Key Actions to Reduce Greenhouse Gas Emissions by U.S. Hospitals and Health Systems
Climate change is increasingly affecting people’s health, which has direct consequences for the health care system . At the same time, the health care system is contributing to climate change. In the U.S., health care accounts for nearly 20% of GDP, making it a major consumer of resources, and as a result, a major producer of waste and greenhouse gases. In fact, the U.S. health sector is responsible for approximately 8.5% of U.S. carbon emissions . These emissions stem from:
- Operations of health care facilities (classified as “scope 1” emissions)
- Purchased sources of energy, heating and cooling (“scope 2”)
- Supply chain of health care services and goods, as well as the value chain and investments within the health care sector (“scope 3”) 
Compared to other health care systems globally, the U.S. is among the top emitters of carbon, and is responsible for 25% of global health sector emissions, which is the greatest proportion among all global health sectors .
To address these impacts, the NAM Climate Collaborative Health Care Delivery Working Group developed a shortlist of key actions for hospitals and health systems to reduce their greenhouse gas emissions. The following actions could be utilized by any hospitals or health systems starting their journey to reach decarbonization goals.
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Key Actions Shortlist
The following list provides specific actions that hospitals and health systems can take to set and meet goals to reduce greenhouse gas emissions.
Step I: Start Your Decarbonization Journey
1. Establish an executive-level sustainability team with broad representation across operational and clinical lines. Engage staff, leaders, clinicians, boards, and patients to achieve goals.
2. Perform a greenhouse gas (GHG) inventory for Scope 1 and 2 emissions, and actionable Scope 3 emissions (e.g., business travel, employee commuting, waste), with an aim for whole organization accounting.
3. Establish specific decarbonization goals. For example, this may include a goal of 10% GHG reduction annually across all operations, aiming to achieve 50% reduction by 2030 and net zero by 2050 or sooner .
4. Develop an implementation plan for your decarbonization goals with documented milestones and deliverables to measure and track progress.
Step II: Implement High Impact Interventions to Reach Your Decarbonization Goals and Track Progress
- Reduce building emissions . Potential actions include:
- Set a goal to reduce building emissions, for example, by 10% per year.
- Improve energy efficiency and electrification .
- Increase the amount of electricity supply derived from renewable sources.
- For new buildings, implement energy efficient strategies into design and construction.
- Reduce emissions from anesthetic gases and pressurized metered dose inhalers. Potential actions include:
- Set a goal of reducing anesthetic gas emissions and pressurized metered dose inhaler emissions, for example, by 50% by 2024 .
- Minimize use of desflurane by removing or limiting desflurane vaporizers in select clinical situations.
- Decommission centrally piped nitrous oxide and substitute portable e-cylinders.
- Substitute nebulizers, dry-powder inhaler (DPI), and soft-mist inhaler (SMI) where pressurized metered dose inhalers are not essential .
- Reduce physical waste and single use plastics. Potential actions include:
- Assess waste streams and identify reduction opportunities (reuse, recycle , compost) by analyzing and tracking data on invoices, including volume and cost.
- Reduce single-use plastics, for example, by 10% per year.
- Switch from disposable to reusable products such as reusable isolation gowns, dishware, linens, surgical supplies
- Optimize reprocessing as allowed per FDA regulations.
- Reduce waste from Operating Rooms and other procedure areas.
- Reduce emissions from food services. Potential actions include:
- Determine baseline for carbon emissions per meal served  and reduce this each year by specific activities, such as limiting purchase of beef and other animal products and substituting with plant-based menu items.
- Implement systems and processes to reduce food waste during preparation.
- Provide post-consumer composting.
- Reduce use of single-use, disposable food packaging.
- Reduce transportation emissions . Potential actions include:
- Set a goal to reduce transportation emissions, for example, by 10% per year.
- Reduce fleet vehicle emissions (e.g., replace with EVs, reduce miles traveled) and optimize product delivery (e.g., reduce frequency of just-in-time deliverables).
- Reduce business travel emissions (e.g., flights, rental cars) through maximizing virtual meeting participation.
- Provide EV charging infrastructure and commuting incentives that promote use of public transportation, carpooling, and active transportation.
- Romanello, M., et al. 2022. The 2022 report of the Lancet Countdown on health and climate change: Health at the mercy of fossil fuels. Lancet 400(10363):5-11. https://doi.org/10.1016/S0140-6736(22)01540-9.
- Eckelman, M. J., et al. 2020. Health care pollution and public health damage in the United States: An update. Health Affairs 39(12). https://doi.org/10.1377/hlthaff.2020.01247.
- Agency for Healthcare Research & Quality. n.d. Reducing healthcare carbon emissions: A primer on measures and actions for healthcare organizations to mitigate climate change. https://www.ahrq.gov/healthsystemsresearch/decarbonization/index.html (accessed May 17, 2023).
- Intergovernmental Panel on Climate Change. n.d. Special report: Global warming of 1.5 C. https://www.ipcc.ch/sr15/#:~:text=Limiting%20warming%20to%201.5%C2%B0C%20implies%20reaching%20net%20zero,particularly%20methane%20(high%20confidence) (accessed May 17, 2023).
- The White House. 2021. Executive order on catalyzing clean energy industries and jobs through federal sustainability. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/12/08/executive-order-on-catalyzing-clean-energy-industries-and-jobs-through-federal-sustainability/ (accessed May 17, 2023).
- Office of the Federal Chief Sustainability Officer. n.d. Net-zero emissions buildings by 2045, including a 50% reduction by 2032. https://www.sustainability.gov/federalsustainabilityplan/buildings.html (accessed May 17, 2023).
- n.d. ASHRAE task force for building decarbonization. https://www.ashrae.org/about/ashrae-task-force-for-building-decarbonization (accessed May 17, 2023).
- ENERGY STAR. n.d. ENERGY STAR nextgen certification for commercial buildings. https://www.energystar.gov/buildings/building_recognition/energy_star_nextgen_certification_commercial_buildings (accessed May 17, 2023).
- Devlin-Hegedus, J.A., et al. 2022. Action guidance for addressing pollution from inhalational anaesthetics. Journal of the Association of Anaesthetists 77:9 (1023-1029). DOI: https://doi.org/10.1111/anae.15785 (accessed May 25, 2023).
- American Society of Anaethesiologists. 2023. “Inhaled Anesthetic 2023 Challenge.” https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/inhaled-anesthetic-challenge (accessed May 25, 2023).
- Woodcock, A., et al. 2022. The environmental impact of inhaled therapy: Making informed treatment choices. European Respiratory Journal 60:2102106. DOI: 10.1183/13993003.02106-2021.
- Janson, C., et al. 2019. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax 75(1). http://dx.doi.org/10.1136/thoraxjnl-2019-213744.
- Environmental Protection Agency. n.d. Reduce, reuse, recycle. https://www.epa.gov/recycle (accessed May 17, 2023).
- n.d. The Coolfood pledge. https://coolfood.org/pledge/ (accessed May 17, 2023).
- Environmental Protection Agency. n.d. Routes to lower greenhouse gas emissions transportation future. https://www.epa.gov/greenvehicles/routes-lower-greenhouse-gas-emissions-transportation-future#:~:text=There%20are%20three%20routes%20to,our%20societal%20goals%20on%20climate (accessed May 17, 2023).
Disclaimer: This document was prepared by Kathy Gerwig (Health Care Without Harm), Hardeep Singh (Michael E. DeBakey VA Medical Center and Baylor College of Medicine), Jodi Sherman (Yale School of Medicine, Yale Center on Climate Change and Health, and Yale-New Haven Health System), Walt Vernon (Mazzetti), and Beth Schenk (Providence St. Joseph Health), who are members of the Health Care Delivery Working Group of the NAM Action Collaborative on Decarbonizing the Health Care Sector, and Jessica Marx (National Academy of Medicine); and reviewed by members of the Action Collaborative. Statements in this document do not necessarily reflect the views of all members of the Action Collaborative; the NAM; or the National Academies of Sciences, Engineering, and Medicine (NASEM). The document is intended to help inform and stimulate discussion. It is not a report of the NAM or the NASEM. Copyright by the National Academy of Sciences. All rights reserved.