Anyone who dedicates themselves to advocacy is used to failure. However, as a physician who is deeply concerned about the climate crisis and its health impacts and who has focused on sustainability in the healthcare sector, I have to admit I was starting to get a bit cocky. After decades of indifference, there has been increasing recognition that the health sector itself has a huge environmental footprint, as it is responsible for 8.5% of U.S. greenhouse gas emissions. In fact, pollution attributable to U.S. healthcare has public health harms with the harms of preventable medical errors. Attention has been focused on this irony of our modern healthcare system.
There are many state-based physician advocacy groups, as well as major medical societies such as the and the , focused on climate health. Lecture series are popping up. is being into undergraduate across the country from Harvard to UCSF to Stanford Medicine to Emory and more.
Then there was the Inflation Reduction Act, which promised to help transition to clean energy and reduce greenhouse gas emissions emissions by up to 40% by 2030. Modeling suggests the associated decrease in fossil fuel pollutants 3,900 premature deaths, 100,000 asthma attacks, and 417,000 lost workdays annually in 2030. Admittedly, many Republicans are seeking to cut off the Inflation Reduction Act at its knees, but I've still been cautiously optimistic.
When the Joint Commission, a body that accredits more than 22,000 U.S. healthcare organizations and programs, announced they were going to institute sustainability metrics as part of their quality metrics, I was on cloud nine. It was almost too good to be true that a national organization would actually recognize that environmental protection was a patient safety issue and follow through by holding health systems accountable for their contribution to environmental degradation. For months, I naively bragged that it was the Joint Commission to the rescue. My stalled state legislation on healthcare sustainability would soon be an afterthought, as U.S. healthcare would blaze forward to a green future, leaving clean air in its wake.
I was giving a talk on April 27 on climate health at a national meeting when, much to my chagrin, I heard the announcement the same day that all the sustainability metrics the Joint Commission was considering would be optional. In a with the National Academy of Medicine, their CEO announced that senior administration in health systems met the proposal with immediate and negative feedback.
No one in healthcare is blind to the difficulties of our systems post-pandemic. We see the burnout, workforce shortages, and patient issues. We know that financial times are tough for health systems. But that is exactly why efforts to decrease waste and decarbonize are so important right now. is already on track to net zero by 2040. Their system has been streamlined, eliminating waste and making care more patient-centered. With cheaper, cleaner energy technologies available and a clear path forward with many available resources, including the , , and among myriad others, we in healthcare are obligated to "do no harm" by minimizing healthcare's climate footprint. The strong financial case for taking action removes any reasonable objection to doing so.
Aside from the business argument, there is the health argument. At least premature deaths occur globally each year due to fossil fuel pollution. The environmental impacts of the care we deliver in the U.S. is estimated to cause lost. Air pollution from fossil fuels has been associated with , , , , , , and increased . and are linked to climate change and elevated levels of CO2 may directly . All of us who care for patients need to address root causes of these illnesses and these ecological determinants of health. It starts by greening our practices.
Am I happy with the turn of events? No. But, am I despairing? No. It was not unexpected that industry would balk at having to do the right thing, that any additional step to protect the public that was not absolutely mandatory would be fought tooth and nail. It was expected that profits would be put ahead of patients and minimal short-term gains would be prioritized over greater long-term benefits.
What it has done is reaffirm that environmental protections and hence the health of our patients can never be taken for granted. It should serve as a galvanizing reminder that physicians must speak up for our patients and our communities and advocate for a greener future for healthcare.
Elizabeth Cerceo, MD, is the chair of Health and Public Policy for the New Jersey chapter of the American College of Physicians, and a member of Clinicians for Climate Action New Jersey. Her views do not necessarily reflect those of her employer.