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Politco: Hospitals Turning into ‘Climate Change Fighting Machines’ – Limiting water with ‘timers for operating room sinks’ – ‘More Earth-friendly drugs’ – Reducing ‘anesthetic gas’ – ‘Decarbonize U.S. health care’


Inside the greening of American health care.

Excerpts: Sometimes they’ll use more Earth-friendly drugs when appropriate. They’ve already stopped using another common anesthetic gas, called desflurane, which remains in the atmosphere for a decade or more, according to Shira Abeles, an infectious disease physician at UCSD, who recently became its medical director of sustainability.

She’s got plenty of science backing these shifts. The American Society of Anesthesiologists has identified alternatives that are better for the planet, just as safe for patients — and often cheaper.

“One hour of that volatile agent (desflurane) is equivalent to driving a car 250 miles, a gasoline car, I should say. And there’s very little we do in one hour,” said Joanne Donnelly, who, as director of the nurse anesthesia program at the University of Minnesota, has trained personnel in sustainable practices in hospitals across Minnesota and Wisconsin.

“Extrapolate that across an urban area, a region, a nation,” she said. “It’s an incredible impact.”

The drive to reimagine anesthesia is part of a broader if belated effort to decarbonize U.S. health care, from the operating room to the cafeteria to the gardens and grounds. It’s a push spurred on by both medical professionals and Washington policymakers, who feel increased pressure to act amid the dangers of climate change and who acknowledge health care has been slow to engage on sustainability.

The health sector is responsible for 8.5 percent of U.S. emissions of greenhouse gases including carbon dioxide, methane and ozone — an outsized impact compared to the rest of the world. (Globally, health care systems contribute roughly 4.6 percent of total greenhouse gas emissions.) Without huge new efforts, the U.S. will have trouble reaching its ambitious emissions reduction goals.

Within American health care, hospitals are the biggest source of emissions, not to mention generators of enormous amounts of nonrecyclable trash from all the single-use, disposable devices and supplies that head swiftly into landfills and incinerators.

Not every hospital is on board with transformation. Change can be expensive, and it’s always hard to overcome the inertia of the status quo. But health leaders see progress, and the Biden administration is doing its own part to push hospitals to overhaul their practices — with some success. The question is, will it be enough?

Hospitals in Vermont and Boston are growing vegetables in rooftop gardens; Seattle Children’s Hospital is planting conifers in greenery-starved poor neighborhoods. In drought-prone Los Angeles, a UCLA plastic surgeon suggested timers for operating room sinks; everyone still scrubs in, of course, but without wasting water.
Some hospitals offer more plant-based meal options; New York Mayor Eric Adams, who follows a mostly vegan diet, saw to that in the city’s 11 public hospitals.
Meanwhile, recycling medical waste is neither easy nor inexpensive; it’s more complicated than tossing a tuna can or yesterday’s newspaper into a blue bin. But that’s slowly changing as more health systems turn to FDA-certified companies that can recycle, sanitize or reprocess such waste.

It’s become harder to ignore how extreme climate events and pollution endanger human health, with poor people, minority groups and elderly people particularly vulnerable. Extreme weather exacerbates heart, lung and kidney disease; it makes asthma worse. Mental health deteriorates. Heat waves kill people — directly, or by aggravating chronic conditions. Power outages in patient homes mean no refrigeration for insulin or electricity to keep oxygen tanks flowing.

“What excites me is that health professionals are starting to connect the reason why they’re there in the first place, which is to take care of patients, with the health impacts that are happening because of climate [which] their health systems are contributing to,” said Shanda Demorest, a nurse who is associate director for climate engagement and education at Health Care Without Harm, which along with its Practice Greenhealth arm, is a major force in pushing for new health and climate work.

The Veterans Administration and the Indian Health Service, which deliver health care to millions of people across the country, have been directed to reduce emissions and energy use as part of the Biden White House’s overall government climate policy.

For the rest of the health care system, HHS unveiled a Climate Pledge on Earth Day 2022 to spur more action. … About 116 health organizations, representing 872 hospitals as well as other health care sectors, have signed on. Along with the federal health systems, that represents about 15 percent of U.S. hospitals, HHS officials said.

The climate pledge is voluntary, but hospital sustainability experts insist it’s not the usual feel-good exercise. Signatories commit to specific actions and must publicly report progress toward cutting emissions by 50 percent by 2030 and cutting net emissions by 100 percent by 2050.

If hospital leaders start to perceive climate action as unavoidable — either because they anticipate it will be mandated or because they will face mounting pressure from within, particularly from younger doctors and nurses — they may start sooner rather than later.

HHS is aware that not all health systems are committed, and that even those that are may need help. McCannon said HHS is rolling out technical assistance and some grants.

But activists and sustainability teams want more. More tools. More metrics. More financial help.

Some advocates would like to see the federal government impose tough regulations and requirements to force change. Others suggest building incentives into Medicare payments to hospitals, which would give a government-imprimatur on health care greening without creating a new mandate. Climate benchmarks could be included in HHS’ “conditions for participation,” the practices that health providers must follow to be eligible for Medicare or Medicaid payments.



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