Minimizing Healthcare’s Environmental Footprint

Jeff Thompson is being honored as a Champion of Change for his work on the front lines to protect public health in a changing climate.

It wasn’t too long ago when you would rarely hear “healthcare” and “sustainability” in the same sentence. After all, many healthcare organizations thought their purpose was solely to take care of patients in a hospital or clinic. But at Gundersen Health System, headquartered in the Midwestern city of La Crosse, Wisconsin, we believe it is also our responsibility to help our patients and communities stay well, and part of that is caring for the health of the environment.

We started working on a number of projects in 2003, but in 2008 we took a hard look in the mirror. We knew that healthcare buildings are some of the most energy intensive buildings around (2.5 times more so than commercial office buildings according to the Department of Energy). We knew that our energy costs were rising at an alarming rate of $350,000 per year and growing, and those costs were being passed along to patients in the form of higher healthcare costs. We needed to take a hard look at our practices and take the necessary steps to improve our environmental impact. It was the right thing to do for our patients, our staff, and the communities we serve.

We developed our sustainability program, called Envision®, and set a goal that surprised many in the healthcare community: energy independence in 2014. As the CEO of Gundersen Health System, I can tell you that we’re on track to accomplish that goal through vigorous energy conservation measures and renewable energy partnerships.

Our Envision team started with “low hanging fruit.” An energy audit in 2008 opened our eyes to dozens of energy saving opportunities available. We examined our heating/cooling systems, lighting, and employee behavior and used a number of measures to improve energy efficiency and reduce energy demand. By the end of 2009, those efforts led to a 25 percent improvement in our energy efficiency. Our $2 million investment saves the organization more than $1 million every year in energy costs.

But energy conservation measures will only take us so far toward our energy independence goal. The rest will come from renewable energy projects. We tapped into a number of natural resources and several government entities and private businesses who saw the benefits of renewable energy partnerships for our communities. Some of our most successful projects are those we’ve accomplished with community partners.

For example, we worked with our local county government to use previously wasted methane gas from the landfill and turned it into a renewable energy source. The project created a revenue source for La Crosse County, saves our health system hundreds of thousands of dollars and made our Onalaska Campus 100 percent energy independent. We also partnered to develop a wind farm with the rural village of Cashton, Wisconsin, and Organic Valley, the largest cooperative of organic farms in the country. The wind farm generates enough electricity to power 1,000 homes. It is a source of income for both Gundersen and Organic Valley, and a source of pride for the people who live in Cashton.

Our goals are to decrease pollution and save healthcare dollars. Along the way, we have been able to inspire our staff and community with projects ranging from energy conservation and renewable energy to sustainable foods and waste management. Gundersen Health System is one of thousands of healthcare organizations in our country. If we all join together and work toward the same goal through programs like the Healthier Hospitals Initiative, think of the difference we can make in the health or our communities. Minimizing our environmental footprint is not just a trend. It’s the right thing to do for our patients, our communities and our country. We all just need to look in the mirror, understand we are part of the problem and take action to become part of the solution.

Jeff Thompson is Chief Executive Officer of Gundersen Health System.

Protecting Health in a Changing Climate

Dr. Linda Rudolph is being honored as a Champion of Change for her work on the front lines to protect public health in a changing climate.

In 2004, I was the local health officer and public health director in Berkeley, California. We worked to improve children’s health by making it easier for kids to walk or bike to school, promoting better access to healthy foods through community gardens and local farmers markets, and reducing exposures to chemicals and pollutants that trigger asthma. Do you see the connections to climate change? I didn’t, at first.

But as California began tackling climate change, two things quickly became apparent to me. First, the impacts of climate change exacerbate many of our most serious health problems – the very chronic diseases I was seeing in all of the communities I served, and which were (and continue to be) especially prevalent in low income communities with limited resources for health care. Second, many of the strategies that reduce greenhouse gas emissions and strengthen community resilience in the face of climate change are the very same strategies that help us to reduce obesity and chronic illness.

I now believe that climate change itself is the greatest health threat we face in the 21st century. I focus on climate change in my professional work, because if we don’t act urgently and comprehensively, climate change will undermine all our other public health efforts.  I’ve also started advocating for climate action as a private citizen, in my personal time, because to truly move the needle (or thermometer) on climate change, we must also engage the passion, activism and voice of every American.

People everywhere care about their health and about the health and well-being of their children and grandchildren. But health workers have a critically important role to play in addressing climate change.  We can connect the dots: warmer temperatures can mean higher ozone levels, longer pollen seasons, and more asthma and allergies. More droughts can mean higher food prices, greater food insecurity, and more obesity and diabetes.

Public health professionals can engage with community partners to identify assets and solutions that build community resilience and fight climate change at the same time. For example, parks and tree canopies soak up carbon and other pollutants, create safe places for kids to play and provide shade to help prevent heat illness. A healthy community design offers transportation options that increase physical activity, decrease air pollution and preserve nearby farmlands and open space.

We can find win-win solutions that fight carbon pollution and climate change, reduce health inequities, and improve the health of everyone in our communities, but it will take a different kind of public health work. It will require that we collaborate closely with those who work in transportation, housing, agriculture, and many other sectors, and that we engage deeply with people in the most vulnerable communities. All of us need to let our policy makers and leaders know that we need to act vigorously on climate change right now, to protect the health of our children, ourselves, our neighbors, and our communities.

My work has shown me that climate action can make our communities more vibrant, attractive and livable. It can make our food systems more diverse and sustainable, our air and water cleaner, and our communities greener and more walkable, all of which will have huge health benefits. In California, we’ve already begun to accomplish some of this, thanks to state climate change legislation championed across party lines and supported and strengthened by the involvement of public health professionals, community advocates and organizations, and residents of communities throughout the state. As a nation, we must do the same – work together to take climate change action that benefits our health now, and protects our health into the future.

Dr. Linda Rudolph is the Co-Director of Climate Change and Public Health Project at Public Health Institute.

Healthy Air, Healthy Kids

Dr. Yadira Caraveo is being honored as a Champion of Change for her work on the front lines to protect public health in a changing climate.

Growing up in Colorado, you learn to appreciate clear blue skies and fresh mountain air – until the smog settles into the bowl-shaped Denver metro area, and suddenly the view isn’t so pretty.  During our training medical professionals like me don’t receive much education on the potential health effects of what humans put into the air.  We learn about bioterrorism, the negative effects of the food we put into our bodies, and the lung diseases affected by things as varied as keeping pigeons to popping too much popcorn.  But we never really learn about the cloud of “smog” sitting over Denver and how it will affect our patients. 

Upon graduating from medical school, I moved to Albuquerque, New Mexico to complete my training in pediatrics.  Albuquerque is another bowl-shaped city flanked by mountains, where bad air can settle and linger for days.  Living near the extinct volcanoes on the city’s west side, I could see the occasional cloud of smog settled over the city as I would drive into work.  On those days I knew what I would see all day at my shift in the emergency department, the children’s ward, or the urgent care clinic: asthma exacerbations.  On days where a brown blanket covered the desert city, I knew I’d be ordering a lot of albuterol, a medicine to help people breathe easier, putting kids on oxygen, and speaking to respiratory therapists.  It would be a day of seeing children struggle just to breathe. 

The focus on child advocacy drew me to residency in New Mexico.  I was interested in learning about how to interact with politicians and candidates, advocate for increased healthcare access in a poor state, and protect the public programs my patients relied on.  I was selected as a resident leader by the National Hispanic Medical Association and an intern in legislative affairs by the American Academy of Pediatrics.  I spent time in Washington with both groups and connected with members of the Union of Concerned Scientists (UCS) and Voces Verdes.  I participated in a conference on the public health concerns caused by emissions from coal-fired power plants and finally learned what I hadn’t been taught in medical school. 

As a Latina, I am naturally drawn to Latino health issues.  Nearly 50 percent of Latinos live in counties that regularly violate the ground level ozone, or smog, standards set by the Environmental Protection Agency, even though our standards for clean and safe air should be even stronger.  EPA estimated that further lowering the level of ozone considered safe would prevent thousands of asthma exacerbations, heart attacks, missed days of school, and hospital visits and deaths.  Obviously clean air affects everyone, but children are at a higher risk of these health effects than the adults who have the power to control pollution.  Due to young children’s size, faster heart rates, and immature systems, their lungs and brains are particularly vulnerable to toxins in our air, water, and environment.  Exposure at an early age could spell years of chronic illness and an impaired ability to learn, play, and work.  Through UCS and Voces Verdes, I advocated for tightening emission standards for coal-fired power plants, and I continue to raise awareness about the health effects of climate change and air pollution. 

Since leaving residency and starting private practice in Colorado, my advocacy efforts have shifted in part to local healthcare access issues in my hometown county and streamlining the referral system for children at risk of physical and cognitive delays due to various issues.  But every time I drive down the hill into Denver and see the brown cloud hanging over the city, I worry for my patients and think of what else we can do to ensure that our children are not just eating healthy, growing, and learning but breathing safe air. 

Dr. Yadira Caraveo is a General Pediatrician.

Healthy Climate, Healthy People

Gary Cohen is being honored as a Champion of Change for his work on the front lines to protect public health in a changing climate.

As we continue to learn more about climate change, we are realizing that it is fundamentally a health issue that will affect everyone in the world. How it damages our health depends on where we live. If we live in Beijing or Baton Rouge, Louisiana, the air could become so poisoned we can't go outside of our homes. If we live in the Midwest of the United States, extreme weather may wreck our communities and heat waves may destroy our crops and increase risk of heat exhaustion. If we live in New York or New Orleans, we may experience stronger hurricanes more often that can flood our streets, trap us in homes with no power, and shut down our hospitals. For many communities climate change can lead to increased risk of asthma among our children and respiratory disease among our most vulnerable citizens. We are learning that climate change impacts can change the patterns of infectious diseases like Dengue fever and malaria, which are spreading by mosquitoes to places that have never seen these diseases before.  We are learning that it is not possible to have healthy people on a sick planet.

These are all reasons why the healthcare sector has a unique responsibility to lead the fight against climate change. 

First, we need to get better prepared for climate change impacts in our communities.  Our hospitals and clinics need to be resilient and fortified so they can anchor the community response during extreme weather events. They need to be the last buildings standing in a hurricane rather than one of the first ones to go down. For example, if hospitals have on-site power they can continue to provide critical care to patients even if the grid is down for days. On-site power can also make hospitals more energy efficient, reduce greenhouse gas emissions and help hospitals save money.

Second, the healthcare industry appears to be addicted to fossil fuels. Hospitals use twice as much energy per square foot as schools and offices  in part to fuel all the life-saving equipment they operate 24/7. That makes hospitals major carbon polluters. Given that healthcare is underpinned by an ethical imperative to “First, Do No Harm," they have a responsibility to reduce their carbon pollution and be leaders on renewable energy, energy efficiency, and other carbon mitigation efforts that support healthier people in healthier communities. Healthcare represents 18 percent of our economy.  If we can harness the purchasing power of this critical sector, we can drive our economy toward a low carbon development path that will reduce our rising disease burden and spiraling healthcare costs. Toward this end, we have built a global coalition for Healthier Hospitals that is accelerating the adoption of sustainable and climate-friendly practices.

Third, healthcare professionals are some of the most effective spokespeople in our society. When we wanted society to address tobacco, we got nurses and doctors to stop smoking first. We banned cigarettes from hospitals, and we educated our patients about the dangers of tobacco. In the global campaign to kick our addiction to fossil fuels and toxic chemicals, doctors, nurses, and other healthcare workers need to be powerful spokespeople for policies that put a price on carbon and support the transition to a renewable energy and toxic-free future. There are 5 million healthcare workers in America. We can enlist them to become climate champions in our communities for local solutions and critical spokespeople at the state, national, and global levels for laws and treaties to rein in carbon pollution. 

In this next period of our collective history, we will need to redefine the purpose of healthcare. It can no longer be exclusively focused on treating chronic disease in individual patients. Healthcare needs to expand its mission and address the environmental and social conditions that are making people sick in the first place. Healthcare needs to lead the fight against climate change. It is our best remedy to this global health emergency.

Gary Cohen is the President of Health Care Without Harm and Co-Founder of Healthier Hospitals Initiative.