Climate change threatens human health in many ways, from increasing heat illness incidences to hastening the spread of infectious diseases. This relationship also goes the other way: The health-care industry is a contributor to the causes of climate change too. In the US, the business of treating patients is responsible for 8.5 percent of the nation's carbon emissions, over four times the footprint of the commercial aviation industry. The US health-care sector spews a quarter of the total greenhouse gas emissions coming from the global health-care sector—more than any other single country. In addition to the typical sources contributing to this output—running buildings, transportation, and delivery services on fossil fuels—some are unique to health care, and those present the best opportunities for change from within.

“Health-care organizations think we get a pass because we're taking care of patients,” said Jodi Sherman, an anesthesiologist at Yale School of Medicine. Potent greenhouse gases flow quickly and freely from the operating room where she does her job, and she is working to fix that. 

Hospitals are difficult places in which to plant seeds of change, as they are highly regulated, but Sherman is part of a growing movement of health-care practitioners reckoning with the industry’s role in climate chaos. In 2022, the White House and US Health and Human Services launched a climate pledge calling for health-care organizations to halve greenhouse emissions by 2030 and reach net zero by 2050. Over 15 percent of US hospitals committed to this goal, though Sherman acknowledged not all signees may be following through. Under the current administration, HHS has since removed the web page about the pledge from its site, and did not respond to requests for comment.  

At the forefront of translating a pledge into practice are individual health-care workers like Sherman who are moving to decarbonize their own workplaces in the meantime. These bottom-up changemakers are proving that environmental sustainability need not be at odds with saving lives. 

Greener gases

Health-care’s largest single source of greenhouse gas emissions come from anesthetic gases. Inhaled anesthetics have climate warming potentials up to several thousand times that of carbon dioxide. The body absorbs only 5 percent or less of this type of anesthesia; the rest is exhaled into the environment. 

Among these volatiles, the most pollutive of the lot is desflurane, an uncannily stable molecule that persists in the atmosphere while it wreaks havoc. Its popularity comes from its fast action, allowing patients to quickly come around once supply has been turned off. But that marginal efficiency comes at a cost to the environment. As with other inhaled anesthetics, desflurane starts as a liquid that is vaporized as it’s administered. Consuming one eight-ounce liquid bottle of desflurane generates the atmospheric warming equivalent of a roundtrip drive from Seattle to Los Angeles. By contrast, the warming potential of isoflurane, the next most polluting anesthetic gas, is a fifth of desflurane’s.

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Removing desflurane from operating rooms is the most straightforward way to make a dent in a hospital’s climate impacts. In 2013, Sherman and her colleagues pushed the Yale New Haven Health System to become the world’s first practice to replace desflurane with greener gases, such as sevoflurane. The University of Wisconsin, Massachusetts General Hospital, and the Fiona Stanley Hospital in Perth, Australia, have since followed suit to either slash or eliminate desflurane use. Last year, the National Health System of Scotland scratched desflurane from its supply chain, making it the first country in the world to do so. 

There is an economic incentive to cut the gas too: Desflurane is the priciest anesthetic among other less pollutive options. Gallon for gallon, the gas can be more than four times the price of sevoflurane. Since ditching desflurane, Yale has saved $1.2 million annually. “There's just no reason not to,” Sherman said. 

Hard evidence goes a long way in getting doctors on board, said Brian Chesebro, anesthesiologist and medical director of environmental stewardship at Providence Health and Services. At first, some colleagues at his practice in Oregon were hesitant to pivot away from desflurane for fear of compromising patient care. After combing through over 20,000 patients’ medical records, Chesebro found that surgery patients anesthetized with desflurane or sevoflurane had similar recovery times. His results were enough to convince most of his fellow anesthesiologists to switch to sevoflurane overnight. Eight years later, the use of desflurane has dropped from 40 percent to less than 1 percent across the Providence hospital network in seven states. 

Among inhaled anesthetics, desflurane is the most polluting and also the most expensive. | Photo by Diesel-50 via Wikimedia Commons

Chesebro has applied the same evidence-based approach to tackling nitrous oxide, another anesthetic that contributes to the greenhouse effect. Hospitals often have a central supply of this gas, but it tends to leak from the delivery networks throughout buildings. Chesebro found that 91 percent was seeping from the manifold valves and gauges and joints dotting the labyrinth of pipes without ever reaching patients. By switching to a portable delivery system, his hospital recovered 99 percent of purchased nitrous oxide. 

Propellants in inhalers also have an environmental impact. The gas medium that carries the active medication being inhaled is usually hydrocarbons, and this class of gases has a greenhouse potency a thousandfold that of carbon dioxide. Over 140 million medical inhalers are sold in the US each year, making their collective puff a burgeoning carbon source. 

Compared with anesthetics, inhaler propellants are much more complicated to decarbonize, because no single green alternative exists for the hundreds of prescriptions for different medical conditions. To untangle this gnarly inventorial challenge, Chesebro examined each propellant available and their doses to evaluate their individual environmental impact and medical efficacy, as the starting point to look for less polluting alternatives. 

“It was a little bit brutal,” Chesebro said. But delving into the nitty gritty is crucial. Otherwise, “you can't make meaningful comparisons, and you can't identify opportunity.” 

When clean isn’t always green 

Among health-care’s carbon emissions specifically, the majority of health care’s carbon footprint comes from the medical supply chain. The production and distribution of health care’s goods and services give off 80 percent of the sector’s carbon spew.  

Such emissions have ballooned in recent decades, as the field has raced toward single-use plastics. Spurring that trend is the myth that disposable products are safest for patient health. Single-use sterile tools are critical for safety during invasive procedures, such as a needle for a blood draw, but for external-use products, such as specula, tourniquets, medical gowns, pillows, and blood pressure cuffs, experts say that proper cleaning between patients is sufficient to make them safe to reuse. This cuts down on the waste of a disposable product itself as well as the sterile packaging around it, both designed to be throwaways. 

“It’s manufactured obsolescence,” Sherman said. “It’s ridiculous.” 

In spite of the formidable challenges of hospital bureaucracy, some medical practitioners are introducing baby steps for reducing plastic use at their institutions. Mallory Zhang, a Kaiser Permanente gynecologic oncologist in San Bernardino, has successfully petitioned her department to switch to plant-based products in place of the plastic kind for the basins and trays that come in every operating room. Her colleague, San Francisco-based ophthalmologist Naveen Chandra, convinced 21 Northern Californian hospitals in the network to swap out plastic for biodegradable basins in operating rooms for cataract surgery.

Nevertheless, their hospitals still process the plant-based waste as biohazards, so the initiative hasn't shrunk the overall volume of medical trash. But most of the emissions associated with plastic occur during the production phase, so reining in demand for such products is still a positive move, even though there is still work to be done to reduce hospitals’ general dependence on disposables. “In the grand scheme of things, it's a very small shift in the needle,” Zhang said. “I have to remain hopeful that it is something that contributes to the overall picture, and that enough of us doing it will, hopefully at some point, [bring] overall systemic change.” 

One way to change the culture of habit and convenience that enables widespread and wasteful plastic use is creating small barriers to access. These include displaying price tags on items in supply closets that make users aware of the costs or introducing a check-out policy for certain items to make them less convenient to obtain, Sherman said. If the use of certain equipment drops, that could justify eliminating it from the inventory altogether. 

Going further than manufactured hassle, Sherman thinks all hospitals should be required to report their carbon emissions and mitigation strategies. “Voluntary measures risk us not getting far enough fast enough,” she said. 

This urgency stems from a sense of ethical righteousness as well as practicality: Climate change is proving to be detrimental to human health. Health care shouldn’t add to its own burden by hastening the very problem it’s scrambling to patch up.