The path to climate-smart, net-zero emissions health care: A grand rounds series

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Grand Rounds Series 2022 Image

Presented by Health Care Without Harm in partnership with the Global Consortium on Climate and Health Education, this virtual grand rounds series explores strategies to reduce health care emissions and improve climate resilience and features the leadership of climate-smart clinicians and researchers.

View summaries and recordings of the sessions below to learn about:

  • Strategies to reduce health care emissions, improve resilience and advance equity
  • Opportunities to bring climate-smart health care to the bedside
  • Emerging research that supports the transition to resilient, net-zero emissions health care

Past sessions

Creating a movement for climate-smart OBGYN care
May. 9, 2023 12 p.m. ET / 9 a.m. PT

Women and girls are uniquely vulnerable to the health impacts of climate change. Prenatal exposure to air pollution from fossil fuels and extreme weather is associated with adverse maternal-fetal health. Impacts include stillbirth, low birth weight, and preterm delivery. These impacts are borne disproportionately by women from disadvantaged communities, including low-income communities and communities of color.

Obstetrics and gynecology (OBGYN) is a critical health care service – millions of women worldwide seek OBGYN care annually, including clinic visits, prenatal and obstetric care, and gynecologic surgeries. Given the magnitude of women’s health services, it is no surprise that OBGYN care contributes to health care’s climate footprint

Recognizing these unique threats, obstetricians and gynecologists are increasingly advocating for climate-smart health care strategies to protect their patients and the planet. In this physician-led session, you will learn how three OBGYNs are engaging and educating their colleagues and creating an OBGYN climate-smart health care movement.

Climate-smart pharmacy: A prescription for a healthier planet
Feb. 16, 2023 11 a.m. ET

In this session, two pharmacists and a physician discussed the climate impact of pharmaceuticals, including metered dose inhalers, along with opportunities for health professionals to promote climate-smart pharmacy practice through education, advocacy, and clinical practice.

Participants learned about:

  • Why pharmaceuticals make a significant contribution to health care’s climate footprint
  • How pharmacists and clinical health professionals are leading action to reduce the impact of inhalers and other pharmaceuticals and promote climate-smart health care
  • Opportunities to reduce pharmaceutical emissions by reducing unnecessary pharmaceutical use, reducing pharmaceutical waste, and evaluating prescribing practices

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Session 5
Plant-forward diets in health care: A prescription for patients and the planet
Dec. 1, 2022 | 11 a.m. ET

During our final 2022 session, moderated by Stacia Clinton, Health Care Without Harm’s chief program officer and former director of the healthy food in health care program, two physicians and the head of the Cool Food Pledge at the World Resources Institute shared how shifting to a plant-forward diet benefits both patients and the planet, and can help decrease food-related health care emissions.

Cardiologist Dr. Rob Ostfeld, the founder and director of the Cardiac Wellness Program at Montefiore Medical Center, discussed his nutrition-centered approach to the management of cardiovascular disease, and explained why he encourages patients to follow a whole-food, plant-based diet to prevent and reverse heart disease. He shared how patients enrolled in the Cardiac Wellness Program can experience health benefits including weight loss, lower blood pressure and cholesterol, more energy and sometimes reversal of type 2 diabetes. In addition, under Dr. Osfeld's leadership, Montefiore Health System created a comprehensive inpatient plant-based food program and this resource for other hospitals and health systems interested in starting a similar program.

Nephrologist Dr. Shivam Joshi discussed the role of plant-based diets in preventing common causes of kidney disease, including type 2 diabetes, hypertension and obesity, along with reducing the progression and complications of kidney disease. Given that high-protein diets with high meat intake can contribute to increased incidence of chronic kidney disease and faster disease progression, Dr. Joshi encourages patients to follow a plant-dominant low-protein (PLADO) diet to treat and prevent kidney disease. He explained that following a plant-rich diet not only yields health benefits, but can also help mitigate climate change as emissions from plant-based products are 10-50 times lower than animal-based products. He went on to discuss how renal care contributes to health care's climate footprint, citing this study finding that dialysis is resource intensive with emissions per dialysis treatment equivalent to driving an average car for 149 miles. Learn more about Dr. Joshi and plant-based diets in kidney disease on his website, Afternoon Rounds.

Edwina Hughes, discussed the Cool Food Pledge, an international effort that supports organizations achieve a science-based collective target of reducing emissions from food by 25% by 2030 through shifting toward more plant-rich diets. Their playbook and resources support pledge signers in promoting plant-rich diets. She reported the Cool Food Pledge is having an impact with a 21% per-plate reduction in GHG emissions through 2021.

The session concluded with Stacia Clinton sharing that Health Care Without Harm and Practice Greenhealth support the U.S. health sector in serving plant-forward food through Plant Forward Future, a set of resources that helps health care facilities set a plant-forward goal, menu and market plant-forward dishes and track their progress. US hospitals can join 64 other hospitals in reducing food-related GHG by joining the Cool Food Pledge through Practice Greenhealth.

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Session 4
Sustainable ophthalmology: Eye care with a vision for climate-smart surgery
Sept. 22, 2022 | 11 a.m. ET

During our fourth ophthalmologist-led session, moderated by ENT surgeon Dr. Neelu Tummala, participants learned how ophthalmologists have created a culture of sustainability within the field of ophthalmology and are leading the climate-smart surgery movement.

Dr. Barbara Erny explained that the climate crisis is not sparing ophthalmology and highlighted many ways that ophthalmologists are working to mitigate and adapt to the health impacts from climate change. Initial climate action efforts were led by the International Agency for the Prevention of Blindness and included forming a climate action working group and issuing a call to action and accompanying guide for sustainable practices in which they outlined ten key areas of action to reduce the environmental impact of eye care delivery.

Erny further explained that eye surgery in the U.S. generates a low amount of waste per case compared to other surgeries, but with phacoemulsification cataract surgery being the most common surgery performed in the U.S., with 4 million cases per year, ophthalmologic surgeries produce the most waste of any surgical specialty. She shared results from a survey of cataract surgeons and nurses showing that the overwhelming majority believed operating room waste is excessive and should be reduced, are concerned about global warming, and wanted medical societies to advocate for reducing the surgical carbon footprint.

Given this concern about waste and inspired by Aravind Eye Hospital’s efforts to successfully reduce OR waste, a small group of ophthalmologists in the American Society of Cataract and Refractive surgery came together and formed EyeSustain with a mission to make healthcare delivery and services in ophthalmology more economically and environmentally sustainable.

Dr. David Palmer began his comments by sharing a story about a patient who experienced pain after eye surgery. Her ophthalmologist applied eye ointment to help her pain and gave her the rest of the tube to take home, instead of throwing the tube of ointment away as required by hospital policy. The ophthalmologist was reported for violating hospital policy. In response to this, Palmer successfully led efforts to get legislation - SB 579 - passed in Illinois, permitting topical medications used for surgeries to be given to patients to take home for post-op care. The bill applies to ophthalmology and other specialties using topical medications in the OR such as ENT, dermatology, and plastics.

Palmer went on to lead efforts to get ophthalmic organizations to release a position statement about multi-dose topical medications with recommendations for reducing topical drug waste with ophthalmic surgeries. He shared that the American Academy of Ophthalmology created a legislative template based on the Illinois law to support ophthalmologists and others interested in proposing this legislation in their states.

Read about the impact of unused pharmaceutical products in cataract surgery in this JAMA Ophthalmology article. Learn more about Dr. Palmer’s efforts and be inspired how one person can make a difference in the fight against climate change.

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Session 3
Sustainable radiology: Bringing climate-smart medical imaging into focus
June 16, 2022 | 11 a.m. ET

Our third session featured panelists discussing how radiologists are successfully creating a sustainable radiology movement through interdisciplinary collaboration, educating colleagues, and engaging radiologists and professional societies.

Interventional radiologist Dr. Jonathan Gross explained the main driver of emissions from diagnostic radiology is energy use for imaging equipment and workstations. Gross shared strategies to reduce emissions from diagnostic imaging equipment including powering down workstations and equipment when not in use, configuring workstations to enter standby mode after short periods of inactivity, and optimizing scheduling to minimize the time equipment is idle. He also gave an overview of the existing radiology literature including:

  • An investigation of abdominal imaging equipment emissions, finding that emissions from manufacturing and equipment use were greatest for MRI and each abdominal MRI generated enough emissions to cool a three-bedroom house for a day or drive a car 180 miles
  • A measure of energy consumption by three CT and four MRI scanners and their associated cooling systems over one year finding that the total was equivalent to the amount of energy used to power a town of 852 people living in four-person households
  • An evaluation of power consumption of radiology workstations finding the workstations were inactive 50% of the time and the majority of the energy was consumed when not in use
  • Research finding that emissions from 25 picture archiving and communication system (PACS) stations left on overnight and on weekends were equivalent to annual emissions from seven vehicles

Researcher Dr. Cassandra Thiel shared results of a life cycle assessment measuring emissions from a hospital interventional radiology department finding the majority of emissions are generated from energy used to maintain climate control and use of single-use supplies. Learn more about this study. Thiel explained that decarbonization of radiology practice and the health care sector will require partnerships and interdisciplinary collaboration with both internal and external stakeholders, including accrediting and regulatory bodies, professional societies, and manufacturers. 

Dr. Julia Schoen, founder and leader of Radiologists for a Sustainable Future (R4SF), shared her experience building a culture of sustainability in the radiology community. The group’s successes include leading efforts to get a climate and health resolution passed by the American College of Radiology and advocating for the theme of the Association of University Radiologists’ 2022 annual meeting to be sustainability, climate change, and radiology.

Schoen explained how medical imaging is a major source of health care overutilization. While the attention to low-value imaging has been motivated by interest in reducing costs and improving patient safety, reducing unnecessary imaging can yield environmental co-benefits including emissions reduction. She shared a study finding that through education and other interventions, inappropriate use of CT-PE (pulmonary embolus) studies decreased by 52%.

Learn more in this Q&A with Dr. Schoen and these articles she co-authored: Climate Change and Radiology and Radiology in Our Changing Climate: A Call to Action.

Radiologists interested in promoting sustainability and reducing the environmental impact of radiology through education, policy efforts, and research are encouraged to sign up for Health Care Without Harm’s Physician Network and join R4SF.

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Session 2
Clinical leaders as drivers of sustainability: a physician-researcher perspective
Mar. 16, 2022 | 11 a.m. ET

During our second session, presented with the Massachusetts General Hospital Center for the Environment and Health, Dr. Jonathan Slutzman discussed why clinician leadership and research are critical in reducing health care emissions, and why climate-health innovation centers are needed to deepen emissions reduction across the sector.

Dr. Slutzman explained why research, including life cycle assessment (LCA) and waste audits, is crucial to quantify health care emissions and provide the data needed for medical professionals to make evidence-based decisions and identify interventions that improve the environmental performance of clinical care. He reviewed health care sustainability science and several studies including an update of US health care emissions, an LCA comparing reusable vs. disposable laryngoscopes, along with two studies of his own - an analysis of transportation GHG emissions reduction related to telehealth and a 24-hour emergency department waste audit. He went on to discuss how clinical care is the driving force of pollution generation in health care and how a focus on prevention along with reducing inefficient, low-value clinical practices can yield waste and emissions reductions

In recognition of the impact of clinical care, hospitals and health systems are appointing medical directors of sustainability to lead efforts to reduce the impact of clinical services and bring a clinical perspective to sustainability decision-making. Currently, eleven US and Canadian physicians serve in this new role, including Dr. Slutzman. Contact Dr. Amy Collins if you want to learn more about this position or want support in making the pitch for the position to your leadership team.

Finally he shared his experience developing the Mass General Center for the Environment and Health and its mission to integrate environmental sustainability into the clinical, research, educational, and community health activities of the hospital. You can learn more about the potential of health system sustainability centers in this Health Affairs commentary by Dr. Matthew Meyer.

If you want to learn more about the medical director of sustainability position and sustainability centers check out the sessions on these topics during CleanMed 2022 Kansas City.

If you are interested in taking action to support the transition to zero emissions health care check out Health Care Without Harm’s health care climate action site. Learn about opportunities to get education about climate and health from the Global Consortium on Climate and Health Education.

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Session 1
Climate, health care and the Race to Zero: A call to action
Jan. 27, 2022 | 11 a.m. ET

In our inaugural grand rounds session, Gary Cohen, president and founder of Health Care Without Harm, issued a call to action to the health care sector to urgently reduce emissions to protect health. He highlighted how the Global Roadmap for Health Care Decarbonization can help the sector meet the goals of the Race to Zero — to halve emissions by 2030 and achieve net-zero emissions by 2050— and why clinician leadership is critical in meeting this goal.

He was joined by Dr. Beth Schenk and Dr. Rengaraj Venkatesh, sustainability leaders from Providence and Aravind Eye Care System. Both of these visionary health systems understand that reducing health care emissions is at the core of their mission to improve health and have signed onto the Race to Zero, committing to reduce emissions across all scopes in line with the Paris Agreement.

Dr. Schenk discussed Providence’s bold commitment to become carbon negative by 2030 using their WE ACT framework, and why environmental stewardship is an organizational priority. She communicated the value of clinician leadership and shared the work of anesthesiologist Dr. Brian Chesebro who led Providence’s efforts to successfully transition to lower-emission anesthetics, achieving an 83% reduction in emissions and a 65% reduction in cost, resulting in $1.79M annual savings.

Dr. Venkatesh shared the inspirational story of Aravind Eye Hospital’s low-carbon eye care system and how they are challenging conventions about surgery and demonstrating that surgery’s climate footprint can be decreased by focusing on patient-centered care, efficiency and decreasing waste - without compromising quality. In addition to Aravind’s sustainability efforts, he also discussed a waste and life cycle assessment of phacoemulsification (a cataract surgery technique) finding that Aravind Eye Hospital’s carbon footprint is 5% of the UK’s footprint for the same surgery.

If you are interested in taking action to support the transition to zero emissions health care check out Health Care Without Harm’s health care climate action site. Learn about opportunities to get education about climate and health from the Global Consortium on Climate and Health Education.

View event recording