets and cut CO2.
"They're vegetarian," Thorp said. "A big part of their work is providing really high-quality vegetarian food and educating their patients on the health benefits."
The emissions reductions come as a co-benefit of cutting out meat, which typically involves much more energy and water to produce, compared to vegetable-based food.
Reducing Emissions Beyond Hospital Walls
Despite all those efforts, there is only so much that managers can do within the hospital walls, and in many cases, the bulk of emissions from a health system come from the upstream supply chain of products it uses—what climate policy analysts call "Scope 3" emissions.
The pharmaceutical industry, with its large-scale and energy-intensive manufacturing sites and research facilities, is a major source of emissions from the health sector.
New Jersey-based Merck & Co., one of the world's largest pharmaceutical companies, sits atop Newsweek's 2024 ranking of America's Most Responsible Companies.
A Merck spokesperson said the company has adopted science-based targets for emissions reductions, including commitments to purchase 100 percent of its electricity from renewable sources by next year and to cut greenhouse gases from its operations roughly in half by 2030.
But as large as Merck is, sustainability officials there also find that the upstream emissions are a big problem.
"A large percentage of our emissions come from the third parties we do business with globally," Merck's Chief Procurement Officer Susanna Webber said in an email.
Webber said Merck is part of a program that helps companies which provide services and supplies to the pharmaceutical industry to green their operations.
Thorp said Health Care Without Harm is encouraging health companies to use their purchasing power as leverage, to reduce emissions throughout the supply chains they depend on.
In the U.S., the federal government has recently become more engaged in efforts to help the health sector reduce emissions.
According to the American Hospital Association, about 3,000 U.S. hospitals are nonprofits, roughly half of all hospitals in the country. Until recently, nonprofit entities could not take advantage of many government incentives for clean energy because those were in the form of tax credits, and nonprofits do not pay taxes.
The Inflation Reduction Act, the Biden administration's signature legislation on climate change, changed that by allowing nonprofits to convert the value of tax credits into direct payments.
That could be a game-changer for hospital managers struggling to find financing for the upfront costs of installing solar panels, for example. This spring, the Department of Health and Human Services is hosting a series of workshops with health systems to explain how they can put those incentives to work.
Read more: Federal Solar Tax Credit Guide
The HHS and White House also launched last year a Health Sector Climate Pledge for hospitals, health and medical companies to cut emissions in half by 2030. More than 130 organizations representing 900 hospitals have signed the pledge, including the hospitals at Stanford and Michigan.
"Health care has to be a part of the solution" Denton said. "To do that, we have to balance between saving lives as well as saving the planet."
About the writer
To read how Newsweek uses AI as a newsroom tool, Click here.
