The statistics are staggering. The global health care industry is responsible for two gigatons of carbon dioxide each year, or 4.4% of worldwide net emissions — the equivalent of 514 coal-fired power plants. If the global health care sector were a country, it would be the world’s fifth-largest emitter of greenhouse gases.
Those are some of the eyepopping numbers from a September 2019 report titled Health Care’s Climate Footprint from Arup and Health Care Without Harm (HCWH), an international organization that’s working to make health care ecologically sustainable. The numbers are particularly disturbing for the United States: The United States is the world’s highest emitter of health care greenhouse gases, accounting for 27% of the global health care footprint (China, at number two, accounts for 17%).
How can teaching hospitals and laboratories improve their ecological efforts? Many institutions have already launched environmental initiatives, from energy conservation to green lab programs. In December 2018, seven Boston-area teaching hospitals and clinical institutes, including Harvard Medical School, announced a commitment to decarbonize. The University of California system has pledged to become 100% reliant on clean electricity for its campuses and medical centers by 2025, and the Cleveland Clinic is working to become carbon neutral by 2027. Numerous hospitals have received LEED certifications (a program developed by the U.S. Green Building Council to rate environmentally friendly buildings), from the Columbia University Medical Center in New York City, New York, to the Shands Cancer Hospital at the University of Florida in Gainesville, Florida.
“There’s a link between climate and health — that definitely motivates us,” says Ilyssa Gordon, MD, PhD, medical director of the Cleveland Clinic’s Office for a Healthy Environment. “It impacts our bid to ‘do no harm.’”
Here’s how some hospitals are caring not only for patients, but for the planet.
Using renewable energy
More than half of health care’s carbon footprint comes from energy use, according to the HCWH report, which recommends a “transition to clean, renewable energy and transportation.” That shift is already underway at many hospitals. The University of Vermont Medical Center began generating electricity via a solar array on its rooftop in December 2018 and participates in the Vermont Gas Renewable Natural Gas Program, which captures methane from a landfill in Quebec, Canada. The Boston Medical Center (BMC) buys electricity from Summit Farms, a 650-acre, 255,000-panel solar farm in North Carolina. Each year, BMC eliminates 119,500 metric tons of carbon dioxide emissions (which is like removing 25,250 cars from the highway).
“As medical professionals our commitment is to ‘first, do no harm.’ Places of healing should be leading the way, not contributing to the burden of disease.”
Tedros Adhanom Ghebreyesus, PhD
World Health Organization
With a mandate to be carbon neutral by 2025, the University of California, San Diego’s (UCSD) two medical centers are working to reduce energy use and find renewable options. The university will prohibit new buildings from using fossil fuels after 2020 — a significant challenge as UCSD prepares to rebuild its Hillcrest Medical Center. The medical centers buy some sustainable energy from the University of California, which generates onsite alternative energy on its campuses, but eventually they may need to generate their own.
“If we don't reach our carbon neutrality goal by 2025, we’ll be required to buy offsets,” says Barbara Hamilton, MAS, sustainability officer for UCSD Health. “As we move forward with our buildout, and as energy prices continue to go up, there’ll be a better ROI for us to invest in more distributed renewable energy on our site.”
Taking the LEED on energy efficiency
The Environmental Protection Agency has ranked inpatient health care as the second largest commercial energy user in the United States. To change that, medical centers like University of Wisconsin Health in Madison, Wisconsin, have taken a variety of energy-saving steps, such as using lighting controls and LEDs, installing high-efficiency equipment, and adding HVAC occupancy sensors and demand-reduction strategies. Many facilities, like the University Hospitals Ahuja Medical Center in Beachwood, Ohio, use natural light to reduce energy (Ahuja also has a white roof, which absorbs less heat).
“It’s simple things — if there’s a waiting room with a TV on and no one's watching it, turn it off. When 62,000 people all do something, that adds up to big savings.”
Energy improvements can be expensive, but the savings can be impressive. BMC’s energy-saving measures have reduced operating costs by about $25 million. The Cleveland Clinic, which has 15 LEED certified buildings, has reduced its energy use intensity (energy per square foot) by 19%, which has led to $50 million in savings.
To finance investments in energy efficiency, the Cleveland Clinic established a $7.5 million Green Fund in 2016. As money is used for various projects, the savings are reinvested in the fund. Initiatives have included an LED retrofit that has reduced electric consumption by 28.6 million kilowatts per year (an annual savings of $2 million), programmed systems that shut off lights in unoccupied areas (lighting accounts for 16% of the clinic’s total energy use), and more efficient chillers. About one-third of the savings have come from operating room improvements.
“The most energy-intense part of hospital operations is the operating room,” says Jon Utech, senior director of the Cleveland Clinic’s Sustainable Strategy Implementation. A good example: The clinic exchanges the operating room air 20 times each hour to keep it clean. “We have this mentality that if 20 was good, 25 must be better, and we ran the air exchanges even higher than that,” he says. “But there’s no reason for it. Heating and cooling that air, putting it in every room, venting it out, just wastes a lot of energy.” After talking with surgeons, the clinic reduced air exchanges from 20 times an hour to six when operating rooms aren’t in use. The savings: $2 million a year.
Buildings aren’t the only focus. In 2017, when Emory University Hospital removed trees to build its 450,000-square-foot, LEED-certified tower, it planted three times as many trees at a variety of locations. The Cleveland Clinic has committed to planting one thousand trees and has partnered with the Arbor Day Foundation for its recently launched Tree Campus Healthcare USA program, which recognizes institutions that are boosting urban tree canopies.
Many hospitals encourage biking, public transportation, and car pools (the University of Pennsylvania Medical Center’s Children’s Hospital of Pittsburgh offers bike racks and showers, plus discounted parking for car poolers). At NewYork-Presbyterian (NYP), the NYP Green program promotes environmental consciousness through staff education, incentive programs, and volunteer events. The Cleveland Clinic provides educational campaigns to encourage its 62,000 staff members to conserve energy. “It’s simple things — if there’s a waiting room with a TV on and no one's watching it, turn it off,” says Utech. “When 62,000 people all do something, that adds up to big savings.”
Labs see the light
At Harvard University, labs compete to see which one can use the least amount of energy for lighting. The winner receives an odd-looking solar-powered lamp, and the competing labs all want it — badly. Quentin Gilly, senior coordinator for Harvard’s Green Labs Program, discovered this one day when he stopped by a darkened lab.
“They were working in the dark in the middle of the day,” says Gilly. “I said, ‘You don't have to work in darkness,’ and they said, ‘Oh no — we want to win.’” A facilities manager entered a lab after hours and found that someone had removed the ceiling lamps from the ballasts. “They wanted to make sure that somebody couldn’t accidentally turn the lights on,” Gilly says.
At Harvard, labs account for nearly 44% of energy use yet only 20% of the university’s space. Competitions help, particularly one called Shut the Sash, which focuses on fume hoods (a ventilated cabinet for storing chemicals). Keeping them closed when they’re not used saves energy by reducing exhaust airflow. The program cuts greenhouse gas emissions by 300 metric tons each year and saves about $240,000 annually (and the labs compete for a biannual wine and cheese party).
Another energy-saving effort involves freezer temperatures. Ultra-low temperature (ULT) freezers are typically set at -80 Celsius, but -70 degrees is just as safe for samples — and it uses a third less energy, says Gilly. At Harvard, the effort is still in its infancy: Of the 900+ ULT freezers on campus, about 20 have been set to -70. At the University of Colorado Boulder (CU), about 50% of ULT freezers are set at -70, up from 3% in 2010 (CU has created a web page on its -70 efforts). The CU Green Labs Program also has a financial incentive program that encourages the purchase of energy- and water-efficient equipment, including energy-efficient ULT freezers.
Many programs work with the nonprofit My Green Lab, which helps create sustainable labs. At UCSD, 69 of its labs have been certified by My Green Lab, says Sara McKinstry, campus sustainability manager. The nonprofit also assesses laboratory products and equipment through its ACT label program, which shows if products are environmentally friendly. “It’s the first third-party evaluation program available for the whole laboratory industry, so we’ve been supporting their work tremendously,” says Gilly, who’s working with vendors to make ACT label products easier to find on Harvard’s online lab supply marketplace.
Reusing supplies is another priority. UCSD is expanding its ChemCycle program: Instead of disposing of unused chemicals, the Environmental, Health, and Safety office distributes them to other labs. The CU Green Labs Program wrote a case study showing the benefits of sharing space and equipment. Sharing often occurs for expensive equipment, but “there is much to be gained by sharing less-costly, major equipment,” says Kathryn A. Ramirez-Aguilar, PhD, manager of the CU Green Labs Program.
At Harvard, Gilly hosts periodic laboratory free cycle days, offering everything from lab equipment to office supplies. “We’ll host an event outside with a bunch of tables and people can just take stuff for free,” he says. “People come from all over and lug carts full of stuff. It’s a great way to promote waste reduction and reuse.”
Recycling and reducing waste (including food)
Hospitals generate over 5 million tons of waste each year, from everyday trash (such as packaging and food) to regulated medical waste, which includes blood-saturated items and objects such as gowns, gloves, scissors, and syringes. Reducing or recycling such waste can be difficult, but UC San Diego Health is establishing new waste reduction goals for January 2020. Its two hospitals create about 30 pounds of waste per adjusted patient day (APD), but the median for hospitals that earn environmental awards from Practice Greenhealth is 20 pounds per APD. To reach that goal, UCSD has launched an RFP for waste services and is working to expand its recycling programs and offer education programs for staff, physicians, and patients.
In 2018, the UCSD hospitals disposed of 3,200 tons of regular trash but recycled more than 2,200 tons.
Likewise, the Mayo Clinic operates its own 11-employee recycling facility at its campus in Rochester, Minnesota, where it recycles not only products like plastic and glass but also materials such as surgical blue wrap (which is sold to a company that converts it back into polypropylene). The University of Vermont also has a program that has diverted 50 tons of blue wrap since 2010.
As China accepts fewer plastics from the United States, the overall recycling market is struggling — “It’s tough times in the recycling world right now,” says Utech — but hospital systems are finding unique ways to reduce waste. NewYork-Presbyterian works with The Afya Foundation, which distributes surplus or phased-out medical supplies to underserved health systems worldwide. Through Afya, NewYork-Presbyterian has diverted more than 340,000 pounds of medical supplies and equipment. Similarly, the University of Vermont Medical Center has established drug waste collection points so patients can safely dispose of pharmaceuticals.
“We’re … reducing the amount of meat and dairy and eggs we buy and increasing the number of vegan and vegetarian options on our menu. That’s good for human health and the environment.”
Barbara Hamilton, MAS
University of California San Diego Health
Sustainability also applies to food. UCSD’s goal is 20% sustainable and local food and beverage procurement. The University of Washington Medical Center works with the Northwest Agriculture Business Center, a local farmers’ organization, to provide organic, sustainable foods to patients and retail customers. At the Boston Medical Center, a 7,000-square-foot rooftop farm produces around 5,000 pounds of food during growing seasons, from arugula to kale.
Organic waste emits methane, a powerful greenhouse gas, so UCSD’s two medical centers have food waste collection programs. Excess food is composted or donated to the Bannister House, a home for families of patients undergoing long-term care (NewYork-Presbyterian also composts food waste, which is converted to renewable energy at a local treatment plant). The UCSD medical centers want to reduce food-related emissions 25% by 2030. “We’re doing that by reducing the amount of meat and dairy and eggs we buy and increasing the number of vegan and vegetarian options on our menu,” says Hamilton. “That’s good for human health and the environment.”
That connection is important for health care providers. Everyone has a responsibility to address climate change, but hospitals may have a greater obligation given global warming’s effects on human health.
“As medical professionals our commitment is to ‘first, do no harm,’” wrote Tedros Adhanom Ghebreyesus, PhD, director general of the World Health Organization, in the HCWH report. “Places of healing should be leading the way, not contributing to the burden of disease.”