Key Takeaways
- The US healthcare system contributes 8.5% of greenhouse gas emissions, and hospitals make up an estimated 36% of these emissions.
- Energy consumption in the US disproportionately affects communities of color, while these communities contribute the least to consumption.
- Energy Star Scores allow for the critique of the energy consumption of hospital buildings, however, there are reporting inconsistencies.
- Standardization of data reporting methods will allow for more accurate and widespread analysis of hospitals and their environmental and social responsibility.
- Governmental and administration commitment to energy responsibility promotes change for healthcare and environmental justice.
Healthcare and its Environmental Impact
With energy efficiency and carbon emissions becoming a greater focus throughout the United States, there has been a push for responsible energy usage from industries, specifically the healthcare industry. Currently, the healthcare industry contributes about 8.5% of greenhouse gas emissions in the US, and emissions increased by 6% from 2010-2018.
Hospitals are some of the largest healthcare institutions in the US, making up one third of all healthcare spending and an estimated 36% of greenhouse gas emissions. As hospitals have grown from small charities to big businesses, so has their carbon footprint. Ironically, hospitals that were created to improve community health may be contributing to health problems through their emissions. Tracking hospitals’ environmental impact and the actions they are taking to improve are important elements of hospital social responsibility.
Environmental Injustice
Hospitals’ environmental impact is especially important for health equity, because pollution and climate change have a disproportionate impact on communities of color. Historically marginalized communities experience the highest burden of environmental injustice while simultaneously contributing the least to it.
Decades of inequality in housing and living conditions have perpetuated into the present day. Historical redlining, or discriminatory loan and services decisions, has led many communities of color to only find housing in areas the most impacted by pollution despite being outlawed fifty years ago. In California, Boyle Heights has a large Latino population, and also has the highest pollution burden score available: 100. Overall, Hispanic and Black communities experience 56-63% excess pollution burden in comparison to their non-Hispanic White counterparts. Pollution– especially particulate matter — causes significant damage to the lungs and worsens heart disease.
How does the healthcare industry contribute to environmental inequities? What are the current measurements that can assess this?
Energy Star Scores
To measure energy consumption, the Environmental Protection Agency (EPA) created a metric called Energy Star Scores. Energy Star scores evaluate the energy use of buildings and adjust usage for building size and geographic area to create a 1-100 scale. For these scores, a score of 50 is the median; a higher score means the building is more energy efficient.
Energy Star scores would be an excellent way to examine and compare hospital performance on greenhouse gas emissions– but unfortunately the availability of this data is very inconsistent. The EPA only makes public the scores of hospitals in the top quarter of performance. Some local and state governments also make energy star data available, but it’s not close to universal.
I took a deep dive into the energy star scores of hospitals nationwide to see what was available and what insights we could glean from the available information. Recent Energy Star scores reported from 2017 to 2022 were collected through city and state databases.
There were 486 hospital buildings across 37 states that had available data. That’s just 8.0% of hospitals in the US total. Although the spread of cities that report Energy Star data is consistent across the United States, the most notable states that had widespread data availability was California (160 hospitals reported) and New York (88 hospitals reported).
I found substantial variation in energy star scores among hospitals, even within the same city. For example, in Anaheim, CA, West Anaheim Medical Center reported an Energy Star Score of 86 in 2021, while the Anaheim Hospital Campus reported a score of 46. Although these hospitals reside in the same city, these drastically different energy star scores indicate a substantial difference of their contribution to energy consumption.
Data availability
However, the paucity of data makes it hard to make substantive conclusions about how hospitals are doing. Another significant challenge with the data is that one hospital may have multiple buildings with many energy star scores. For example, New York Presbyterian Queens Hospital “West Building + Garage” has an energy star score of 100, but their main building and other wings are not reported. While it is logical that these hospitals do report different buildings, it’s hard to know how to evaluate a hospital with multiple different scores. The lack of a hospital identification number also makes it difficult to match hospitals with their buildings without the use of address matching.
Energy star scores have the potential to allow a deeper understanding of how hospitals are doing on the “E” in ESG (Environmental, Social, and Governance). However, data availability and consistency issues have precluded this becoming a tool for nationwide comparisons. Ideally, this data would be available in state benchmark databases. These databases would include information regarding Energy Star Scores that allow for city-by-city comparison, as well as regional and national comparisons. Additionally, data reported would be accessible to the public, including a standard reporting method that reduces confusion and uncertainties.
That would give allow us to track hospitals’ progress over time and better understand patterns of environmental injustice and health disparities.
Climate Action
What are government agencies and hospitals currently doing to reduce greenhouse gas emissions? As of June 2022, the Biden Administration launched a Health Sector Climate Pledge to halve the carbon emissions made by 2030 and reach net-zero emissions by 2050. However, this Climate Pledge is a voluntary commitment. For greater environmental benefits to occur, mandatory adherence to environmental responsibility will be needed.
Even without regulatory mandates, many healthcare corporations are already creating policies to target their energy consumption. Some notable hospital administrations that are making changes to reduce their carbon footprint include Gundersen Health System becoming energy independent as of 2014 and Rochester Regional Health completing the development of a solar farm and contributing to renewable power.
Hospitals are striving to be community partners in health, but heavy greenhouse gas emissions contribute to climate change and make people less healthy. Environmental impact is an essential part of social responsibility, but progress has been slow and lack of data is a considerable challenge. While some hospitals and policymakers are taking action, we need system-wide changes to make sure hospitals are accountable for environmental harm and pollution.
Environmental health is interconnected with public health– the prioritization of one requires the prioritization of the other. With greater change, our environmental responsibility can benefit us all.