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As Dr. Jodi Sherman thought about her residency at Stanford University, she couldn’t help but notice how many medical supplies, plastic, resources — stuff — she was throwing away every day.
“It just felt wrong,” she said. Sherman couldn’t put out of her mind that she was feeding into pollution and dirty air that would, at some point, send more people to hospitals.
“It was clear that we were using so much stuff, it was going somewhere and it was coming from somewhere, and we must be causing so much harm to the environment,” she said. “At the time, there was no resources to understand the magnitude of the problem and be able to guide better practice.”
She made a pact to herself that she wouldn’t practice medicine unless she got involved in greening medical systems.
Ten years later, as an anesthesiologist at Yale University and director of the school’s Program on Healthcare Environmental Sustainability, Sherman is one of many doctors still prodding U.S. hospitals and health systems to take action on sustainability. But without a standard framework, U.S. hospitals are slow to green.
Across the globe, health care is responsible for nearly 5 percent of total greenhouse gas emissions, and the United States is among the world’s highest emitters along with China. According to Sherman’s estimate, 8.5 percent of all U.S. greenhouse gas emissions came from the health care industry in 2018.
Emissions from running the hospital and its vehicles accounted for 17 percent of the sector’s worldwide footprint, and indirect emissions from steam, electricity, cooling and heating made up another 12 percent. The bulk of health care emissions — about 70 percent — stemmed from the supply chain of goods and services, notably pharmaceuticals, medical devices and food.
A 2018 study found that pollution from health care results in a loss annually of up to 614,000 disability-adjusted life years — a figure that combines years of life lost due to both premature mortality and time lived in states of less than full health.
And the problem goes beyond emissions; the sector also has a huge waste — especially plastic — problem. The health care industry produces around 5.9 million metric tons of medical waste per year in the United States, and of that amount, 1.7 million metric tons is plastic.
“The latest framework is this idea that we have to go zero carbon because we are dramatically approaching climate tipping points,” Sherman said. But in addition to that, “we need to understand more about other dimensions of the issue and how to quantify them — greenhouse gases aren’t the only emissions of concern.”
Where are the numbers?
A hospital is a resource-eating beast — it has to be always alive, prepared and moving. The building and its lights, heat and electricity run 24/7. Trucks move in and out, feeding it medical and food supplies. Waste from single-use devices, gowns, masks and more piles up in the dumpster, waiting to see a landfill. And hundreds of miles away, plastics are molded into gloves, tubes and needles to be used once and thrown out.
Few medical centers in the U.S. are measuring and reporting their emissions, but Harvard Medical School and the Cleveland Clinic are among the exceptions. Harvard is aiming to be fossil-fuel neutral by 2026, and the Cleveland Clinic has a goal to be carbon neutral by 2027.
Other hospitals, like Boston Medical Center, have carbon-neutral goals but don’t publicly track their progress. The Boston facility has pledged to become carbon neutral by 2030 and has won awards for its green initiatives, but it doesn’t publicly report environmental impact or emissions data. As hospitals declare sustainability and net-zero goals, green advocates wonder whether there can be accountability without data.
The Cleveland Clinic, a nonprofit medical center, has been pursuing green initiatives since 2007 — strides ahead of other U.S. hospitals.
Not only does the clinic’s Office for a Healthy Environment track and report its emissions across the spectrum, but it’s also one of the first medical facilities to adopt a clinical plastic recycling program, use alternative fuel vehicles including patient transportation vans and buses, and repurpose unused medical tools. It installed the campus’s first solar array over a decade ago.
As a result, the clinic has reduced its carbon intensity by 28 percent since 2007. And its public data report proves it.
“Doctors and nurses see [the sustainability] issue and want to get involved,” said Jon Utech, senior director of the clinic’s Office for a Healthy Environment. “We actually have a custom recycling program that happened because of engaged physicians and nurses — it troubled them to see all these materials being thrown away.”
For example, Utech said the clinic has a program to repurpose medical supplies that were set out but not used during procedures, including catheters, blood pressure cuffs and laparoscopic devices.
But convincing hospital leadership to adopt green goals can be tricky, especially as mergers happen and operations get larger. Existing sustainability and reporting goals can get lost in the shuffle as health companies buy up smaller ones, and it can be hard for physicians and nurses to advocate for green goals as management shifts.
Health Care Without Harm, a global nonprofit organization, is one of the largest operations dedicated to helping hospitals reduce their environmental footprint. For a fee, hospitals and medical systems can become a partner and access materials and advisers through Practice Greenhealth to improve their sustainability.
Although its goal is to set hospitals on a path to net neutrality and public emissions tracking, Sustainability Solutions Director Janet Howard said the organization sometimes has to start small with sustainability goals. Some facilities don’t have the workforce to set up infrastructure needed for robust programs. Others come to Practice Greenhealth with hopes to improve on one issue — like waste reduction — and don’t have the capacity to take on other sustainability problems.
“We do the fundamentals, helping them put the roots down,” Howard said.
But out of Practice Greenhealth’s about 1,400 partners, only 350 shared any sort of environmental data last year. The company also does not require hospitals to make data public.
Howard said that’s because medical facilities that join as partners have environmental programs at different maturity levels — some programs are so new that pushing for tracking and reporting could overwhelm the facilities and deter them from going green. Practice Greenhealth also gives out yearly environmental awards that do require data sharing. But that data is not made public.
“We advocate for [data reporting], but it takes time,” she said. “It can be a heavy lift for some of these hospitals to get their arms around.”
‘Yes, I’m optimistic’
By nature, hospitals’ missions and business models complicate sustainability efforts.
For one, medical systems sometimes struggle already to fulfill their primary calling to care for patients; especially in the face of the Covid-19 pandemic that has taken a huge toll on health care workers and resources, recycling and renewable energy come second to saving lives.
And the market competition that has been driving Wall Street to adopt sustainability measures doesn’t exist for hospitals — when in need, patients typically go to the nearest hospital or the one that best suits their medical needs, regardless of the facility’s green goals.
Although a handful of hospitals have voluntarily adopted emissions tracking, there’s still a push from green-minded doctors across the U.S. for mandatory reporting.
Department of Health and Human Services Assistant Secretary for Health Rachel Levine said last month that the federal agency is working with health systems to find ways to lower emissions voluntarily. That gives Sherman hope for greener hospitals.
“Yes, I’m optimistic,” she said. “If I weren’t hopeful, I wouldn’t be able to get out of bed in the morning.”