Why Decarbonizing Matters for the U.S. Health Sector 

Exposure to excessive heat, air pollution, and other effects of climate change are worsening health outcomes year after year across the United States. The health sector contributes a significant portion to overall U.S. greenhouse gas emissions. By reducing this environmental footprint—or decarbonizing—health care organizations can better deliver on their foundational mission of preventing harm and providing care to create a more sustainable and healthy future for all patients and communities. 

Duty to act: How climate change impacts human health  

Climate change creates broad and inequitable harms. 

Climate change has brought about more frequent and severe wildfires, heat waves, hurricanes, and floods.

Climate change matters to the health of everyone, everywhere. However, climate change impacts are not equally distributed. People with pre-existing health problems, under-resourced communities, communities of color, and communities that have been historically marginalized bear the greatest health burdens from effects like increased air pollution. 


Climate change threatens the ability to deliver affordable, high-quality health care. 

Extreme weather events damage health care facilities and increase health care demand, all while simultaneously impeding care access for patients and staff, disrupting supply chains, and increasing the costs of care delivery. In 2021 alone, climate change associated disasters in the United States set a record for most deaths and caused $145 billion in damages. 

  • In a 2021 survey of nearly 800 global leaders of healthcare organizations, 70% of U.S. respondents reported that climate change was already compromising care delivery. Respondents also indicated they expect major and moderate impacts on care delivery to increase by almost 3 times in just the next 3 to 5 years. 
  • Safe haven in the storm: Protecting lives and margins with climate-smart health care showcases the financial impacts of being ill-prepared for extreme weather, the fiscal and operational benefits of preparedness, and appropriate responses.  


The effect of climate change: 

  • worsens air quality through catalyzing ground level ozone—or smog—production and wildfire smoke;  
  • undermines food and water security; and 
  • can promote the spread of vector borne diseases to new locations.  

Health care currently relies heavily on fossil fuels and is responsible for a significant share of air pollution. 

The burning of fossil fuels to support facility operations—electricity in hospitals and clinics, production of pharmaceuticals and medical devices, transportation, and food production—results in greenhouse gas emissions and air pollution. Through these activities, health care provision generates roughly 8.5% of all greenhouse gasses and all particulate matter air pollution of the entire country.   

Value of decarbonization: How reducing carbon emissions benefits health and health care 

Providing high-quality care improves patient outcomes and reduces emissions. 

Health care facilities, including the electricity they consume, account for about 18% of the health sector’s total carbon footprint, while the remaining emissions are largely embedded in supply chains for food, pharmaceuticals, and disposable supplies, among other sources. Health care interventions to promote healthier lifestyles lower disease risk, and, as a result, health care facilities can improve outcomes, lower costs, and reduce greenhouse gas emissions. 

Decarbonizing can improve financial and care delivery stability. 

Decarbonization strategies can reduce energy costs as well as improve resilience to extreme weather and power outages that have grown more common with climate change. Although energy costs can be highly volatile, participation in financial or physical power purchase agreements can stabilize energy costs for the long term. 

  • For example, rooftop solar and solar microgrids can decarbonize facilities and promote resilience.  
  • In Puerto Rico, 80 of 84 Federally Qualified Health Centers that were solarized after Hurricane Maria remained operational during an island-wide power outage in April 2022. 
  • Solarization can improve financial security for frontline health clinics. A solar microgrid for the Blue Lake Rancheria, for example, saved $150,000 in annual electricity costs. 
  • Health care facilities that turn now to renewable energy sources also prepare themselves for recent and potential future changes in regulatory rules and requirements.


“With a physical PPA, the customer receives the physical delivery of electricity from the seller through the grid. With a financial PPA, the customer does not receive the physical delivery of the electricity; rather, the generator sells the energy to the grid.” (U.S. Environmental Protection Agency)    

Decarbonizing can advance health equity. 

The effects of climate change cause disproportional harm to people and communities who have historically been marginalized, as well as to future generations, robbing people of the stable homes and communities they need in order to lead healthy lives. Climate change also creates unprecedented intergenerational inequities: today’s children will endure many more heats, floods, droughts, fires, and food shortages in their lifetimes. 

Health care organizations can lead climate action 

The health sector is positioned to lead by example and motivate other sectors to take climate action. 

Health professionals are one of the most trusted voices in the country and, as health is a major motivator for climate action, are positioned to be key messengers to advance decarbonization efforts and build momentum toward climate initiatives. 

  • In a survey conducted by The Commonwealth Fund, about four in five clinicians surveyed believe that it’s important for their hospital to address climate change and that doing so is aligned with their organization’s mission.  
  • In that same survey, about six in 10 clinicians indicated a prospective employer’s policies and actions on climate change would impact their decision to apply for a job. 


New sustainability opportunities and supports are becoming available. 

Unprecedented actions on climate change nationally and internationally have unfolded in the past few years and create momentum for further decarbonization. In April 2021, President Biden announced the new national goal to cut emissions in half by 2030 and to get to net zero by 2050. Meeting this goal to keep warming to 1.5°C can avoid the most catastrophic impacts of climate change. In November 2021 at COP26, the U.S. joined 50+ countries committing to decarbonize their health systems and prepare their facilities and communities for climate impacts. 

In August 2022, the Inflation Reduction Act (IRA) became law. The IRA provides $390 billion to decarbonize the U.S. economy through investments in transit, buildings, land management, and the electrical grid. Combined with the Infrastructure Investment and Jobs Act, which is investing $1.2 trillion in improving our nation’s infrastructure, there has never been more funding available to meet the challenges of the climate crisis. 


Resources are available to support you on accelerating your decarbonization journey.  

The National Academy of Medicine’s Action Collaborative on Decarbonizing the U.S. Health Sector has created an unprecedented collaboration among all stakeholders in U.S. health care to accelerate progress toward a net zero system. Highlighted resources include:

The funding support extended by the NAM Climate Grand Challenge’s sponsors makes work like this possible. See full list of sponsors. 


Disclaimer: This document was prepared by Ari Bernstein, MD, MPH (Harvard Medical School), who is a member of the Health Professional Education and Communication Working Group of the NAM Action Collaborative on Decarbonizing the Health Care Sector; 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. 

Questions? Contact us at ClimateandHealth@nas.edu

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