How Healthy Is Health Care?

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Abstract

The health care industry is uniquely charged with tending to human health and wellness and has been called on to help lead the transition to a sustainable world.1,2 Yet, modern health care itself is a leading emitter of environmental pollutants, responsible for 10% of national greenhouse gas emissions and 9% of criteria air pollutants in the United States alone.3 In the United States, health care pollution causes indirect harm to public health, commensurate with the 44 000 to 98 000 deaths from preventable medical errors first reported by the Institute of Medicine (IOM) in To Err Is Human 2 decades ago.3,4 That landmark IOM article sparked a patient safety movement, but the health care industry lags behind in its efforts to reduce harm caused by its own pollution footprint. Senay and Landrigan5 examine how the health care industry compares with other industries with respect to corporate social responsibility (CSR) reporting. Corporate social responsibility reporting represents a growing commitment to publicly communicate environmental and social performance. International reporting standards exist for environmental performance indicators most notably through the Global Reporting Initiative,6 and also the Carbon Disclosure Project7 with participants representing nearly a fifth of global greenhouse gas emissions. Currently, CSR reporting is voluntary in the United States but published by a majority of the largest publicly traded companies as well as many private and nonprofit companies. Senay and Landrigan5 astutely point out the natural synergy of the mission of health care with environmental and social responsibility—what is good for health and well-being is good for health care. They describe the advantages of sustainability efforts associated with CSR reporting, including reduced operating costs, improved employee wellbeing, and protection of human health. Yet, they found that the 49 largest US health care organizations (HCOs) included in their study lagged behind other large corporations in CSR reporting during the 2015 to 2016 study period (50% vs 78% of Fortune 500; 33% vs 82% of S&P corporations; 12% of all HCOs including private and charitable organizations). Although the authors went on to extend criteria for HCO reporting beyond the Global Reporting Initiative and the Carbon Disclosure Project, to encompass a web presence for sustainability initiatives, the health care industry still fell short. Senay and Landrigan5 have applied a unique method to uncover an alarming statistic in health care, much like the aforementioned IOM report on medical errors; but, unlike the timing of the IOM report, the sustainability movement may already be under way. Senay and Landrigan5 defined their inclusion criteria as those HCOs on at least 1 of the following lists: 2016 Fortune 500, S&P 500, Forbes 100 Largest Charities, 2015 Largest Profit and Nonprofit Health Care Systems by number of facilities compiled by Becker’s Hospital Review, and June 2016 Largest Employer in Every State compiled by 24/7 Wall St. Thus, 49 large HCOs were identified, enabling some direct comparisons with CSR reporting by other large corporations. These 49 HCOs represent a small fraction of the more than 5500 hospitals in the United States, and therefore, the majority remains unexamined by the authors. More than 1200 US hospitals enrolled in the Practice Greenhealth Healthier Hospitals Initiative that hosted the following 6 key health care sustainability challenges: engaged leadership, healthier food, leaner energy, less waste, safer chemicals, and environmentally preferable purchasing.8 While only some metrics were publicly reported by the Healthier Hospitals Initiative, this represents a much broader interest in sustainability than the authors were able to measure. Similarly, the American Hospital Association has several health care challenges and provides an option for benchmarking direct energy consumption through the + Related article