Climate change is increasingly affecting the health and well-being of people across the United States, leading to worsening health outcomes that disproportionately impact communities that have been marginalized. Hospitals and health systems are committed to supporting the health and well-being of the communities they serve, and there is growing recognition across the health sector about the need to address its own environmental impact and reduce carbon emissions. Through facility operations, purchased energy supply chain of goods and services, and investments, the health sector produces 8.5% of U.S. carbon emissions. Health care organizations are increasingly prioritizing sustainability initiatives that reduce this environmental impact and create a more sustainable and resilient health sector, while also having significant health, social, and economic benefits.

Airica Steed. Photo courtesy MetroHealth

The National Academy of Medicine spoke with hospital and health system leaders about the sustainability initiatives their organizations are championing and how others in the field can take action, including concrete actions that come with up-front and long-term benefits. In this interview, Dr. Airica Steed, President and Chief Executive Officer of MetroHealth, shares strategies for hospitals and health systems to pursue sustainability goals that center health equity and community well-being.

Why is decarbonizing the health sector an issue that is important to you and your organization?

We are committed to enhancing the health and wealth of all our communities. And sustainability is a huge part of the equation for a very simple reason: better environmental health leads to better human health and better health equity. It should not come as a surprise that underserved communities and communities of color are often the ones that are most impacted by negative environmental effects. Sustainability therefore needs to be a central focus of our overall health equity strategy because it will directly support eradication of the heath disparities we face. This is why so many health systems nationally are making sustainability and climate protection a big part of their community health strategy.

It should also be noted that the health care sector is a huge user of fossil fuels, creating almost 10% of all carbon emissions nationally. It is therefore imperative for health care systems to be creative in implementing programs that reduce emissions and address climate change. We must be part of the solution to the environmental challenges we face.

Enhancing sustainability as part of the drive to address health inequality is particularly important in Northeast Ohio because the environmental impacts we face are severe. Communities across our region are experiencing respiratory issues due to air pollution. They are dealing with increased exposure to lead paint and other toxic chemicals, and they are facing reduced access to oxygen-creating green spaces and healthy and locally grown food. This makes environmental factors a key social driver of health along with other factors, such as food insecurity and joblessness, that can have as much to do with a person’s overall health as their physical symptoms and vital signs.

At MetroHealth, we are focused on dealing with this problem by attacking it head-on through addressing social drivers of health as part of a comprehensive community wellness plan, in partnership with organizations from across our region. This includes working to make our institution more sustainable and carbon neutral, while also actively supporting efforts to address the negative environmental impacts facing the most marginalized communities in Northeast Ohio.

And this is not new for us; it is a historic strength of our institution. For example, MetroHealth researcher Dr. Robert Griggs conducted groundbreaking scholarship on the consequences of lead poisoning in humans in the mid-1960s which helped drive community efforts to restrict lead paint use and implement remediation strategies.

What are your organization’s specific goals around addressing the sector’s environmental impact and strengthening its sustainability and resilience?

We helped create the Clark-Fulton/MetroHealth EcoDistrict as a mechanism for establishing sustainable goals with our community partners and measuring the impact we are having. We want to reduce carbon emissions, enhance sustainability across our region and eradicate the disparities that have hampered the environmental and human health of so many of our communities. Some of the specific activities we are undertaking include:

  • Incorporating sustainable design principles and green materials in all main campus and ambulatory construction projects, as part of our ongoing campus transformation.
  • Utilizing our soon-to-be-created MetroHealth Community Advisory Councils—which will represent all parts of our service area—to continue to assess the negative environmental impacts affecting our communities and how they can be addressed.
  • Expanding opportunities through MetroHealth’s Institute for H.O.P.E. to enhance access to healthy, locally grown food.
  • Continuing to use MetroHealth’s expertise and community partnerships to address the lead paint crisis in Cuyahoga County.
  • Adding sustainability criteria to our procurement processes to enhance the use of green products and services across the supply chain.
  • Installing a composting program at our Main Campus to divert food waste from landfills and enhance local sustainable agriculture.
  • Investigating opportunities to reduce toxic chemical use across the health system.
  • Expanding the reach of our Sustainability Department to increase the number and effectiveness of community and employee programs, better manage waste streams, and track relevant data to guide policy and practices moving forward.

What successes have you had within your organization related to decarbonization, and what do you attribute those successes to? How have these accomplishments helped your organization in unexpected ways?

Health care organizations need to make a conscious effort to include diverse community voices and community partners in every aspect of their organizational structure from the medical care we provide, to the sustainable goals we implement, to the buildings we build and where we build them. This will allow the decisions we make to be more equitable and more impactful. And it is why we have made partnerships a major component of our sustainability efforts to date. This includes collaborating with the Greater Cleveland Foodbank to expand access to healthy and locally grown food and better address food insecurity and nutrition as part of a broader health and wellness strategy. For example, we are one of the main partners in the Food Bank’s soon-to-be-opened Community Resource Center which will collocate medical services—including a community health clinic—with other social service agencies and food bank resources to ensure efforts to address social drivers of health, including environmental factors, are being better coordinated with medical services. We are also working with MedWish International to repurpose unused medical supplies and ensure they get to groups that can use them, collaborating with local electronics recyclers RET3 and Bulldog Battery to divert e-waste from landfills, and partnering with the Environmental Protection Agency to expand our overall recycling infrastructure at facilities across our health system.

In addition, we have implemented an onsite autoclave to sterilize biohazard waste and dramatically reduce our carbon footprint compared to previous processes. We are also providing instruction and training modules to all our employees to assist in enhancing the implementation of reuse, decarbonization, and sustainability strategies in all aspects of our operations.

Finally, we are working to enhance medical education and research in the areas of sustainability and decarbonization. This includes research on the overall carbon footprint of health care as well as the creation of a graduate course on climate change and health at Case Western Reserve University. MetroHealth also recently created a new research position focused on the health impacts of climate change.

These activities have not only reduced our carbon footprint, they have also enhanced our efforts to address health inequality in our region, supported the drive to reduce costs, and expanded educational and research opportunities for the many residents MetroHealth hosts each year.

What barriers did you face when you began your decarbonization journey? How did you overcome these?

Like other safety net hospitals across the nation, we are experiencing financial strains due to inflation, staffing shortages, and a lag in returning to pre-pandemic levels for patient visits. While this could be seen as an inhibitor to fully implementing our sustainability goals, it is really an opportunity. By continuing to improve sustainable processes, taking advantage of new green technologies, and further enhancing partnership opportunities, we can reduce clean-up costs, energy use, and waste-hauling expenses, which will reduce budget pressure and provide more resources to support our patients. Health care institutions need to be bold and aggressive in implementing sustainability because it is better for our bottom lines and for our communities.

What do you know now that you wished you knew before you started this work?

The most important thing that we know now is the critical role sustainability plays in the social drivers of health and in health equity. By enhancing decarbonization, reducing pollution, addressing lead paint poisoning, and expanding access to healthy and locally grown food, we can make all of our patients and communities healthier. You cannot properly address sustainability without ensuring everyone is included, particularly underserved communities. You also cannot properly attack the social drivers of health and health disparities without going after the negative environmental factors that play such a huge role in so many communities nationwide.

How do you inspire other health care organizations to become motivated if they aren’t involved in addressing decarbonization already?

Incorporating sustainability in organizations can be challenging given the competing priorities health care leaders currently face and the upfront investment in time and resources that many initiatives require to be successful. My advice is two-fold.

First, ensure that sustainability initiatives are used to augment and expand your primary strategic goals, particularly in the areas of health equity and community health. One feeds and supports the other, and leaders need to message that connection and include sustainable goals in their broader plans to properly tackle and ultimately eradicate health disparities. You will be better able to reach both goals by linking the two.

Second, the long-term return on investment in sustainability will ultimately reduce costs and increase overall financial health. Leaders need to be bold in making upfront investments that can lead to long-term gains in waste reduction, energy efficiency, and reduced clean-up costs that can have a significant impact on an institution’s bottom line. Sustainability is a financial growth strategy.

More Resources from the National Academy of Medicine

Carbon Accounting 101. Learn more about the basics of carbon accounting through a recorded webinar series with related resources and real-world examples.

Key Actions to Reduce Greenhouse Gas Emissions. Read a shortlist of key actions for hospitals and health systems to reduce their greenhouse gas emissions.

More from the Health Leaders Interview Series

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