Perlin speaks about the Sustainable Healthcare Certification during a panel discussion at the Climate and Health Day of the US Climate Action Summit in April 2024. Photo: Vijay Iyer
When Dr. Jonathan Perlin first learned about the impact of sustainability matters on the health care field, he knew he had to do something about it—and he has, in a big way.
For Jonathan Perlin, a career as a physician was a family affair. “As the first-born son of a physician, really, the only question was which specialty I would choose,” he jokes. “In all seriousness, though, I grew up in a very service-oriented family, and so it was appealing to me to go into a field where I could help others.” Some counterculture advice from his family members along the way initially led him in a different direction as an English and philosophy major, though he says there was never much of a question as to what career path he would ultimately pursue.
But it wasn’t until years later—when Perlin became the seventh President and CEO of the Joint Commission Enterprise in 2022—that he started specifically focusing on the issues of sustainability and greenhouse gas emission reduction within the health care field. At that time, National Academy of Medicine (NAM) President Dr. Victor Dzau approached Perlin with a request that would point him in a whole new direction: to serve as a Steering Committee member for the NAM Climate Collaborative, in particular to provide strategic guidance on policy, regulatory, and metrics considerations for the initiative.
“The truth of the matter is, up until that point, I didn’t really know a whole lot about the effect of health care on climate,” Perlin admits. “But over the past couple of years, I have become very educated on some of the statistics related to this issue, and many of them are very daunting.”
Just some of those stark statistics: If health care worldwide were a country, that country would be the fifth-largest emitter of greenhouse gases. The United States represents 27% of the worldwide footprint, and almost 9% of the carbon footprint in the United States comes from the health sector.
“So, once you know that kind of information, it’s a bell that you can’t really un-ring,” Perlin says. “It becomes your personal and professional mission to make a change and improve the health of the community and the care of individual patients. So, it would be inconsistent not to acknowledge the disproportionate impact that health care is having on climate.”
“Like the old adage goes, if you can’t measure it, you can’t manage it—and that certainly holds true when it comes to this grand challenge of promoting sustainability in health care.”
Perlin now serves as co-lead of the Policy, Finance and Metrics Working Group of the NAM Climate Collaborative, alongside Center for Medicare and Medicaid Services (CMS) Innovation Center director Elizabeth Fowler and former CMS administrator Don Berwick. In this role, he is charged with bringing together the experts to make those types of statistics—and their impact on the country and world—well known.
“Like the old adage goes, if you can’t measure it, you can’t manage it—and that certainly holds true when it comes to this grand challenge of promoting sustainability in health care,” Perlin says. “Through being part of the Climate Collaborative, it has just been a great privilege of an opportunity for me to be able to bring together the experts to promulgate the understanding of how to create policies and incentives to support reduction of the health care sector’s collective carbon footprint.”
And while serving in this position, Perlin simultaneously continues to strive for excellence in health care sustainability through the Joint Commission enterprise. This organization’s overarching vision, he explains, is to allow all people to experience the safest, highest quality, and highest value health care across all settings.
“We have two roles: first, enabling the highest performance of health care, but also upholding public trust that the care is safe,” Perlin says. “We’ve launched what we call the HELP agenda, which is an acronym for Health Equity, Environmental Sustainability, Learning and responsible use of AI, and Performance integration,” he explains. “The performance goal is to make the process of evaluating hospitals and health care programs less performative and more integrated into operations.”
Over the next decade, Perlin notes that the Joint Commission enterprise has made a pledge to reduce its own greenhouse emissions by 50%; and by 2050, the Commission would like to see that number at net zero. Many participants in the Climate Collaborative have also made this same White House Health Sector pledge.
Perlin also emphasizes that the priorities of the HELP agenda align well with NAM’s goals—not only in terms of environmental sustainability, but also when it comes to learning.
“Our overall mantra is increasingly evidence-based, data-driven, and outcomes-oriented,” he points out.
Perlin’s role with the NAM Climate Collaborative has proven to be a valuable experience in this regard. Notably, it led to his realization that the Joint Commission enterprise could help accelerate the transition to more sustainable health care. What followed was the development of the Sustainable Healthcare Certification (SHC) program, which launched in January 2024.
“Through the Collaborative, it was obvious that once people understood the problem, they wanted to engage,” Perlin says. “But it was equally obvious that this is a new subject. I often start presentations with this question: ‘How many of you have spent your formal academic and professional career studying climate change or climate change as it relates to health care?’ The answer, of course, was virtually no one except those experts who had come together through NAM. So, we realized that the Joint Commission could be a mechanism for accelerating more sustainable health care.”
“What I care about is that people are motivated to take action, and the Joint Commission SHC really helps those who don’t have the tools create a road map for their organization to take action.”
When it comes to why the Joint Commission established the SHC, Perlin says the answers are plentiful.
“It’s a social justice issue, a health issue, a patient safety issue, a financial issue, and a community resilience issue all at once,” he says. “Take, for instance, the fact that 81% of primary care clinics were closed for at least one day in the last three years— according to Harvard’s Chan School of Public Health—because of an extreme weather event directly linked to climate change.” Perlin adds that the effects of climate change are contributing to a changing landscape of illnesses in the United States. Respiratory and cardiovascular diseases are worsened and ‘tropical diseases’ like dengue fever and malaria have increased dramatically in the United States in the past several years, he explains.
Given these many different reasons for the SHC’s importance, Perlin says his overall goal within the organization is clear.
“What I care about is that people are motivated to take action, and the Joint Commission SHC really helps those who don’t have the tools create a road map for their organization to take action,” Perlin explains.
The SHC program requires participating hospitals and health systems collect baseline data on three types of greenhouse gas emissions—things like energy use, anesthetic gas use, fleet vehicle carbon-based fuel use—and then create a strategic plan to reduce them. The organization must demonstrate that sustainability is a strategic priority moving forward. It is well established that commitment to environmental improvements at the executive and governing body levels is essential to the success of the organization, programs, and initiatives. SHC organizations also commit to evaluating performance annually to make improvements in identified areas.
As Perlin notes, obtaining certification can benefit organizations in a variety of ways. For one, doing so is consistent with their mission (i.e., promoting the health of the community). Certification also demonstrates a commitment to sustainability, which can help employers grow and maintain their teams.
“It’s absolutely essential in terms of today’s workforce,” Perlin says. “Clinicians and younger workers absolutely want a commitment to environmental sustainability.”
In addition, Perlin points out that efforts to promote sustainability are cost-saving in the long term. “Organizations that have signed up for green energy coalitions actually have hedged their energy prices over the next decade, and we’ve seen the benefit reported on that,” he says.
As a way for interested organizations to build resilience and implement sustainable health care practices, the SHC program is a valuable and timely intervention. The program is also an inspiring example of how the NAM Climate Collaborative’s network of peers, collaborators, and organizations are continuing to raise awareness, transmit ideas, and inspire action.
“The NAM convened a coalition of experts and a coalition of the willing,” Perlin explains, “and that coalition of the willing cultivated more experts and in turn they became committed partners.”
These committed partners are working to expand the coalition in a variety of ways. And the SHC program demonstrates the value of doing so.
“We are very excited and look forward to seeing the progress not only through the Joint Commission and that program, but also through all of the work of NAM’s partners on collaboration,” Perlin says.
As Perlin points out, participating organizations in the SHC may be motivated by a range of factors including concerns about health equity and community resilience. They may also be drawn to financial incentives available under the Inflation Reduction Act that pay for improving the sustainability of infrastructure or supporting green energy.
“The great thing about it is, you don’t have to invent everything yourself. You can beg, borrow, and steal the best practices—and that’s what having that network is all about.”
But for Perlin, the reasons for getting involved are up to the organization. And regardless of their motivation—whether it relates to environment, equity, or finance—interested parties can look to both the Joint Commission SHC program and the NAM Climate Collaborative for trusted collaborators as they chart a path toward providing more sustainable health care.
Looking toward the future, Perlin stresses that he would like to see more formal standards adopted by the government that are related to sustainability in health care matters.
“In IT, there is an old joke that says, ‘Aren’t standards wonderful? There are so many to choose from.’” Perlin quips. “But it’s obviously a joke, because a standard isn’t a standard unless everyone adopts it. And the government has, for example, not yet announced a clear standard for things like energy accounting for health care—but doing so would definitely eliminate a whole lot of confusion.”
And in the continuing effort to promote health coordination sustainability efforts, Perlin notes that the importance of surrounding himself with a supportive network of peers cannot be underestimated. For example, the NAM’s new Climate and Health Movement, which is open for organizations to join, is an effective way to gain access to an important peer network.
“The great thing about it is, you don’t have to invent everything yourself,” he says. “You can beg, borrow, and steal the best practices—and that’s what having that network is all about.”
