Health Sector CARES Pledge

Unfortunately, natural disasters are increasing in both severity and frequency. Without a rapid phase-out of fossil fuels, one in 12 hospitals worldwide are at high risk of total or partial shutdown by the end of this century. The good news is that action now can help prevent the worst impacts of climate change.

Planning for resilience and finding ways to become more energy efficient are common-sense strategies to support your patients, community, and staff. For example, installing energy-efficient building equipment extends the length of time a facility can function on back-up power systems.

Whether or not your organization officially signs a commitment, these goals are still worth striving for. Signing the Health Sector CARES Pledge offers access to resources and a community of support that can help you identify and prioritize opportunities, track your progress, and achieve your goals.

The pledge is completely free, as are the educational resources and networking opportunities provided.

Health Care Without Harm has created resources to support pledge signatories at every stage of their journey. We will be rolling out additional learning and networking opportunities in the coming months, and welcome feedback from signatories regarding what supports are most useful.

The pledge is open to any health sector organization, including hospitals, health centers, rural health clinics, suppliers, insurers, and group purchasing organizations.

The pledge elements are similar to those of the Health Sector Climate Pledge previously led by the U.S. Department of Health and Human Services. By offering a similar pathway, Health Care Without Harm aims to create an open door for those ready to deepen their climate and resilience efforts.

When signing the pledge, organizations commit to publicly reporting on progress reducing Scope 1 and 2 emissions annually, sharing strategies for reducing emissions, and developing and releasing a climate resilience plan. Health Care Without Harm encourages organizations to share links to their publicly reported information, or any other pledge progress, such as their Scope 3 emissions inventory, with our organization. After signing the pledge, organizations will receive a point of contact with whom to share information, questions, and comments. Health Care Without Harm will not share any information without the organization’s consent, but may report on aggregate numbers such as metric tons of GHG emissions avoided.

The business case for resilient and sustainable health care is strong, including potential significant cost savings. Many sustainable and healthy design strategies bring multiple co-benefits to health care organizations, such as reducing utility costs and enhancing their resilience to climate change-related events.

Key actions like installing onsite alternative energy systems can help a health care organization stay operational during and after a crisis, avoiding lost revenue and better supporting patients. For example, Greenwich Hospital’s combined heat and power system has allowed them to stay open during storms, even admitting new patients and housing staff during Superstorm Sandy.

The National Institute of Building Sciences found that every $1 invested in climate resilience activities returns up to $13 in reduced risk of damage to infrastructure. A 2012 study analyzed cost savings data from hospitals that implemented programs to reduce waste, energy use, and operating room supply efficiencies. After standardizing metrics across the hospitals studied and generalizing results to hospitals nationwide, the analysis finds that savings achievable through these interventions could exceed $5.4 billion over five years and $15 billion over 10 years.

Retrofitting inefficient lighting, adjusting thermostats for seasonal changes and occupancy, investing in highly efficient HVAC systems, and educating staff and patients about how their behaviors affect energy use are some important first steps. Health Care Without Harm’s Cooling energy efficiency checklist for health care facilities can help you get started.

For inpatient facilities, deactivation or avoiding construction of central nitrous oxide piping can save money and reduce emissions. In 2021, Providence St. Vincent Medical Center deactivated central piped nitrous oxide and substituted portable E cylinders after discovering high rates of infrastructure leaks. The deactivation of central nitrous oxide piping reduced losses by 958 tons of carbon dioxide equivalent (CO2e) (the equivalent of 206 gasoline-powered passenger vehicles off the road) in one year and saved $12,000 in procurement costs.

Another relevant example for inpatient facilities is switching from the high global warming impact anesthetic gas desflurane to a lower emissions alternative like sevoflurane. The Yale New Haven Health System formulary made that switch in 2013, resulting in annual savings of $1.2 million across the health system. From the largest hospital alone (1,490 beds), 1,600 tons of CO2e emissions were eliminated that year, equivalent to removing 360 gasoline-powered passenger vehicles from the road.

Health care leaders can protect lives and the organization’s financial viability by preparing for weather events and investing in climate resilience. Health care facilities need to be built and operated so they can stay open, operational, and able to serve their communities during and after extreme weather events. There is a strong business case for investing in health care climate resilience.

For example, in 2012, after Superstorm Sandy, NYU Langone Medical Center was forced to evacuate 322 patients at night, disrupting patient care and delaying treatment. As a result of the event, surgery was suspended for two months, the emergency department was closed for 18 months, over 500 providers sought privileges elsewhere, and the facility lost 10,000 carefully bred research rodents. Total costs exceeded $1.4 billion, and an estimated loss of revenue exceeded $400 million.

In the case of hospitals, FEMA estimates that the average infrastructure cost to hospitals from storm damage ranges from $600,000–$2 billion per facility, whereas the cost of resilience retrofits for the three types of equipment that are most likely to be damaged (elevator crankcases, windows, and generators) is much less. WHO estimates that nonstructural retrofits that enhance a hospital’s resilience cost 1% of the facility’s total value and can protect up to 90% of its assets.

A climate resilience plan should be developed through equitable engagement with community partners, use an all-hazards approach to emergency preparedness, and address the needs of community members at disproportionate risk from climate-related disruptions and health hazards. Learn more, and find a recommended climate resilience plan outline and example plans, on Practice Greenhealth’s climate resilience planning page.

You may be required to have an emergency preparedness plan to participate in programs like Medicare and Medicaid. Health Care Without Harm encourages you to use the climate resilience planning process to improve and further integrate existing emergency preparedness plans. For example, CommonSpirit has created a climate-informed framework to apply to all of its hospitals’ emergency response plans. The framework is refined by each hospital to reflect local resources and meet the specific needs of each community. This includes coordinating with local partners and tailoring response plans to local climate hazards.

Consider signing the United Nations High-Level Climate Champions for Climate Action (UNFCCC) Race to Zero and Race to Resilience – global initiatives aligned with the Paris Agreement’s goals for emissions reduction. The Health Sector CARES Pledge has a lower barrier to entry than Race to Zero, which requires emissions reduction across all scopes rather than just Scopes 1 and 2, and the Race to Resilience, which aims to quantify community resilience at the individual level.

Join Practice Greenhealth. This network of over 1,700 hospitals across the United States and Canada is a rich peer collaborative supported directly by sustainability subject matter experts who can help your organization identify and implement practical, cost-effective solutions and realize your climate and sustainability goals.

Consider joining the National Academy of Medicine Initiative to Accelerate the National Climate and Health Movement. This initiative mobilizes health organizations at any stage of their sustainability journey, offering free membership, guidance, resources, and networking opportunities. You can also still take advantage of many of Health Care Without Harm’s resources.