The National Academy of Medicine formed late last year a collaborative convening public and private stakeholders from across the healthcare industry to work together in reducing healthcare’s contribution to carbon emissions. Victor Dzau, MD, president of the National Academy of Medicine, discussed with Modern Healthcare Custom Media the impetus for establishing the collaborative, the importance of measuring this work and the business case for healthcare organizations to prioritize decarbonization.

The National Academy of Medicine launched the Action Collaborative on Decarbonizing the U.S. Health Sector in fall 2021. What was the motivation for forming the collaborative?

Climate change and environmental factors are main sources of public health illness. If you look at just climate alone and you look at global data, about 20 million deaths per year are related to climate factors. Secondly, it affects poorer countries, and in our case in the U.S., the social and economically challenged communities, a lot more than the richer communities, so it's an equity problem as well.

I've only discovered over the last few years that the U.S. healthcare sector admits 8.5% of carbon emissions of the entire country. That's a huge number—it’s bigger than many other industries. We have an accountability issue. We have to be part of the solution to reduce carbon emissions.

What does it mean to be part of the collaborative as a healthcare organization?

This is a coalition of the willing. Our (recent) meeting of the entire collaborative, which has 60 core members and another 60 network members, all agreed to set a goal of 50% reduction in carbon emissions by 2030 and net zero carbon emissions by 2050, supporting the Biden administration's goals.

Where we are right now is for (healthcare leaders) to say, ‘This is a good thing to do. We will commit our organization to these goals.’ That is simply the beginning. Our (next) focus is to agree on what to measure and what protocols to follow. Once we get a standard, I believe more organizations will feel comfortable (getting involved in this work). The collaborative will not only determine what to measure, but also what are the tools available to help your organization do this work.

How should a health system make the business case to their board for addressing decarbonization, considering investments will likely be involved?

We are actually going to do a study on the business case for doing this. Healthcare can find lots of savings when we deliver care differently. We’re also talking to the Center for Medicare and Medicaid Innovation about using some of these measurements in value-based payment. So, we're thinking about all those possibilities.

Of course, these things will require initial investment. We will figure out a way to incentivize (healthcare organizations) to do this work. I also think that there's a big role for clinicians to play here. In the quality movement, we incentivize clinicians to come up with new ideas of how to improve quality of care for patients; I believe we can do the same here.

What are your near-term goals right now for the collaborative and decarbonization in healthcare overall?

Over the next couple of months, we will release how healthcare organizations can measure decarbonization efforts. Then, we’d like to see organizations applying these measures and determining their baseline. Following that is providing a toolkit to help organizations do this work. (The toolkit will feature case studies from health systems already focused on decarbonization). We're going to help each other and learn from each other.

And within the collaborative, we expect every organization to share a report with us (on their efforts). These things will have to happen fairly quickly. In 2023, we’ll see where we are as a group, and whether we need to ramp up.

Is there appropriate governance structure for ESG that organizations should adopt?

It has to permeate at all levels, no question. Commitment and participation are not going to work from the top-down. That being said, the board has to take this on seriously. When I was at Duke University Health System, we installed a chief patient safety officer who reported to the board. That's important. If you look at clinician burnout, our academy collaborative advised organizations to start hiring chief wellness officers. I think what we need here are chief sustainability officers, and not every institution has them. So, high priority from the very top, but it must integrate within the organization at all levels.

What are your thoughts on the current state of ESG today in healthcare?

More and more organizations are certainly understanding their important role with regards to social responsibility, but I don't think we do enough about social responsibility and social good. Environment is one of those social responsibilities, and I think institutions can do a lot in elevating environment—the ‘E’—along with the ‘S’ and the ‘G’.