Background/Objectives

Human activity is warming the climate in unprecedented ways. Climate change is intensifying existing health problems and leading to the emergence of new health threats (Romanello et al., 2023). These impacts include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, air pollution and heat waves, changes in the prevalence and geographical distribution of foodborne and waterborne illnesses and other infectious diseases, and negative impacts on mental health (Watts et al., 2020; USGCRP, 2016). The World Health Organization (WHO) has declared climate change to be the defining public health issue of our time, while the United Nations (UN) Secretary-General has called the climate crisis a “code red for humanity” (UN, 2021). The Intergovernmental Panel on Climate Change has warned that many of the impacts of global warming are now irreversible; however, there is “still a brief window of time to avoid the very worst” impacts (Pörtner et al., 2022). Certain populations are being disproportionately affected, including those who belong to historically marginalized communities, such as communities of color, low-income communities, and older adults (Romanello et al., 2022). 

All sectors of society must take urgent action to address this threat. The 28th UN Conference of the Parties (COP 28) hosted the first-ever dedicated Health Day on December 3, 2023 launching a critical call to action, which includes a Declaration on Climate and Health and calls to increase climate financing for health (Ghebreyesus et al., 2023). Within health care, hospital and health care delivery system leaders have a unique duty to take action because their fundamental mission is to provide care, improve health, and do no harm. Given that 8.5% of U.S. greenhouse gas emissions (GHGs) are from health care activities, health care must first be accountable for its own decarbonization, i.e., a broad array of activities that institutions can participate in to reduce their GHG emissions and mitigate their contributions to climate change (Laktos et al., 2023; Eckelman et al. 2020). Health care emissions stem from health care facility operations, purchased energy, supply chain of goods and services, and investments (Eckelman et al., 2020). While health care also needs to adapt to the impact of climate change and improve its resiliency, this abstract is primarily an intervention in Central Ohio to mitigate emissions from OhioHealth's care delivery system. 

With over 200 health journals calling on the United Nations, political leaders, and health professionals to recognize that climate change, environmental justice and human health are one indivisible crisis and must be tackled together to preserve health and foster equity. In 2022, OhioHealth signed onto the Health and Human Services (HHS) climate pledge to reduce greenhouse gas emissions by 50% by 2030 and achieve net zero emissions by 2050. As of today, we are the only hospital in Ohio to have signed the HHS pledge.  At OhioHealth, we believe sustainability is at the heart of our healing mission and core values and the HHS pledge is in direct alignment. It’s a commitment to stewardship that directly affects the health and well-being of the people and communities we serve. 

Approach/Activities

 As a large health system, we have a responsibility and opportunity to reduce our environmental footprint. But it’s not just about reducing waste, using different energy sources, or removing chemicals of concern. Environmental health equals public health – it’s improving patient, employee, and caregiver health. OhioHealth is committed to accelerating sustainable practices that lessen our environmental impact without sacrificing quality or safety. 

Costs Associated with Operations 

Energy represents a significant portion of a hospital and health system’s expenses, as they operate energy-intensive facilities and consume purchased electricity and fuel, which can contribute to climate change and pollution. Implementing practices such as energy-efficient lighting and heating, ventilation, and air conditioning systems and relying on renewable energy sources can enable hospitals and health systems to reduce energy consumption and save money on utility bills. Moreover, efficiency-enhancing mechanisms could be implemented; for example, clinic space and equipment could be used for longer periods to reduce capital expenses while optimizing the physical space necessary for the same workload. Estimates indicate that as much as 30% of the energy consumed in hospitals and other commercial buildings is used unnecessarily (Schierhorn, 2016). Given that energy is approximately 50% of a facility manager’s budget (i.e., utilities and building management), hospitals can reduce their operating costs by using energy more efficiently (Schierhorn, 2016). 

Tactical cost reduction implementation at OhioHealth to decarbonize and improve resiliency: 

Energy Champions at each hospital. 100% of lighting to LEDs, safer / brighter spaces. $2.4 M cost savings FY23 (all energy) Energy Star 75 on future builds 

Implemented projects, such as switching to washable isolation gowns 

98% reduction desflurane anesthetic gas to sevoflurane from 2020 levels. The global warming potential of desflurane, scaled by clinical potency is approximately 40-50 times that of sevoflurane and isoflurane over a 100 year period.  

Costs Associated with Physical Waste (Health Care, Food, and Others) 

Hospitals and health systems generate significant amounts of medical and pharmaceutical waste, and disposal fees for such waste are typically higher than that of non-hazardous waste. Addressing waste via enhanced waste segregation strategies, recycling, and reuse can lead to significant cost savings by lowering disposal costs and decreasing the need to purchase new supplies (which would increase resource consumption and related emissions). Reducing waste also helps address the climate change crisis by limiting the amount of waste sent to landfills and the amount of raw materials being used, and reuse reduces the need to order new products. 

Food waste has a cascading environmental impact because it requires more food grown or raised, requires energy and transportation, and has impacts related to methane and carbon dioxide from landfills (Alshqaqeeq et al., 2018). Efforts to reduce patient food waste can also potentially generate substantial cost savings for hospitals and health systems (Hegwer, 2019). 

OhioHealth invested in digesters, composters, and food donation programs to eliminate food waste to landfill. We incorporated purchasing controls to eliminate food waste in food production and procurement, which resulted in a 18% reduction in food cost. As a nonprofit care health care delivery organization, we utilize surplus food to nourish our community rather than harm it.  

OhioHealth has more than 80 changing stations and is able to be the first hospital in the nation to bring on all electric vehicals to reduce GHG and pollution. 

Results/Lessons Learned

A broad-level goal moves the needle on environmental sustainability and a three-year goal window accelerated wins. Setting up a governance structure was a critical success factor. 

Leadership support and trust of functional implementation teams to make an impact was key to sustainability goal ownership across the organization.  

Implementation of sustainability goals requires consideration of key stakeholders. 

We’re far from done, but the established structures will continue to support meaningful advancements in environmental stewardship, operational performance, and community heath while building a culture of excellence.  

Don’t outsource the hard work and of insight and creativity; trust internal experts to know their areas, leveraging sustainability to foster engagement and boost culture.  

Set teams up for success by celebrating wins AND learning from challenges.