U.S. Health Care Workers Want Their Employers to Address Climate Change

Introduction

Within the United States, the health care sector is responsible for 8.5 percent of greenhouse gas emissions, largely from hospital care and from physician and clinical services.¹ While a growing number of U.S. health care delivery organizations pledged to halve their emissions by 2030 and achieve net zero emissions by 2050, progress has been mixed. Many health systems have not made this pledge or taken meaningful steps toward decarbonization.²

Effective sustainability and decarbonization efforts in health care require organizationwide buy-in to new innovations, policies, and procedures targeted at reducing waste and water consumption, adopting green building features, protecting facilities from extreme weather damage, converting to renewable energy, and other activities to advance a more sustainable health system.³ And buy-in from frontline health care workers — nurses, physicians assistants, nurse practitioners, primary care physicians, and specialists — is especially critical.

In this brief, we present findings from a national survey of 1,001 U.S. clinicians about their views of what health systems can do to address climate change. All those surveyed worked at a hospital or at a health system comprising more than one hospital; some had leadership responsibilities within their organization. (See “How We Conducted This Survey” for further details.) It is our hope that the findings could help motivate health care organizations to consider ways to decarbonize and reduce their environmental impact.

Survey Findings

Four in five respondents agreed or strongly agreed that it’s important for the organization they work at to play a role in addressing climate change or minimizing its impact on the environment. At an individual level, three in four clinicians surveyed agreed or strongly agreed it’s important that they personally play this role when they are at work, and four in five said they should try to do so outside of work. Responses were similar by geographic region, gender, age, provider type, and organizational tenure (see the appendix).

Regardless of their level of responsibility, the clinicians we surveyed believe addressing climate issues is important to their institution’s overall mission. Among those clinicians who indicated that “organizational leadership” was their primary job responsibility at their health system or hospital (246 of the 1,001 clinicians surveyed), more than four in five said addressing climate-related issues was very important or somewhat important to the institution’s overall mission. Among those clinicians who said they were not in leadership positions (755 of 1,001 surveyed), around three in four said the same.⁴

Health systems and hospitals are engaged in a variety of activities to address their impact on the environment. Around seven in 10 surveyed clinicians who were responsible for organizational leadership said their organization was taking steps to reduce waste and energy consumption — the two most commonly reported activities among those asked about in the survey. Nearly half of respondents said their organization was working to understand its emissions footprint, with another 25 percent saying they planned to in the next three years.

About three in 10 respondents in leadership roles at their organization said their hospital or health system was currently defining or setting emissions targets or was measuring and reporting such targets. A similar number said that they planned to commence activities around defining, setting, measuring, and reporting emissions targets in the next three years, indicating a substantial increase in the hospitals and health systems engaged in this work. According to the survey, a majority of hospitals and health systems plan to be engaged in all the activities that the survey asked about within three years.

Organizational leaders reported on additional activities related to governance or policy taking place at their health system or hospital, though the level of engagement in these activities varied. About seven in 10 said they were creating emergency preparedness plans to withstand climate-related shocks, like floods, wildfires, and severe storms, but fewer than one in five said their organizations were tying executive pay to climate goals.

Around four in 10 said they were establishing governance mechanisms like a chief sustainability officer or integrating emissions reduction into their strategic planning process. More health systems expect to engage in these activities in the near future.

Health care workers were asked how much effect an organization’s actions to reduce its environmental impact and address climate change had on their decision to join the organization, stay at their current job, or apply for a job at a new organization. Less than half of surveyed workers said these policies “somewhat” or “to a great extent” influenced their decision to join their current organization, but more than six in 10 said it would impact their decision to seek employment with a future employer. More than half said their organization’s climate policies and actions affected their decision to remain in their current job.

Discussion

Addressing climate change is important to health care workers. Our survey’s findings suggest clinicians overwhelmingly want their employers to be working to address climate change. A majority of respondents said it was important to them that their organization play a role in minimizing its impact on the environment, as well as important that they personally address climate change at work and at home.

Climate change mitigation activities also have an impact on whether hospitals or health systems are seen as an attractive place to work. Hospitals actively engaged in addressing climate change and minimizing their environmental impact may have an easier time retaining and recruiting clinical staff. A majority of respondents said the extent to which an organization was trying to reduce its environmental impact would play a role in their decision to remain at their current job or seek work at another organization.

Hospitals and health systems can utilize federal funds to reduce their environmental impact. The 82 percent of respondents who said their institutions were engaged in activities to reduce their energy consumption or planning to in the near future could take advantage of financial incentives in the Inflation Reduction Act (IRA) to help finance this work.⁵ These include new or expanded tax credits for energy efficiency in commercial buildings, incentives for installing solar power panels, and incentives for adopting other forms of renewable energy. In addition, health care organizations could take advantage of tax credits for electric vehicles in commercial fleets, as such for patient transport or other hospital purposes. Unlike many previous financial incentives, these federal funds are also available to organizations that don’t pay taxes, such as nonprofit hospitals, because of a “direct pay” option that provides federal funds as a payment for the value of a tax credit.

Resources are available for health systems addressing climate change or want to begin doing so. Hospitals are integrating their climate work into the core of their businesses through tactics like including emissions reductions into their strategic plan and tying executive pay to climate goals. Hospitals have a range of existing resources to draw from to strengthen these efforts:

• New York University’s Stern Center for Sustainable Business has developed the Healthcare Delivery Systems Decarbonization Framework, which identifies eight decarbonization strategies that delivery systems can use to “make the internal business case for implementing decarbonization practices, develop more resilient organizations, and drive financial value.”⁶
• The Black Directors Health Equity Agenda, a group of board directors and senior leaders working to eliminate health disparities and inequities, published a decarbonization action guide for hospital board directors interested in mitigating the health care system’s contributions to emissions-driven climate change and climate-driven health disparities.⁷
• The National Academy of Medicine established the Action Collaborative on Decarbonizing the U.S. Health Sector (Climate Collaborative), a public–private partnership of leaders from across the health care sector committed to addressing the sector’s environmental impact while strengthening its sustainability and resilience. Resources from the Climate Collaborative include a sustainability journey map, toolkits, and webinars on carbon accounting for health care delivery systems.⁸
• The Health Care Climate Council, a leadership body of U.S.-based health systems committed to addressing climate change run by Health Care Without Harm, has created a Climate Action Playbook to showcase examples of member organizations’ efforts to achieve “climate-smart health care.”⁹ The playbook illustrates how health systems are operationalizing climate solutions to inspire and encourage others to take action on measurable outcomes.
• The Bipartisan Policy Center has released best practices on immediate actions hospitals can take to reduce health care greenhouse gas emissions, including: 1) leveraging federal funding opportunities, particularly those created by the IRA; 2) employing executive-level staff or contractors to support organizationwide efforts to reduce emissions; 3) gradually reducing use of potent greenhouse gasses, like those used for anesthesia (desflurane gas and nitrous oxide); and 4) reducing emissions from food waste.¹⁰