We work in a complex, dynamic industry, one requiring constant innovation and adaptation.
Similarly, we are living in complex times as they relate to global warming and climate change. Opinions vary, but our care for patients is clearly being challenged by climate’s rapid shifts and increasingly severe extremes in weather.
What stays relatively unrecognized is the impact healthcare as an industry has on climate change. Recognizing that, at some level, all physicians are leaders in healthcare, there is now clear opportunity as physicians, and as leaders, to make a positive impact on the industry and our evolving climate predicament.
There are many iconic places of beauty in this world, and some of us have an opportunity to visit them in person. On a recent road trip with my family, I was looking forward to seeing Crater Lake in the U.S. Northwest. Having seen several images of the lake in the years before our trip (see Figure 1), I had high hopes.
We finally arrived after a long, hot summer drive to a region we knew was being impacted by severe seasonal forest fires. The access route was simple enough, but we kept looking for the lake. Where was it? We entered a pullout area, parked, and at once began to feel the rough air in our lungs and the smoke and ash in our eyes.
Where was that darn lake? Rather than the stunning beauty we were looking forward to seeing, we were met with a completely different view (see Figure 2).
Our disappointment in the vista was obvious; the unexpected impact on our well-being was the surprise. Recognizing that our health was being adversely affected by the atmosphere, we snapped a couple of quick photos, gobbled our sandwiches, and left. Even the family dog did not want to hang around.
A COLLECTIVE AWARENESS
A collective awareness of the deteriorating global climate and its effect on our health is gradually becoming better defined: It is linked to respiratory and cardiovascular disease, poor mental health, injuries, and even death (see Figure 3). Children, the elderly, people with chronic diseases, those in low-income communities and communities of color, and other marginalized groups are being disproportionately affected.
Air pollution has been linked to myriad ailments, including asthma and heart disease. In 2015, an estimated 9 million premature deaths globally(1) were attributed to diseases caused by air pollution — three times the number of deaths from AIDS, tuberculosis, and malaria combined.(2) Long-term exposure to air pollutants has also been associated with mental health disorders and depression.(3)
The healthcare industry is bearing the costs of treating these illnesses amid more frequent extreme weather events. Droughts, storms, heat waves, rising sea levels, melting glaciers, and warming oceans generate the potential for global crises.
The non-government organization Healthcare Without Harm and others are bringing many of these issues to the forefront.4 Paradoxically, many in our industry are unaware that the healthcare industry sectors treating the effects of climate change are also among the strongest contributors to the problem — predominantly from the generation of greenhouse gases or GHGs (see Figure 4).
Healthcare is responsible for almost 5% of global greenhouse gas emissions (the equivalent of 514 coal-fired power plants). More than half of all healthcare industry emissions come from energy consumption, with the industry supply chain accounting for the majority of that energy.(4)
If the global healthcare industry were a country, it would be the fifth largest polluter on Earth and the United States would be the primary healthcare carbon emitter in the world, both in absolute terms and per capita. The United States emitted 546 million metric tons total, or 1.72 metric tons per person. By comparison, the European Union emitted 0.49 metric tons per person, which is 28% of the per capita emissions of the United States.(4)
Further, professor Renee Salas and colleagues(5) have highlighted that greenhouse gas emissions fall largely under three categories: scope 1, which are emissions under direct control of the healthcare facility (such as fleet vehicles); scope 2, derived from electricity purchased by the facility; and scope 3, the majority (71%), comprising all other indirect emissions, such as those from supply chains. Emissions from supply chains include the production, transport, and disposal of medications, food, medical devices, and hospital equipment.
In their BMJ article “A Pathway to Net Zero Emissions for Healthcare,” Salas and his colleagues explain that “to achieve net zero GHGs, emissions from all sources — electricity generation, industry, transportation, buildings, and so on — must be reduced to as close to zero as possible, and any remaining emissions must be balanced by removing carbon dioxide from the atmosphere, through such means as reforestation and direct physical-chemical removal. Modeled estimates vary on the specifics, but the needed direction of travel is clear: We must urgently and radically reduce GHG emissions.” (see Figure 5)
Recently, in an effort to limit global warming to 1.5 degrees centigrade and to reduce harmful emissions to net-zero rates, several countries have entered into initiatives, pledges, and consortia efforts, the Paris Agreement and the COP26 being two of the most obvious. In this regard, 50 countries now have pledged to develop climate resilient and low-carbon health systems; however, there is more to be done, and the initial burden remains on the economically strong countries to provide the example initiatives.
CALL TO ACTION
While “greening” the healthcare industry will take time and collective efforts, there is also opportunity to incorporate other technologies such as low-carbon building design and construction, sustainable water resourcing and disposal, energy efficiency support systems, alternative transport methods, medical waste management, increased use of telehealth, and alternative anesthetic gas management strategies.
But a worsening global climate situation is also creating a sense of urgency in healthcare where we are already seeing the adverse impacts on patients and our communities. For an industry focused on the principle of “first do no harm,” it’s therefore imperative the healthcare industry also acts more quickly, collectively, and globally to mitigate its own impact on populations, climate, and our environment.
As healthcare providers and as physician leaders, it is our responsibility to provide the best clinical care and disease management, but individually and collectively, we must act responsibly to lessen the negative consequences of climate change as we strive to improve the overall health and well-being of populations.
At the AAPL 2024 Annual Conference in Nashville, Tennessee, Jonathan Perlin, MD, president and CEO for The Joint Commission (TJC), outlined several activities TJC will be undertaking from their national and international accreditation platform to influence the needed changes in healthcare. Other national society and federal agency groups are also strongly considering how best to move initiatives forward.
For example, in late 2022, the Agency for Healthcare Research and Quality (AHRQ) produced “Reducing Healthcare Carbon Emissions: A Primer on Measures” and “Actions for Healthcare Organizations to Mitigate Climate” and listed a series of approaches to alleviate the current contributions our industry makes to global warming. I encourage you to consider initiatives from both TJC and AHRQ as practical approaches.
AAPL will be developing information resources and educational programs in the coming months as a measure of our commitment to building the awareness and momentum to not only recognize these critically important issues, but also to begin addressing solutions for them on personal, local, regional, state, national, and international levels. More specific information is forthcoming.
Remember, leading and helping to create significant positive change is our overall intent as physician leaders. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.
As physician leaders, we must embrace the complexities and the opportunities where our individual and collective energies can create beneficial changes for our industry. An effort toward more responsible climate protection is now among the plethora of competing transformation priorities, and we must continue to be innovative and adaptive in our efforts. Let us all continue to maximize the opportunities continually available to our profession.
Through this AAPL community, we all can seek deeper levels of professional and personal development and recognize ways to generate constructive influence at all levels. As physician leaders, let us become more engaged, stay engaged, and help others to become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach — individually and collectively.
References
Landrigan PJ, Ruller RF, Acosta NJR, et al. The Lancet Commission on Pollution and Health. The Lancet Commission. 2018;391(10119): 462–512. https://doi.org/10.1016/S0140-6736(17)32345-0
GBD 2105 Mortality and Causes of Death Collaborators. Global, Regional, and National Life Expectancy, All-Cause Mortality, and Cause-Specific Mortality for 249 Causes of Death, 1980–2015: A Systematic Analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1459–1544. https://doi.org/10.1016/S0140-6736(16)31012-1
Braithwaite I, Zhang S, Kirkbride JB, Osborn DPJ, Hayes JF. Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2019;127(12):126002. https://www.doi.org/10.1289/EHP4595 . Epub 2019 Dec 18. PMID: 31850801; PMCID: PMC6957283.
Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Health Care’s Climate Footprint. Health Care Without Harm. September 2019. https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
Salas RN, Malbach E, Pencheon D, Watts N, Frumkin H. A Pathway to Net Zero Emissions in Healthcare. BMJ. 2020;371:m3785.