Nurses and other health care providers are increasingly being identified as essential contributors to climate action. But what does it mean to decarbonize the health sector? And should this be prioritized amid other urgent issues, including an ongoing pandemic?
The answer is an emphatic yes, according to Donald Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement, who was the keynote speaker at "Nursing Leadership in Decarbonizing the U.S. Health Sector," a policy dialogue hosted by the American Academy of Nursing's Expert Panel on Environmental and Public Health on January 20.
"There's a list of really urgent things going on now, none of which can be ignored," he acknowledged. "It's an ask for attention at a time when attention is in very short supply [but] we must force this issue." The World Health Organization, he noted, has ranked climate change "the number one threat to human health on the planet."
During the virtual event, speakers and attendees discussed the health and environmental effects of climate change, how the health sector generates greenhouse gas emissions, and what nurses can do to expedite decarbonization.
HEALTH IMPACTS OF CLIMATE CHANGE
Panelist Elizabeth Schenk, PhD, RN, FAAN, executive director of environmental stewardship at Providence Health and Services, noted that carbon is used as a form of shorthand to refer to all greenhouse gases, including carbon dioxide, methane, nitrous oxide, and halogenated chemicals. "Carbon dioxide is the most common greenhouse gas, about 80% of the total in our atmosphere," she said.
As these gases build up in the atmosphere, they trap heat, warming the planet. "This persistent warming is causing a number of changes, including extreme weather events," explained Schenk.
"Climate change is not just a future thing, it's now," said Berwick. "Extreme weather events, floods, fires, drought, these are now present in our lives." The resulting health effects are evident, "even in a wealthy country like the United States, let alone, for example, vulnerable countries around the world, where water supply and food supply and security, as well as new zoonotic diseases, are existential threats."
Schenk noted that the health impacts of extreme weather events affect all aspects of patients' health, including their mental and financial health. "We know that these do not hit everyone evenly," she said. "More vulnerable members of our communities are hit the hardest."
"We are going to see the planet warm beyond levels of comfort," Berwick noted, but he emphasized that the situation can be turned around by mitigating greenhouse gas emissions and building resilience into systems. At this point in the crisis, he said, "we really have to do both."
Decarbonization entails reducing greenhouse gas emissions and capturing and storing these emissions. "This is a nursing issue," Schenk explained, because of the impact extreme weather events are having on human health. Additionally, pollution from the health sector is a significant contributor to the climate crisis, "killing thousands of people a year," she said. "Decarbonization of health care is an action toward reducing this harm."
HEALTH INDUSTRY EMISSIONS
The health sector is responsible for 8.5% of the greenhouse gases produced by the United States, according to a report on U.S. health sector emissions in the December 2020 Health Affairs. Emissions directly released from facilities (from a furnace, for instance, or medical gases) are referred to as Scope 1, whereas those indirectly emitted (such as from the electricity a facility purchases) are called Scope 2. Scope 3 emissions are those produced in the supply chain (for example, from materials and services a facility uses). The good news, said Berwick, is there are numerous ways to reduce emissions.
Schenk cited examples from her health system's efforts to become carbon negative by 2030. The organization is targeting five key sources of greenhouse gas emissions-waste, energy and water, agriculture and food, chemicals, and transportation-and aims to use 100% renewable electricity by 2030. Wide-ranging efforts include "addressing the carbon intensity of meals served and buying more sustainable and local foods," she said. Additionally, "We have done nation-leading work reducing greenhouse gases from anesthetic agents and nitrous oxide, and we are capping business travel and supporting commuters while encouraging the transition to electric vehicles." The organization is addressing supply chain emissions by asking vendors to be transparent about emissions and partnering with them to reduce these further.
"One of our key strategies to reduce emissions from purchases is by working with clinicians, including nurses," Schenk said, "to assess their practice and make planet-safe decisions."
OPPORTUNITIES FOR NURSING ACTION
Nurses can help to support such efforts by advocating for government policies that drive down emissions, from building standards to incentives for electric vehicles, Schenk said. Such policies require hospitals to meet energy efficiency targets and will facilitate change at the organizational level. Additionally, she said, nurses can review and update policies related to climate health at nursing organizations and boards of nursing. "We can be a force for change," she said.
Beverly Malone, PhD, RN, FAAN, president and chief executive officer of the National League for Nursing and the endnote speaker, said it's essential that nurses work together to address the climate crisis and decarbonization efforts. She added that although nurses are essential to this work, the burden doesn't fall on them alone. "This is an issue for every professional group."
Nursing engagement is critical to health care decarbonization policy efforts, said panelist Katie Huffling, DNP, RN, CNM, FAAN, executive director of the Alliance of Nurses for Healthy Environments. "Our unique nursing perspective, which is grounded in justice and equity, will help to ensure that health care decarbonization benefits those most impacted by climate change first and helps to build resilience in our most vulnerable communities."
Huffling explained that "a strong commitment from the Biden administration" is currently providing "a unique opportunity to make big policy shifts and to really dream big about how the health care industry can make large-scale changes that are needed to hit our decarbonization goals by 2030." She highlighted a few of these:
Action Collaborative on Decarbonizing the U.S. Health Sector. Launched by the National Academy of Medicine in 2021, this public-private partnership is identifying goals and actions for decarbonization in the health care supply chain and infrastructure; health care delivery; professional education and communication; and policy, financing, and metrics. "The nursing perspective has been a vital part of the policy discussions," said Huffling.
Health Sector Climate Pledge. Health care systems representing more than 650 hospitals, plus pharmaceutical manufacturers and insurance providers, committed to this White House and Department of Health and Human Services pledge to reduce greenhouse gas emissions by 50% by 2030 and achieve net zero by 2050. "Nurses can provide support and input on policies that can help all health care institutions engage in these efforts," Huffling said.
Securities and Exchange Commission proposed rule to standardize climate-related disclosures. This would require publicly traded companies to provide robust reporting on climate risks and greenhouse gas emissions. Currently, companies can withhold information that's considered proprietary, Huffling noted, so purchasing departments can't determine the climate impacts of many products. The proposed rule, she said, "would help health care institutions access the critical greenhouse gas metrics of the products they're purchasing."
The Inflation Reduction Act of 2022. Forty percent of climate funding from this legislation goes to disadvantaged communities, Huffling explained. "While some of these funds will go directly from the federal government to communities, a large portion . . . will go to the states, who will then determine how these funds are allocated," she said. "Individual nurses, but also our state and national nursing organizations, can play a critical role in ensuring the funds go to the communities most in need of support through infrastructure upgrades, access to renewable energy sources, energy efficiency, and climate adaptation plans."
'BE BOLD AND COURAGEOUS'
"It is a crisis," Malone emphasized. "This is not a time for any delay, and we need to speak not only about decarbonizing, but also about resilience." Nurses, she said, can do this at every level of the health care system-as individuals or at the organizational level-and contribute to local, state, and national policy discussions.
"If there was ever a time for us to be bold and courageous," she concluded, "This is it."-Corinne McSpedon, senior editor