Health care sector decarbonization to accelerate in 2023: How to do it best

As health care sustainability enthusiasts, we’re hopeful. Major health care institutions are publicly recognizing both the impact health care sector carbon emissions have on our environment and global health, and the need to do something about it.

In 2021, the New England Journal joined over 200 medical journals in declaring climate change “the greatest threat to global public health.” In 2022, the National Academy of Medicine, the Institute for Healthcare Improvement, and The Joint Commission (TJC) all directed resources toward decarbonizing the health care sector. And just this November the Department of Health and Human Services (HHS) announced more than 100 health care organizations signed the Health Sector Climate Pledge.

In 2023, we expect a lot more of the health care sector to join these 102 early adopters. Some will recognize the societal and financial value of eliminating waste, conserving energy and decarbonizing the practice of medicine. Others will be compelled by federal action: the Centers for Medicare and Medicaid Services (CMS) has highlighted the “importance of setting goals for reduced emissions.” We expect thoughtful regulations guiding health care sector decarbonization to follow.

Honing the health care decarbonization metric

HHS’ Health Sector Climate Pledge focuses on absolute emissions reduction until 2030 and then a “net-zero” emission goal by 2050. We strongly prefer an absolute emission reduction metric to “net-zero” for both short and long-term goals.

Consider that an organization mandated to be “net-zero” by 2050 can continue to emit carbon without reduction until 2049. And then in 2050 that organization can continue to emit carbon, account for the carbon it emits, purchase traditional carbon offsets equivalent to the carbon it emits, and claim “net-zero” emissions. “Net-zero” may result in decades of emissions without any reduction.

Even the use of traditional carbon offsets (e.g. paying for solar electricity generation, conserving forests and planting trees) is concerning. Traditional carbon offsets often do not necessarily achieve what they claim: Renewable energy power plants may be built because they’re cost-effective, conserved forests result in the substitution of non-conserved forests for lumber and saplings die before they mature into trees.

If an institution cannot meet an absolute emission reduction goal, we recommend direct capture of carbon as an acceptable, market-based, solution instead of carbon offsets. Direct air capture of carbon sequesters atmospheric carbon into subterranean rock formations. The International Energy Agency (IEA) estimates the current cost of direct air capture between $134 and $344 per ton. With an average hospital patient generating 45 kg of carbon emissions per day, direct air capture of those emissions could cost as little as $6 per patient per day.

We recommend reasonable absolute emission reductions on a five-year schedule as the primary health care sector decarbonization metric.

High-value, health system-focused decarbonization

From personal experience, we recognize many health care sector institutions including health systems have yet to consider how to decarbonize. High-value health care is fundamental to decarbonization: optimize patient outcomes, eliminate waste. While eliminating carbon emissions entirely from the health care sector may require innovation and time, there are many opportunities to reduce emissions now. We offer three suggestions that can be implemented today to help companies start toward their absolute emission reduction goals:

1. Telemedicine can be used for many clinic visits. The UK’s National Health Service calculates about 5 percent of its emissions come from patient travel. Optimizing telemedicine will eliminate emissions from transportation and overtime from the construction and maintenance of clinic buildings.
2. Operating rooms require a high number of emission-intensive, conditioned air exchanges during surgery to maintain sterility. This major source of emissions can be reduced at nights and weekends without impacting clinical care. Other examples of emission-intensive clinical processes with no clinical benefit need to be investigated and disseminated as best practices by TJC.
3. Preferentially support companies that are actually reducing emissions from their supply chain (not just using carbon offsets). Decarbonization of the $4 trillion health care sector will ripple throughout the global economy as many sustainable practices (e.g. less energy intensive) will be financially superior at scale.

Health care’s future is decarbonized

The health care sector in the United States represents 8.5 percent of U.S. carbon emissions and over 17 percent of U.S. GDP. Decarbonization of the health care sector has started and will accelerate in the new year — billions of dollars will be spent. Early adopters have already signed HHS’ Health Sector Climate Pledge. TJC, CMS and other entities are marshaling their substantial resources to gently compel health care sector institutions to decarbonize. Focusing on “net-zero” emissions may delay emissions reductions and result in money being spent on less effective carbon offsets.

The devil is in the details, and execution matters — decarbonization aligns with high-value health care. We strongly encourage the health care sector to adopt absolute emission reductions as its decarbonization metric, as well as direct carbon capture as the best way to account for emissions when absolute emission reduction targets are not met. We look to the rest of the year with hope that the health care sector can leap from laggard to leader in the climate change public health crisis.

Matthew J. Meyer, MD, is co-chair of UVA Health's Sustainability Committee and a steering-committee member of Virginia Clinicians for Climate Action. He is also a perioperative sustainability researcher, innovator/inventor and advocate at the University of Virginia.

Bill Shobe, Ph.D., is an environmental economist, professor and the director of the University of Virginia's Center for Economic and Policy Studies with expertise in carbon emission markets and carbon capture technology.