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.

Janice E. Nevin. Photo courtesy ChristianaCare

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. Janice E. Nevin, President and Chief Executive Officer of ChristianaCare, based in Wilmington, Delaware, discusses opportunities for health care organizations to develop sustainability initiatives that engage caregivers and communities.

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

The Lancet Commission has characterized climate change as both the “biggest global health threat” and “the greatest global health opportunity” of the 21st century.

At ChristianaCare our core values are love and excellence. We lead with love, and when you lead with love, you walk toward difficult problems and develop solutions.

Over the past few years, we have increasingly recognized the powerful link between health and the environment, including chronic environmental issues like air and water pollution, natural disasters, like flooding and heat waves, and human-caused disasters.

We also recognize that health equity and environmental health are deeply interconnected. Members of underserved communities often live in areas where they are more likely to be subject to natural disasters and pollution. In our home city of Wilmington, we have double-digit differences in life expectancy between people who live just a few miles apart, and impoverished neighborhoods have experienced real harm from floods in recent years.

Hospitals are responsible for more than one-third of the health care industry’s greenhouse gas emissions. So, we have both a responsibility and an opportunity to address it.

By reducing our own carbon footprint, we are living our mission of making a positive health impact on the communities we serve—and we often find that the environmentally sustainable solution is also the best solution from a purely business perspective. Last year we measured our Scope 1 and Scope 2 carbon emissions. We found we had already reduced Scope 2 emissions by 80% through purchasing zero-emissions electricity. That change was a no-brainer even before we fully understood its impact on our carbon footprint. The switch to zero-emissions electricity saved us money—evidence of our conviction that addressing environmental justice has a financial benefit. If, at the same time, we can improve health and health equity through the way we purchase our products, reduce our waste, and use energy in our buildings, why wouldn’t we? It is a win for everyone.

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

There may not have been a perfect time to undertake such a substantial environmental, social, and governance (ESG) project, but the middle of a pandemic was definitely a difficult time.

ChristianaCare, like all health systems across the country, has faced strong financial headwinds. Recognizing that initial costs of the ESG work will eventually give way to long-term financial benefit helped us to push through that challenge.

Another obstacle is that in a large organization, with almost 14,000 employees, there are many different viewpoints. Some people simply do not believe climate change is a real threat. Others believe it is real, but they do not believe humans have caused it or can solve it. That makes it important to continually highlight the health benefits of the ESG work that we’re doing to the communities we serve. Improving the health of our patients and our community is something that we all can rally around, regardless of our individual feelings about climate change.

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?

As ChristianaCare launched the work around developing our ESG structure and governance in fiscal year 2023, our goal for the year was to identify outcome measures and key initiatives for our long-term sustainability plan.

The outcome measures include:

  • Using 100% renewable energy by 2025.
  • Cutting operational emissions in half by 2030.

Some of the key initiatives are:

  • Develop a climate resilience plan.
  • Implement decarbonization activities.
  • Find project funding opportunities.
  • Be transparent and accountable for progress.

In November 2022, aligned with those goals, we signed on to the White House-HHS Health Sector Climate Pledge.

Creating a robust governance structure for ChristianaCare’s ESG efforts has been a great success that is further strengthened, somewhat unexpectedly, by the passion of so many of our caregivers.

This year we launched a new Environmental Sustainability Caregiver Committee, which is bringing the dedication and expertise of our caregivers directly into the improvement process. The committee is a part of our overall ESG governance framework. It is tapping into the energy of our caregivers, helping them connect with a sense of purpose that deeply aligns with their values and develop an even greater sense of pride in working for ChristianaCare. In turn, that helps us to foster and retain an engaged workforce.

One of the Committee’s first actions has been the launch of an Eco-Champion initiative that empowers individual caregivers to serve as leaders in their units to generate ideas and organize efforts to promote sustainability. We are already getting ideas around waste reduction and a community garden that highlight the benefits of organization-wide opportunities for involvement.

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

Out in your community, there is a wealth of knowledge and expertise available from people who want to engage and help you make a difference, whether that is from the government, higher education, or local environmental groups.

You do not have to start your work from square one. That said, as you align on the work with people outside your organization, you also want to make sure you maintain your independence—strike a balance. The last thing you want to do is drive more requirements, rules, and regulations.

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

The environment in which people live has a huge impact on their health. We know that clinical interactions only account for about 20% of a person’s health outcomes. So, ultimately, this is about health, and health is our mission.

The challenge in front of us is great, but it is also an opportunity to make a lasting impact. If we dig deep, if we take strong action, we can change the trajectory. While the big picture is long-term, there are short-term benefits—cost savings, engaging with caregivers in a higher purpose, and demonstrating your organization is committed to improving the health of your community.

The best place to start is with a deep and honest assessment. Determine where you are before you think about where you want to go. Engage the passion of your employees. Even a small group of committed team members can help bring along a large organization with them.

Maintain a focus on equity. For ChristianaCare we have linked our sustainability and equity work together through an aspiration in our five-year strategic plan to end disparities. Remember that underserved and under-resourced communities often live in the most environmentally vulnerable areas.

Tap into the knowledge and experience of your community. Work with partners to address negative drivers of health.

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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