Researchers call for mandatory emissions reporting from US health care organizations

As climate change continues to impact our world, more industries are looking for solutions to lower carbon emissions, and the health care system is no exception. In a new Sounding Board published in the New England Journal of Medicine, researchers at Baylor College of Medicine and other institutions propose strategies to advance the industry into a net-zero emissions future, beginning with mandatory emissions reporting from U.S. health care organizations.

“Excessive greenhouse gas emissions are causing preventable harm to our patients, the health care workforce and society,” said Dr. Hardeep Singh, lead author of the report and professor of medicine at Baylor and the Michael E. DeBakey VA Medical Center.

“Decarbonization should be an essential component of quality improvement efforts. We propose that all health care organizations should start measuring and reporting greenhouse gas emissions for transparency, accountability and improvement purposes.”

“Voluntary initiatives are clearly not working. Health care organizations lag behind other industries in environmental performance reporting when they should be leading in matters pertaining to good corporate citizenry for healthier populations,” said Dr. Jodi Sherman, senior author and associate professor of anesthesiology at Yale School of Medicine.

“Mandatory standardized transparent reporting through trusted governmental entities is essential to prevent greenwashing, identify best practices and ensure rapid progress as called for by the scientific community.”

Currently, health care organizations, with the exception of those operated by the federal government, are not required to report their carbon emissions output. Without this data, the environmental impact of non-federal health care systems cannot be accurately accounted for, making it difficult for this industry to meet the United Nations’ Intergovernmental Panel on Climate Change goals of reducing overall carbon emissions around the world. Singh and colleagues propose that all health care organizations should now start reporting their greenhouse gas emissions.

“The implementation of standardized metrics for reporting health care greenhouse gas emissions is essential to quantify progress, identify best practices and ensure accountability,” write Singh and colleagues. “Other countries have begun measuring, setting targets and implementing interventions to achieve health care decarbonization goals.”

The team proposes use of international frameworks and standards already being used in other industries to help calculate total greenhouse gas emissions for health care organizations. This framework consists of three scopes: greenhouse gases emitted directly from health care facilities, those emitted indirectly through purchased energy, and all other indirect emissions, including emissions from purchased goods and services, employee commuting and waste management.

“U.S. health care contributes to 8.5% of U.S. emissions, the majority of which comes from purchased goods and services. Overconsumption of resources and inappropriate care comprise about 30% of all health care so there is an opportunity here to reduce unnecessary tests, treatments and procedures,” Singh said.

Reporting on these metrics is only the first step in reducing the industry’s carbon footprint. Authors believe health care organizations also will need to designate leadership responsible for decarbonization that is committed to implementing measurement activities and improving health care infrastructure, supply chain and delivery processes to reduce pollution while maintaining or improving quality of care.

The authors acknowledge that all health care organizations are resource constrained and will need support and guidance on measurement and reporting. They add that health care policy changes should create these support mechanisms, including the development of a standardized and systematic reporting structure for performance tracking and external accountability.

“Health care pollution harms human health, similar in magnitude as harm due to medical errors. Health care pollution prevention requires its own accountability efforts, similar to those dedicated to preventing direct harm from medical errors, that can be incorporated into existing patient safety and quality infrastructure,” Sherman said. “Actions proposed herein could accelerate the transition to a sustainable future.”