Healthcare companies in recent years have largely focused on reducing greenhouse gas emissions as they strive to become more environmentally sustainable. While that focus has produced several innovations in conservation and alternative energy use, critics argue those actions have only scratched the surface of reducing healthcare's climate footprint.
Hospitals have remained one of the world's largest polluters despite increased calls to address climate change. Healthcare greenhouse emissions rose 6% from 2012 to 2018, according to a December 2020 Health Affairs study. As a whole, the industry now makes up more than 8% of all U.S. emissions.
"The healthcare sector has been a real laggard in terms of climate," said Jessica Wolff, director of climate and health for Health Care Without Harm, an international advocacy organization that promotes ecological healthcare practices. "In corporate America, many, many companies have done full greenhouse gas inventories and set ambitious goals—that's not the case with this sector."
Much of the problem has involved a lack of progress in addressing the single largest contributor to healthcare-related greenhouse gas emissions: the supply chain. Studies estimate more than 80% of greenhouse gas emissions came from sources like hospital waste disposal services, food and pharmaceutical production, and medical device and equipment makers.
Those healthcare-related greenhouse gases are categorized as "Scope 3" emissions, which encompass sources not directly owned or controlled by hospitals and health systems.
Some healthcare providers have launched initiatives focused on reducing Scope 3 emissions as part of their broader goal of becoming "carbon neutral" over the next few years. Providers set goals to limit business travel and employee commutes well prior to the pandemic, and have reduced emissions from their food service and waste disposal operations. Kaiser Permanente employed similar strategies as part of their process to become the first health system in the country to achieve carbon neutral status in September 2020.
But the conversation among climate advocates has shifted away from carbon neutrality in the years since health systems began committing to that goal. Many advocates believe health systems need a more ambitious target of achieving "net zero" status.
"Carbon neutrality is a bit outdated because it permits overreliance on carbon offsets," said Dr. Jodi Sherman, founding director of the healthcare environmental sustainability program at the Yale School of Public Health's Center for Climate and Health. "We need to mitigate everything within our direct influence before purchasing offsets, and we can't ignore these [Scope 3] emissions."
Both "carbon neutral" and "net zero" refer to entities that offset the amount of greenhouse gases they add to the atmosphere by removing an equal amount of emissions. But carbon neutrality sets a lower bar. Healthcare providers can focus largely on reducing their direct emissions and fossil fuel-based energy consumption while investing in non-related, "carbon offset" programs that reduce greenhouse emissions elsewhere as a means of reaching carbon neutrality.
But net zero goes further because it encompasses reducing and eliminating all direct and indirect carbon emissions related to the operation of that healthcare organization, independent of carbon offsets.
"That's the next phase because it really points to a faster pace of decarbonization across all scopes," Wolff said.
Going for 'zero'
Calls have grown louder for healthcare stakeholders to be more proactive in addressing the greenhouse gases and pollutants emitted from their supply chains. In an opinion article published in the New England Journal of Medicine on Oct. 13, a group of authors that included National Academy of Medicine President Dr. Victor Dzau wrote that tackling carbon emissions that come from the healthcare supply chain was,"...central to decarbonizing the sector."
Wolff said Health Care Without Harm has partnered with several providers over the past year to conduct Scope 3 assessments and identify certain emission "hot spots" within the supply chain.
Kaiser Chair and CEO Greg Adams said he saw tackling the carbon intensity of the supply chain and other indirect emissions created through the integrated health system's business activities as its next big environmental sustainability goal.
"We have already undertaken a robust inventory of those indirect emissions and are exploring the next avenues for addressing the inseparable issues of climate change and health," Adams said.
Renton, Wash.-based Providence is working with its vendors to reduce carbon emissions from its purchased goods and services. It's is a vital factor in the health-system's overall goal to become carbon negative by 2030, according to Alison Santore, chief advocacy and sustainability officer.
She estimated greenhouse gases emanated from their supply chain accounted for nearly 40% of Providence's total carbon emission output.
Providence hopes to reduce emissions from transportation by 40% by 2028 and cut its total waste to landfill or incineration by half by 2030. At Providence Portland Medical Center, clinicians began in 2019 replacing anesthetic gases containing the agent desflurane, which once released can last up to 14 years in the atmosphere, with sevoflurane, which has 20 times less impact on the climate and lasts up to one year in the atmosphere. Because of the switch, Providence hospitals in Oregon have reduced the amount of greenhouse emissions coming from the use of surgical anesthesia by 70%.
Looking ahead, Santore said the health system has made environmental sustainability an integral part of its commitments to improve supplier diversity. In June, Providence announced plans to purchase $1 billion from women- and minority-owned businesses over the next five years. The health system has been collecting data on all of its current vendors to evaluate who and where it is buying its goods and have put in place an environmentally preferable purchasing program where sustainability expectations are built into contracts with vendors.
"We have tremendous leverage and a tremendous opportunity and responsibility to shape the Scope 3 emissions around the supply chain," said Santore, who estimated Providence's total annual supply chain budget was between $4 billion and $5 billion.
Providence's plan is a first because of the health system's commitment to reach its emission-reduction goals without the use of carbon offsets, she said.
"We could become carbon negative tomorrow with the wholesale purchase of offsets, but we want to do this the right way," Santore said. "We have committed to doing the work."
Other health systems have also sought to use their buying power to improve environmental sustainability within their supply chains.
Mass General Brigham in Boston has set a goal of becoming carbon neutral from direct emissions by 2025 and has reduced its emissions by 78% compared to 2008 levels.
But the health system has also been active in addressing supply chain issues. In 2016, Mass General Brigham along with nine other major health systems formed Greenhealth Exchange, a purchasing collaborative aimed at sourcing from suppliers of sustainable products.
The exchange is planning on rolling out a new program, Greenhealth Approved, to evaluate products and certify green products.
"In this way we hope to make it easier for healthcare supply chain managers, and indeed supply chain managers in other market sectors, to select high quality environmentally responsible product," said Dennis Villanueva, senior manager of energy and sustainability, real estate and facilities for Mass General Brigham.
Healthcare as a whole needs to make a more concerted effort in addressing Scope 3 emissions, according to Yale's Sherman. The lack of progress is largely stemming from an overreliance on individual providers' voluntary actions. That could change if regulators require healthcare organizations to report and mitigate their emission reduction efforts.
"This is very serious business—we have to do it and we have to do it quickly," Sherman said.