How hospitals are taking action (or not) to address the climate crisis

Hospitals have become big businesses in the US, accounting for about $1.2 trillion dollars of healthcare spending each year. As this industry grows, its adverse impact on the climate has also increased. The US healthcare industry accounts for an estimated 8% of all carbon emissions in the nation and about one quarter of global healthcare emissions.

The carbon emissions from healthcare giants like hospitals– the largest emitter of greenhouse gas pollution in the industry– undoubtedly worsen all of our health. The harms associated with the climate crisis, such as fossil fuel pollution, extreme heat and weather events, infectious disease outbreaks caused by climate change, and other public health effects, cause an estimated 98,000 deaths per year in the US. This impact is far from equal; people with low-income, people of color, and people with chronic illness or disabilities, are at greater risk of harm.

Despite the urgent call from researchers, communities, and even the President, the health industry has done little to reduce emissions from hospitals. What can hospitals do to take action?

In a recent article in Health Affairs Forefront, health policy consultant and climate and health expert David Introcaso offers some solutions. We spoke with Mr. Introcaso on this topic to learn more.

Lown Institute: You write in Health Affairs that the Centers for Medicare and Medicaid (CMS) has had at least two opportunities to write a rule regulating hospitals’ carbon emissions, but so far they haven’t taken action. Why aren’t these regulatory agencies doing anything, given the increasingly adverse effects the climate crisis is having on human health?

David Introscaso: Climate change is the greatest threat to human health in history, yet federal healthcare regulators and the industry are on balance doing nothing. It remains inexplicable why we still do not connect environmental degradation with human health. Part of the inaction may be the white-coat effect; providers view themselves as being above reproach or believe their carbon pollution is the “cost of doing business.”

What could CMS do to reduce hospital carbon emissions?

CMS already conducts several value-based purchasing programs (VBPP), which provide incentives for hospitals to improve quality and reduce waste. They could create a “hospital decarbonization” VBPP that ties Medicare reimbursement to a hospital’s carbon emissions.

The Environmental Protection Agency (EPA) has the ability to measure energy intensity. They already do this for many hospitals through their Energy Star program. CMS and EPA could work together to assess each hospitals’ energy efficiency and determine their value-based payment. If that sounds radical, take a look at the National Health Service in the UK. They’ve been doing this work since 2008 and have reduced emissions by approximately 60%.

The Inflation Reduction Act invests $370 billion in spending and tax credits into clean energy. What impact do you see this having on hospitals’ environmental initiatives?

Beyond climate-related funding to the EPA and several other agencies, the IRA offers approximately 40 tax credits. While these would have been largely irrelevant to hospitals since nearly two-thirds are tax exempt, the IRA breaks new ground by making climate-related tax credits refundable to tax-exempt entities.

What have some individual hospitals done to reduce their carbon footprint?

The poster child is Kaiser Permanente. Two years ago Kaiser announced that they had become the first health care system in the US to be certified carbon neutral – meaning they both reduced their 800,000 ton annual carbon footprint or offset their carbon emissions by removing or eliminating emissions elsewhere.  The effort, they estimated, is equivalent to taking 1,750,000 cars off the road annually. Beyond making the air cleaner for their patients and employees to breathe, Kaiser noted the effort helps them retain and recruit clinicians in part because young clinicians are particularly intent on addressing a destabilizing climate.


Dr. Bernard Lown, the late founder of the Lown Institute, urged healthcare leaders to go beyond the walls of the clinic and take on the issues most important to human health. As he said in his remarks accepting the 1985 Nobel Peace Prize,

“We physicians have focused on the nuclear threat as the singular issue of our era. We are not indifferent to other human rights and hard-won civil liberties. But first we must be able to bequeath to our children the most fundamental of all rights, which preconditions all others; the right to survival.”

The climate crisis is the singular health issue today; it cannot be ignored. Healthcare leaders must advocate for the health of future generations by taking action on the climate crisis.