Climate change, as The Lancet Commission put it in 2009, is “the biggest public health threat of the 21st century.” Since then, the climate crisis has only deepened, and the science has become increasingly irrefutable, heightening the urgency for action.

We know climate change is already exacerbating a wide range of health problems around the world. As the earth warms, infectious diseases like malaria and dengue are spreading to new locations, threatening to reverse hard-won health gains in many parts of the planet. Heat waves are growing in intensity and number, killing tens of thousands outright and aggravating asthma, heart disease, and heat stroke. Increasingly severe storms, droughts, fires, and floods, harm human health and put oft-overstretched and ill-prepared health systems at risk.

If greenhouse gas emissions remain unchecked, climate change will, within a matter of decades, have severe, pervasive, and irreversible effects, undermining the food and water supply in many parts of the world, setting off mass migrations, and thereby triggering potentially unmanageable public health crises. While everyone will experience the scourge of climate change, the most vulnerable populations – the urban and rural poor, those who are least responsible for the problem – will suffer the greatest impacts.

Fossil fuel combustion, particularly burning coal, is the single greatest contributor to greenhouse gas emissions. Fossil fuels are also the source of significant local health problems. For instance, fossil fuels make a major contribution to air pollution, which, according to the World Health Organization, killed 7 million people in 2012, causing twice as many deaths as AIDS, malaria, and tuberculosis combined.

In order to protect local and global health from climate change and its sources, the world needs to move toward an economy based on clean, renewable, healthy energy. A transition to a clean energy economy will benefit both the climate and public health.

As providers of health care, we recognize that we can play a leadership role in this transition by fostering climate-smart health care.

We pledge to do our part to meet the challenge posed by climate change – a test perhaps as great as human civilization has ever known – by taking the following steps:

1. Reduce our own climate footprint: Our collective vision is to reduce our health care systems’ emissions, moving toward low-carbon, and ultimately, carbon-neutral health care. Many hospitals are major energy consumers and can make large reductions in greenhouse gas emissions. Other hospitals and health systems are energy-starved and can deploy renewable energy to foster greater access to health care and better health outcomes. We pledge to lead the way toward low-carbon health care by setting greenhouse gas reduction targets. We will work to implement energy efficiency measures and, when feasible, deploy clean renewable energy to power our buildings. We will measure and report on our progress, including financial savings related to these actions. We will also seek to identify our institutions’ other climate impacts, including transportation systems, use of anesthetic gases, purchasing policies, waste generation, and disposal. We will develop and implement plans to reduce these impacts as well.   
    
2. Prepare for climate impacts: In order to serve our communities, hospitals and health centers need to remain operational during and after an extreme weather event. We need to understand, anticipate, and be equipped to manage the health needs of our immediate community and prepare for shifting disease patterns. We pledge to prepare for the impacts of climate change by becoming more resilient to increasing incidents of extreme weather. We will work to implement a series of measures to assure our physical infrastructure, staff, and communities are prepared for the immediate impact of extreme weather events and the longer-term impacts of changing patterns of disease, as well as other climate impacts, combining these efforts with low-carbon solutions when possible.   
    
3. Lead the way to a low-carbon future: As health care providers respected by local communities, government and business, we commit to provide leadership in our societies for a healthy climate. We pledge to do so by educating health care professionals and hospital staff, as well as the communities we serve, on challenges and solutions related to climate and health. We also pledge to encourage public policy, economic development, and investment strategies that move our societies away from fossil fuel dependency and foster instead a healthy energy future, thereby protecting local and global health from fossil fuel combustion and climate change.

By moving toward climate-smart, low-carbon health systems, health care can mitigate its own climate impact, save money, and lead by example. By becoming more resilient, health care can help prepare for the growing impacts of climate change. And by providing societal leadership, we can help forge a vision of a future with healthy hospitals and healthy people living on a healthy planet.