Climate change events — rising temperatures, floods, hurricanes, wildfires — have an impact on health and mental health, with vulnerable communities often disproportionately affected. Emissions from health care account for as much as 4.6 percent of emissions globally, but the U.S. health care contribution is much higher, closer to 8.5 percent. Without action, there are predictions that global emissions from health care will reach six gigatons a year by 2050, equivalent to emissions from approximately 1.26 billion cars.
Ongoing efforts to reduce emissions in energy, transportation, waste, food, and some medicines are supported by financial incentives in the Inflation Reduction Act. But closing the gap to net-zero carbon emissions requires making changes in care delivery, the supply chain, and research and innovation.
Reducing Emissions Through Delivery System Reform
Redesigning health care can improve outcomes and reduce costs; there are now calls for redesign to help reduce carbon emissions. Strategies include:
- Providing care closer to home in primary care or community settings to deliver better patient outcomes and experiences, reduce the cost of care, and reduce emissions by shifting care from the most energy intensive buildings (i.e., hospitals).
- Increasing use of telehealth and digital tools can offer patients greater choice in how and when they access services and reduce emissions from travel. Digital tools for remote monitoring can improve continuity of care and provide early warning of deterioration, which can prevent future hospitalizations. NHS Virtual Wards, which use digital tools to provide remote monitoring for patients at home, have demonstrated a reduction in carbon emissions and cost savings.
- Shifting to lower-emission treatments that deliver the same outcomes. Emissions vary across treatments and procedures. Innovative technologies like robot-assisted surgery can improve outcomes for patients and reduce lengths of stay. However, they may also be carbon intensive. A 2015 life cycle assessment of four surgical approaches for hysterectomy (abdominal, vaginal, laparoscopic, and robotic) found the robot-assisted approach to have the largest environmental footprint and higher costs.
- Ensuring appropriate use of care by reducing overtreatment or unnecessary care. In the U.S., estimates suggest spending on Medicare overuse may be as high as 29 percent of total spending, with two out of three prescribed medications going unused. This waste costs the system more than $2.4 billion per year.
- Early detection and diagnosis can help lower emissions, reducing the need for more complex carbon-intensive care later. Effective secondary prevention and ongoing management of long-term conditions can also reduce emissions.
- Long term care management can reduce complications and therefore the need for future complex treatments and their associated emissions. For example, people with diabetes who manage their blood sugar levels through glucose-lowering treatment generate fewer emissions than those with untreated diabetes.
Reducing Emissions Through Prevention
Preventing the need for services in the first place delivers an even bigger reduction in emissions than service redesign. Public health and prevention initiatives — including provision of more green spaces, increasing physical activity, encouraging a healthier diet — reduce the burden from noncommunicable diseases and deliver additional climate benefits through reduced carbon emissions, air pollution, and toxic exposures.
Some health care organizations are contributing to these efforts and acting as “anchors” in their community by using their resources and managing their business practices in ways that contribute to improving local health outcomes.
Conclusion
Reducing carbon emissions and other environmental impacts should be considered as part of all health care service redesign, as a benefit alongside patient outcomes and cost factors. Health systems wanting to take further action to reduce their contributions to climate change may also wish to consider how they can not only redesign their care, but switch from a focus on treating sickness to supporting health and wellness, including increasing their investment in public health and prevention for local communities.
