Decarbonizing the US Health Sector — A Call to Action | NEJM –

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Nowhere are the effects of climate change manifesting more clearly than in human health. Although many people consider climate change a looming threat, health problems stemming from it already kill millions of people per year.1 It is well established that rising levels of greenhouse-gas emissions, which cause climate change, also cause or exacerbate myriad health problems associated with air pollution, severe weather, wildfires, extreme temperatures, changes in vector ecology, and disturbances in the food supply, among other stressors. Furthermore, these health threats are not evenly distributed or experienced across geographies or populations: they disproportionately affect the most vulnerable and disadvantaged groups. The climate crisis is thus a public health and equity crisis that, absent concerted action, will continue to pose significant threats to human health.
The Biden administration has committed to focusing on environmental justice to help address these disparities. We believe that those of us who have the privilege to serve in health care also have an obligation to address this major threat. Specifically, we can mobilize to reduce our own carbon footprint and take actions to improve our system’s resilience and adaptability to climate change.
The U.S. health sector is responsible for an estimated 8.5% of national carbon emissions. These emissions stem directly from the operations of health care facilities (scope 1) and indirectly from both purchased sources of energy, heating, and cooling (scope 2) and the supply chain of health care services and goods (scope 3). Between 2010 and 2018, our sector’s greenhouse-gas emissions increased by 6%, reaching 1692 kg per capita — the highest rate among industrialized countries.2 Indeed, the U.S. health sector accounts for 25% of global health sector emissions — the highest proportion attributable to any individual country’s health sector.
Ameliorating the sector’s environmental effects and reducing greenhouse-gas emissions could not only improve health for everyone, but also reduce costs of care. The World Health Organization estimates that the costs of climate change’s direct damage to health (not including costs of damage mediated by effects on agriculture, water, and sanitation) will reach $2 billion to $4 billion per year by 2030.3 Furthermore, climate change is affecting our ability to deliver safe, effective, and efficient care. Extreme weather and other climate-sensitive events lead to hospital evacuations, power outages, infrastructure damage, shortages of medical products and supplies, and other disruptions. This strain on the system worsens the quality of care and patient outcomes and exacerbates existing health care inequities.
Dramatically reducing the carbon footprint of the health care ecosystem would have immense health, social, and economic benefits. Though there is increasing momentum in this direction, much more must be done to urgently activate all parts of the sector to decarbonize. Progress in four areas will be essential for decarbonizing and responding to climate change: the health care supply chain, health care delivery, health professional education, and policy, financing, and metrics.
The U.S. health care supply chain is a complex global system, encompassing the production, transport, use, and disposal of goods and services. Because it is responsible for an estimated 80% of the sector’s carbon footprint,1 tackling its carbon emissions is central to decarbonizing the sector. Some companies in the biopharmaceutical, biotechnology, and medical device industries are expanding their environmental, social, and corporate governance initiatives with the goal of reducing emissions and waste. Accelerating their progress will require rapid innovation to create more sustainable products, packaging, and distribution methods; incentive systems that encourage such innovation; and more consistent and transparent emissions metrics and reporting structures.
Health care delivery is the second major area of opportunity for decarbonization. Though some U.S. health systems and hospitals are leading environmental initiatives to reduce their carbon footprints, we need systemwide commitment and change to bring national hospital emissions down to more sustainable levels. Such a shift will require a clearer business case for supporting decarbonization, along with financial and payment incentives and greater consistency in measuring and reporting emissions.
Furthermore, educating health professionals more thoroughly about the effects of climate change could lead to more sustainable clinical practices and better outcomes for patients. In particular, clinicians and health care administrators will be better positioned to “green” their practices, advise patients with climate-sensitive health conditions, care for people experiencing climate-related health effects, and mitigate disruptions in care during extreme weather events and disasters. Clinicians are well positioned to communicate the importance of the health effects of climate change. Yet most clinicians have been taught little about the links between climate change and health — few health professional education programs include curricula in this area, and those that do tend to make participation voluntary.
Finally, and fundamentally, substantial progress will require supportive, equity-driven policies and financing, as well as common metrics. Decarbonizing the U.S. supply chain will require policies and incentives that support sustainable innovation, and delivering health care that is environmentally friendly and resilient will necessitate rethinking how we prevent disease, provide and pay for care, and educate our clinicians. Transparency and accountability in this process will be paramount, so we must develop standardized sets of sustainability metrics with clear expectations for reporting.
Given the urgency of this endeavor, the National Academy of Medicine (NAM) is launching — and we are cochairing — an Action Collaborative on Decarbonizing the U.S. Health Sector. This public–private partnership of leaders from the federal government, the biomedical and pharmaceutical industries, hospital systems, private payers, and health professions aims to develop and implement a shared action plan for decarbonizing the health sector and strengthening its sustainability and resiliency.
The collaborative will focus its decarbonization efforts on four areas. We will seek to work with industry to reduce scope 3 emissions, as well as facilitate coordination with the federal government to accelerate and better enable low-carbon innovations. To accelerate climate-sensitive health care delivery and practice, beyond highlighting direct mechanisms for reducing scope 1 and scope 2 emissions, the collaborative will identify opportunities for linking performance on sustainability metrics to value-based payment and reimbursement and for expanding health professionals’ curricula and programming on climate change. Finally, we will develop sustainability metrics and indicators for industry and health systems, along with shared plans for public reporting.
The health impacts of climate change are real and are happening today, and the U.S. health sector faces immense opportunities for leadership and action. As a critical first step, the collaborative will leverage the NAM’s independence and authority to mobilize the sector to establish shared goals for decarbonization and commit to sustainable and equitable transformation. We hope that by spotlighting the human health effects of climate change and the capabilities of public–private collaboration, the collaborative’s efforts will reverberate beyond the health sector and mobilize other sectors to take action against climate change to achieve the broader systemic transformation that is needed. The time for leadership, commitment, and action is now — our health and future hang in the balance.
Disclosure forms provided by the authors are available at
This article was published on October 13, 2021, at
From the National Academy of Medicine (NAM) (V.J.D.) and the Department of Health and Human Services (R.L.) — both in Washington, DC; Cardinal Health, Dublin, OH (G.B.); UnitedHealth Group, Minneapolis (A.W.); and the NAM Action Collaborative, Grand Challenge on Climate Change and Human Health, National Academy of Medicine (V.J.D., R.V., G.B., A.W.).

1. Zhao Q, Guo Y, Ye T, et al. Global, regional, and national burden of mortality associated with non-optimal ambient temperatures from 2000 to 2019: a three-stage modelling study. Lancet Planet Health 2021;5(7):e415e425.
2. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood) 2020;39:20712079.
3. World Health Organization. Climate change and health. February 1, 2018 (

December 2, 2021
N Engl J Med 2021; 385:2117-2119
DOI: 10.1056/NEJMp2115675

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