Health Care's Climate Change Contradiction

March 24, 2022

The U.S. health care system is responsible for 8.5% of the country’s greenhouse gas emissions. We discuss how health care contributes to climate change, how some hospitals are trying to reduce their carbon footprint and what more needs to be done.

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NOTE: This episode has been updated to clarify Practice Greenhealth’s operating model.

Dan Gorenstein: The evidence is clear.

Climate change is bad for our health, often deadly.

And the industry that’s supposed to heal us is a big part of the problem.

Gary Cohen: The health care sector is almost 10% of our greenhouse gas emissions. So the health care sector is a major climate polluter.

DG: Today, health care’s role in the climate crisis and what policies are needed to shrink its carbon footprint. 

From the studio at the Leonard Davis Institute of Health Economics, I’m Dan Gorenstein and this is Tradeoffs.


GC: The U.S. health care system represents all the contradictions of our economy. It’s built on fossil fuels. It’s built on toxic chemicals. It buys food that contributes to the very diseases that it’s trying to solve for. So the health care sector is itself a major polluter. But its mission is to heal people. So the contradiction between its mission and its operations is profound.

DG: Gary Cohen is the co-founder and president of the global nonprofit Health Care Without Harm.

Gary’s been an environmental activist since the mid-80s.

GC: Working with moms and dads who were concerned with the fact that their kids might wake up choking because of the bad air or that they got skin lesions after they took a bath.

DG: But in 1996, Gary read a government report that shifted his focus. 

It said medical waste incinerators were one of the top sources of cancer-causing pollution.

GC: When we learned that the health care sector, hospitals were a leading source, we said, “My God, we have to do something about that.” Because this sector of any sector of the economy needs to understand the links between the environment and people’s health and clean up their own house, their facilities.

DG: That year, Gary got together with a few other environmentalists and health advocates to start Health Care Without Harm, primarily to help hospitals do better.

Over the next 15 years, the organization helped shrink the number of medical waste incinerators in the U.S. from around 4,500 to just 54.

It was a major victory and part of the reason Gary won a MacArthur Genius award in 2015.

But the buildings that heal us are still causing us harm. 

And the stakes have only gotten higher.

Clip: Climate change is a health emergency.
Clip: Climate change is causing more severe weather disasters.
Clip: Tropical cyclones, hurricanes, floods, wildfires, periods of extreme heat.
Clip: Causing things like decline in water quality, increase risk of respiratory disease and a negative impact on our mental health conditions.
Clip: We are doing this to ourselves.

DG: In the early 2000s, Gary helped start Practice Greenhealth, which sells health care organizations tools and resources to help them reduce their environmental impact. 

The latest research shows that 8.5% of all greenhouse gas emissions in the U.S. are produced by the health care sector. 

Some of those emissions come from the hospital itself — anesthetic gasses used in surgery, gasoline-guzzling vehicles, the electricity needed to keep the lights on.

But the vast majority of health care’s emissions, Gary says, come from outside the four walls of the hospital.

GC: It’s in the supply chain and the investments they make, and that’s somewhere between 70 and 82 percent of the entire climate footprint of the health care sector.

DG: Given that so much of the pollution is happening via the supply chain, Gary, as opposed to what’s happening on the campus, what options do hospitals have to really try to make changes to the supply chain footprint?

GC: Yeah. Our experience over the last 25 years has shown us that if you can aggregate the power of many hospital systems, they can go to the supply chain, to the companies that are producing and say, “Look, this is what we want: to buy safer pharmaceuticals, to buy reusable materials instead of throwaway plastics, to buy more local and sustainable food for their facilities instead of industrialized food produced with lots of pesticides.” And the companies will respond because the volume of health care is so large. Health care is 20% of the U.S. economy, so it has enormous economic power. And so we see that as the driver for innovation in the supply chain.

DG: What, Gary, is the best example of these hospitals marshaling their resources and leveraging their buying power where you’ve seen some significant movement?

GC: We found that the furnishings that hospitals bought for their facilities were full of toxic chemicals. So we designed a standard with the hospitals that said, we don’t want to have any of these flame retardants that are toxic. We don’t want to have any of these Teflon-like chemicals that build up in our bodies. We don’t want to have PVC plastics. And over the course of 4 years, several hundred hospitals bought safer furnishings worth over $800 million. And 100 different companies said we can innovate to provide those safer furnishings. So they’ve responded to the huge economic demand of the hospital saying we want healthier products for our facilities. 

DG: Gary says a great next step in greening the medical supply chain would be for hospitals to purchase fewer items made with toxic plastics and switch to reusable or biodegradable materials for things like IV bags, gowns and gloves.

Gary, I know some hospitals are also trying to cut back on the emissions more directly under their control — switching to renewable energy, electric vehicles, things like that. But what percent of hospitals are seriously engaging in thinking about how to be less of a polluter in their community and in the world? Like, I mean, are we talking about like a minority of hospitals or what?

GC: So we have a membership division called Practice Greenhealth, and this is sort of the technical assistance arm that provides guidance to hospitals around the kind of changes they could make. There’s 1,400 hospitals in the United States that are members of that, so that’s 25% of all the hospitals in the country. Inside of that, there’s a leadership group of about 10% of the U.S. hospitals that are really making these bold commitments around their own climate footprint. We need to get that up to 20% and 30% and then we need hopefully the government to come in to incentivize that and to regulate them so that’s standard for the future of health care.

DG: When we come back, Gary shares what policies he thinks are needed to get the rest of the country’s hospitals to start cleaning up their environmental act.


DG: Welcome back.

We’re talking with Gary Cohen, co-founder and president of Health Care Without Harm.

The nonprofit helped slash the amount of toxic waste coming from hospitals in the 1990s, and now it’s focused on helping health care fight climate change.

Gary, I’m really curious: How has COVID affected momentum on reducing health care’s carbon footprint? 

GC: Covid has cut both ways in an interesting way. In some cases, the hospitals were traumatized themselves, and the staff was so traumatized themselves they couldn’t focus on anything other than COVID. And that made total sense. And it’s still true in many hospitals. In other hospital systems, there were major commitments around bold climate goals at the same time as COVID was happening. Why?

Clip: The Caldor Fire in northern California continues to rage, as crews…

GC: Because in the last two years, we’ve had 42 extreme weather events in the United States. 

Clip: The Dallas-Forth Worth area has seen coldest temperatures in a generation this week…

GC: Each of them costing them more than a billion dollars.

Clip: A series of tornadoes tore across six states last Friday…

GC: So we’ve seen the recognition that health care needs to be addressing the climate crisis, even as they’re having to respond to this COVID pandemic.

DG: Gary, there are still 75% of health systems out there that are not on board. There are lots of reasons that we’ve heard, why not. It’s too expensive. There are other priorities. They’re busy with COVID.

What’s one meaningful step that virtually all U.S. hospitals could take in 2022 and start moving this forward?

GC: Every hospital in America could green their operating room. That means using safer anesthesia, reprocessing, reusing some of the materials they use instead of throwing them away. Every hospital could do that, and hundreds of hospitals have already done it, and we’ve shown how much money it can save them, so it’s a no brainer.

DG: So, there’s about a quarter of hospitals that are engaged in…

GC: On the path. They’re on the path.

DG: They’re on the path. Fair enough, and 10% that are really engaged. But to make a dent in this 8.5% carbon footprint, this sector being a major major polluter in our country, we’re going to need all those other hospitals to get on board. They’re not doing it on their own, Gary, as you are acutely aware. What are a couple of policies, just two or three, that you think we need to see the other hospitals come in line?

GC: Well, an innovative strategy would be to get the Joint Commission who accredits hospitals, to make climate action a quality measure in health care delivery. That would get all the hospitals in America evaluating their climate plans and demonstrating that to the Joint Commission. But one of the most important policy initiatives the federal government could enact is to require hospitals to measure their greenhouse gas emissions and make progress on their climate goals as a condition of being reimbursed by Medicare. In other words, if a hospital doesn’t measure its greenhouse gasses and doesn’t make progress on reducing its climate footprint, they wouldn’t get paid by Medicare.

DG: Just this week, the federal Securities and Exchange Commission proposed requiring all publicly traded companies to report their greenhouse gas emissions each year.

This would apply to hundreds of hospitals nationwide, including some of the country’s largest health systems like HCA, CHS and Tenet.

Gary, has the Biden administration actually done anything to suggest they’d be willing to take such a big swing at this?

Are we seeing, for example, the administration force companies, hospitals, drug makers, et cetera, to do anything that they’ve not done before?

GC: The Biden administration is requiring federal facilities — the Veterans Administration, Indian Health Service, the military hospitals — to be tracking not only their energy use, but all of the supply chain climate footprint. So that’s new, and that’s going to drive billions of dollars of purchasing for low-carbon, more sustainable technologies. That’s brand new. 

DG: And what about this new climate office Biden opened up at HHS?

Is there anything happening there?

GC: This new Office of Climate Change and Health Equity is exploring how can we get the rest of the hospitals in the country to follow on the same path? What incentives can we put together? What training programs can we put together? What tools can we offer the hospitals so that they can also travel down this path? So I think all of those things are on the table.

DG: So in your mind, Gary, what’s the clearest indicator that hospital executives, supply chain companies are taking this seriously?

GC: So, so hospital executives now are committing their entire institutions toward measurable climate goals to become carbon neutral. Some of the largest systems in the United States are making those commitments. And these are institutions with 150 hospitals, 180 hospitals and thousands and thousands of clinics. And so that’s new and that is a harbinger for the rest of the sector.

DG: Do you feel like you’ve been successful?

GC: I’d say we’re in the top of the fourth inning. 

DG: What’s the score? 

GC: Score is we’re starting to win. When we were going to have the climate treaty negotiations in Glasgow, Health Care Without Harm got together with the World Health Organization and the British government and asked countries to commit to decarbonise their health care systems and to make them more resilient in the face of climate change. Fifty-two countries, a quarter of all the countries in the world, signed up for that health program, including the U.S. government. So the momentum to address climate as a fundamental health issue exponentially accelerated in the last year. That gives me an enormous amount of hope that we have countries to work with, we have health care systems to work with. I just think there’s incredible momentum to move on this issue, and I’m more hopeful than I’ve been in 30 years.

DG: Gary, thanks for taking the time to talk to us on Tradeoffs.

GC: Thanks for having me, guys.

DG: I’m Dan Gorenstein. This is Tradeoffs.

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Episode Resources

Additional Research, Reporting and Resources on Health Care and Climate Change:

Health Care Pollution And Public Health Damage In The United States: An Update (Matthew J. Eckelman, Kaixin Huang, Robert Lagasse, Emily Senay, Robert Dubrow and Jodi D. Sherman; Health Affairs; 12/2020)

What Can Hospitals Learn from The Coca-Cola Company? Health Care Sustainability Reporting (Emily Senay, Todd Cort, William Perkison, Jasminka Goldoni Laestadius and Jodi D. Sherman; NEJM Catalyst; 2/16/2022)

The SEC wants companies to disclose how climate change is affecting them (David Gura, NPR, 3/21/2022)

Climate Change Is Affecting Our Mental Health (NIHCM Foundation, 3/17/2022)

Climate change is killing people, but there’s still time to reverse the damage (Rebecca Hersher, NPR, 2/28/2022)

US health agency will prod hospitals to cut carbon emissions (Ricardo Alonso-Zaldivar, Associated Press, 8/20/2021)

Estimated Global Disease Burden From US Health Care Sector Greenhouse Gas Emissions (Matthew J. Eckelman and Jodi D. Sherman, American Journal of Public Health, 4/26/2018)

Action Collaborative on Decarbonizing the U.S. Health Sector (National Academy of Medicine)

Episode Credits


Gary Cohen, President and Co-Founder, Health Care Without Harm and Practice Greenhealth

The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions and Epidemic Sound.

This episode was produced by Ryan Levi and mixed by Andrew Parrella.

Additional thanks to:

Jodi Sherman, Shaneeta Johnson, Natasha DeJarnett, the Tradeoffs Advisory Board…

…and our stellar staff!