Taking Action on Climate Change: Steps for Health Care Providers

November-December 2018

Emily Audet, BA

Sarah Huang, BA

Elizabeth Rhoades, PhD

Susan Lesser, MPH

Health care providers have two important roles in responding to climate change: taking actions to mitigate climate change and addressing its impact on patients. This article, the second in a two-part series, will discuss how the health care sector contributes to climate change and focus on steps that clinicians can take on a clinical, institutional, policy, and personal level to slow climate change.

The first article, “Climate Change and Health in LA County: Opportunities for Clinical Intervention,” summarized the latest science on the health risks of climate change, described the populations in Los Angeles County most likely to be impacted, and offered specific strategies that clinicians can use to protect the health of their patients from extreme heat, wildfires, poor air quality, and vector-borne diseases.

Impact of the Health Care Sector on Climate Change

The health care sector in the United States contributes significantly to greenhouse gas (GHG) emissions, the primary contributor to climate change. In fact, if the U.S. health care sector were a country, it would be the world’s 13th largest emitter of GHGs, ranked higher than the United Kingdom. While national GHG emissions, as tracked by the Environmental Protection Agency (EPA), have decreased, GHG emissions from the U.S. health care sector have increased approximately 30% over the last decade, rising to nearly 10% of total U.S. emissions in 2013.¹ The figure below shows the health care sector’s total GHG emissions against its share of total U.S. emissions. Both steadily increased between 2003 and 2013.

Greenhouse Gas Emissions from U.S. Health Care Sector, 2003 – 2013¹

                          Orange bars represent absolute emissions (in million metric tons).
                               Blue line represents the percentage of national emissions.

Suppliers of energy, goods, and services account for the largest sources of GHG emissions in the U.S. health care sector. Among these suppliers, power generators (off-site power plants supplying power to heath care facilities) account for the largest source (36%) of these emissions.¹

Actions to Mitigate Climate Change

There are many opportunities for clinicians to use their expert knowledge and professional influence to slow climate change and protect their patients’ health. Examples of recommended clinical, institutional, policy, and personal actions are described below. See the Further Engagement section for resources for getting involved.

Interactions with Patients

Many behaviors that promote health also mitigate climate change. It is likely that clinicians already provide advice that helps patients reduce their GHG emissions. For instance, encouraging patients to walk or bike (rather than drive) and replace some of the meat and processed food in their diet with vegetables not only promotes a healthier lifestyle but also mitigates climate change.²

Consider prominently placing informational materials related to climate change and health in waiting rooms. Resources include the Center for Climate Change & Health’s Climate and Health posters and the Los Angeles County Department of Public Health’s fact sheet on reducing one’s carbon footprint.

Another clinician behavior that promotes health, which may also mitigate GHG emissions, is the reduction of use of unnecessary tests and treatments such as those recommended by the Choosing Wisely initiative. Clinicians can read a prior Rx for Prevention article to learn more about Choosing Wisely.

Institutional Action

Clinicians can also advocate for climate action within their affiliated hospitals, clinics, or professional associations. The American Medical Association provides short- and long-term steps clinicians can take to improve the sustainability of their practice. For hospitals, the American Hospital Association has a free Sustainability Roadmap, which includes instruction on how to improve sustainability in hospital operations in relation to energy use, procurement of supplies, and other recommendations. Examples of steps clinicians can support within their institutions to decrease GHG emissions are described below.

Promoting Sustainable Transportation

• Propose commuter programs and transportation assistance programs for staff and patients that incentivize the use of vanpool programs or mass transit, such as discounts, rebates, vouchers, and shuttles to nearby transit stops.
• Work with the facilities/operations department to include:
  • Facilities that support active transportation, like lockers, showers, and bike parking.
  • The addition of electric vehicle (EV) parking and charging stations.

Reducing Energy Use

•  Work with the facilities/operations department to:
  • Install renewable energy and energy efficiency measures, like solar panels or energy-efficient lighting.
  • Implement energy efficiency campaigns, such as those that encourage using stairs instead of elevators or turning off unused lights.
  • Adopt green procurement policies, including preferences for local supplies and local food in cafeterias.
  • Install cool and green roofs and landscape with shade trees, and other vegetation to reduce the urban heat island effect.

Education

• Encourage professional associations to host climate change and health-related educational opportunities (e.g., conferences, workshops, articles) to inform health care providers and administrators more specifically about how they can reduce greenhouse gas emissions.
• Request that the human resources training and development department include information on the health impacts of climate change in employee orientation and training programs.

Reducing Waste

• Propose that the facilities/operations department adopt landfill waste reduction strategies, such as instituting composting in cafeterias, reducing bottled water use, and recycling paper and other waste.

To support these and other institutional changes, clinicians can encourage their affiliated organizations to join an initiative that is working to reduce the health care sector’s impact on climate change.

Policy Activities

Framing climate change in the context of health has been shown to be the most effective way to elicit support for climate policies and programs—even more than environmental or national security frames.³ Health care providers can use their expert knowledge, respected professional stature, and a health lens to advocate for scientifically-informed legislative action on climate change. Examples of policy activities are noted below.

• Describe the probable public health impacts of climate change adaptation and mitigation bills and support measures that benefit both climate mitigation and health, such as active transportation funding and infrastructure. Clinicians can stay up-to-date on proposed legislation in the California State Legislature through the Southern California Association of Governments’ Legislative Tracking Report and the Health Officer Association of California’s Bill Report, which are updated regularly.
• Promote policies that address climate change and promote health equity, such as policies that improve public transit accessibility or increase green space in communities lacking these resources, at local urban planning agency public meetings.⁴ 
• Advocate for programs and policies that make personal mitigation actions more accessible to people with low incomes, for example, supporting acceptance of SNAP EBT (Supplemental Nutrition Assistance Program Electronic Benefits Transfer) at farmers’ markets.
• Join an organization that promotes health care sector action on climate change.

Clinicians can learn how to leverage their medical expertise to positively impact policies that promote the health of patients and communities by viewing a webinar from Kyle Ragins, MD, MBA of Doctors for America, which was cosponsored by the LA County Department of Public Health.

Personal

As individuals, health care providers can reduce their own contributions to climate change through simple actions that modify their daily habits at home and at work. Some examples of personal actions you can consider are to:

• Buy more locally-grown food, such as from farmers’ markets, community-supported agriculture programs, and the local food section of grocery stores.
• Decrease water usage by taking a shower in place of a bath or adding water-efficient fixtures for both outdoor and indoor use.
• Use CFL (compact fluorescent light) or LED (light-emitting diode) bulbs in the home and office, which are more energy-efficient than regular light bulbs.⁵

See the LA County Department of Public Health’s 10 Things You Can Do to Reduce Climate Change fact sheet for additional ways to decrease personal contributions to climate change.

Health Care System Climate Change Success Stories

As noted, the health care sector is a major contributor to climate change. However, through the adoption of approaches discussed in this article, health care providers and institutions can significantly reduce their impact on emissions and climate change. Some large health care systems, including the two described below, have led the charge in using these and other strategies to decrease their carbon footprint, demonstrating the potential for robust mitigation efforts from the health care sector.

Gundersen Health System, Wisconsin, U.S.

In 2014, Gundersen Health System became the first U.S. health care system to generate more energy than it used.⁶ This was accomplished through a multitude of sustainability initiatives, including reducing energy consumption, using renewable energy, reducing waste, and improving recycling procedures.^7,8 For example, retrofitted lighting was estimated to avert about $265,000 of energy expenses annually, and the health system replaced a conventional boiler with a biomass boiler that uses locally-sourced wood as fuel and produces fewer emissions.^7,8

The National Health Service, England

The National Health Service (NHS) decreased their carbon emissions by 11% from 2007 to 2015, with most of the reduction coming from improved procurement practices.⁹ England’s Sustainable Development Unit worked on behalf of the health and care system to create the Procuring for Carbon Reduction toolkit. This toolkit includes standards for sustainable procurement, a tool for professionals to measure their current emissions and identify potential high-impact areas, and other resources.¹⁰ Changes in travel and facilities’ energy consumption also contributed to the drop in emissions.⁹ For example, NHS implemented the Active Travel Plan, which encourages staff, patients, and visitors to use sustainable forms of travel, such as cycling, walking, car sharing, or public transit, and institutions to provide supportive infrastructure, including showers and bike storage.¹¹

Considering the Needs of Vulnerable Groups

As health care providers consider actions to address climate change, it is important to acknowledge that climate change disproportionately harms low-income communities and communities of color, as discrimination against and disinvestment in these populations means that they are under-resourced to adequately prepare for and respond to climate change impacts. For example, people with low incomes and people of color are disproportionately vulnerable to the negative health impacts of extreme heat because they often live in urban heat islands and are less likely to have access to vital coping tools, like air conditioning in the home or a vehicle to travel to cooling centers.¹²

When acting to mitigate and adapt to climate change, clinicians should consider potential impacts on these groups, prioritize actions that benefit them, and value their voices in the planning process. For instance, clinicians can draw on the emerging field of geomedicine, which provides environmental health information related to a patient’s place of residence, to get a fuller picture of an individual’s potential health concerns¹³ and develop care plans that address their unique vulnerabilities and risks. When acting on institutional or policy levels, clinicians can ensure that those most impacted by climate change are centered in planning and decision-making. Because low-income individuals and communities of color are also disenfranchised in the political process, their participation is particularly important.

Further Engagement

Read additional resources on the role of clinicians in addressing climate change. 

• The Public Health Institute’s Center for Climate Change & Health published A Physician’s Guide to Climate Change, Health and Equity,¹⁴ a comprehensive guide to support physicians taking action on climate change, including sections on specific climate-health impacts, such as the relationship between air quality, climate change, and public health. Many of the recommendations included in this article were adapted from this guide. Clinicians can use the guide to select the actions that are most appropriate for them, their institution, and their patients.
• The American Medical Association’s Guide to Improving Sustainability of Health Care Practices addresses short- and long-term steps providers can take to decrease their carbon footprint, along with relevant resources to support implementation.
• My Green Doctor provides resources for improving sustainability of provider offices and outpatient facilities.

Join an organization that develops health care sector action on climate change. Examples include:

• The American Lung Association in California has two initiatives on climate change and health: Doctors for Climate Health, which showcases health professionals’ endorsement of climate change legislation in California, and Health Professionals for Clean Air, which facilitates advocacy among health professionals on legislation to decrease air pollution and climate impacts.
• The Medical Society Consortium on Climate & Health provides resources to promote health professionals’ efforts to advocate for climate change policy, spread awareness of climate-health impacts, and improve sustainability of their workplaces and personal habits.
• The US Climate and Health Alliance supports climate policy that produces health co-benefits, increases public knowledge on the health impacts of climate change, and develops health professionals’ ability to address climate change through their work.
• The Alliance of Nurses for Healthy Environments has a Global Nurses Climate Change Committee, an international team of nurses focused on education, political advocacy, and professional development related to the climate change and health connection.
• The Resource Innovation Group’s International Transformational Resilience Coalition is a network of mental health, trauma treatment, and other professionals focused on developing psychological and social resiliency among the global population to the many traumatic events anticipated from climate change.

Encourage the leadership of health care facilities and systems to join an organization that is working to decrease the impact of the health care sector on climate change. Examples include:

• Health Care Without Harm focuses on decreasing the negative environmental impacts produced by the health care sector. Clinicians can encourage their affiliated health care facilities to join Health Care Without Harm’s Global Green and Health Hospitals network, which supports sustainability of health care facilities.
• Practice Greenhealth supports sustainability initiatives in health care operations. Clinicians can advocate that their affiliated hospitals join Practice Greenhealth’s Healthier Hospitals Initiative, which invites hospitals to commit to achieve sustainability goals and provides them with tools to meet these goals and track their progress. The Healthier Hospitals Initiative also offers specific resources to aid in obtaining the support of hospital leadership.

For additional information and resources to support actions to mitigate climate change and address its impact in your practice and community, visit publichealth.lacounty.gov/eh/climatechange.

References

1. Eckelman, MJ, Sherman, J. Environmental impacts of the U.S. health care system and effects on public health. PLoS ONE. 2016;11(6):e0157014. doi:10.1371/journal.pone.0157014
2. Luber G, Knowlton K, Balbus J, et al. U.S. Global Change Research Program. National Climate Assessment. 2014. https://nca2014.globalchange.gov/report/sectors/human-health. Accessed April 30, 2018.
3. Myers, TA, Nisbet MC, Maibach EW, Leiserowitz AA. A public health frame arouses hopeful emotions about climate change: A letter. Climatic Change. 2012;113(3-4): 1105–1112. doi:10.1007/s10584-012-0513-6
4. ChangeLab Solutions and TransForm. Getting Involved in Transportation Planning: An Overview for Public Health Advocates. 2013. https:/www.changelabsolutions.org/sites/default/files/Health_Transport_Factsheet_FINAL_20110713_%28rebrand_20130409%29.pdf. Accessed October 11, 2017.
5. Los Angeles County Department of Public Health. 10 Things You Can Do to Reduce Climate Change. 2014. http://www.publichealth.lacounty.gov/eh/docs/climatechange/ThingYouCanDotoReduceClimateChange.pdf. Accessed October 18, 2017.
6. Our programs. Gundersen Envision website. 2018. https:/www.gundersenenvision.org/envision/our-programs. Accessed July 2, 2018.
7. Energy conservation. Gundersen Envision. 2018. https://www.gundersenenvision.org/envision/our-programs/energy-conservation. Accessed July 2, 2018.
8. Renewable energy. Gundersen Envision. 2018. https://www.gundersenenvision.org/envision/our-programs/renewable-energy. Accessed July 2, 2018.
9. Carbon footprint update for NHS in England 2015. NHS England and Sustainable Development Unit. 2016. https://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx. Accessed April 30, 2018.
10. Procuring for Carbon Reduction: Executive Summary. NHS England and Sustainable Development Unit. 2010. https://www.sduhealth.org.uk/areas-of-focus/commissioning-and-procurement/procurement/research-tools-and-guidance.aspx. Accessed June 4, 2018.
11. SDU Knowledge Briefing 1: What does a NHS Active Travel Plan look like? NHS England and Sustainable Development Unit. 2011. https://www.sduhealth.org.uk/documents/publications/Activetravel2011.pdf. Accessed May 31, 2018.
12. Morello-Frosch R, Pastor M, Sadd J, Shonkoff, SB. The Climate Gap: Inequalities in How Climate Change Hurts Americans & How to Close the Gap. University of Southern California Program for Environmental and Regional Equity (PERE). 2009. https://dornsife.usc.edu/pere/climategap/. Accessed April 30, 2018.
13. Davenhall, B. Geomedicine: Geography and Personal Health. Esri. 2012. http:/www.esri.com/library/ebooks/geomedicine.pdf. Accessed June 4, 2018.
14. Rudolph, L, Harrison, C. A Physician’s Guide to Climate Change, Health and Equity. Center for Climate Change and Health and Public Health Institute. 2016. http://www.climatehealthconnect.org/wp-content/uploads/2016/09/FullGuideTEMP.pdf. Accessed July 24, 2017.