University of Southern California researchers seek sustainability solutions and advocate for change

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How health care can go green

Keck School of Medicine of USC researchers seek sustainability solutions and advocate for change

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For physician-scientist Howard Hu, the irony is hard to take.

The same medical community that makes its mission to improve health also substantially contributes to climate change, a global threat with numerous, widespread detriments to health. In the U.S. alone, the health care industry accounts for between 8 and 10 percent of all greenhouse gas emissions.

“The contribution to emissions is huge,” said Hu, MD, MPH, ScD, holder of the Flora L. Thornton Chair in Preventive Medicine and chair and professor of population and public health sciences at the Keck School of Medicine of USC. “That insight became a clarion call for us to do something about it.”

That spur to action has added a new line of study for his research efforts, which also focuses on revealing the effects of pollution on human health. As an outgrowth of his recent work related to climate change, Hu has organized colleagues from across multiple disciplines to examine the medical industry’s impact — and uncover potential solutions. The effort involves not only rigorous science, but also advocacy to engage more and more health workers.

“There are currently very few health care professionals at the grassroots level who are aware of this issue, and that needs to change,” Hu said. “The push to decarbonize health care won’t truly gain traction until the larger health care community see this as a major problem that must be dealt with, and incorporate that into their ethos as caregivers.”

His own caregiver’s ethos is at the core of Hu’s motivation.

“We all want to save patients and improve patient care,” he said. “Doing it in a sustainable way — constantly looking for opportunities to lower our carbon footprint — is part of our responsibility to our patients.”

The many faces of carbon emissions in the medical industry

Just as his mission to help decarbonize health care was driven by a revelation, Hu was first drawn to issues around climate change and human health when he and other researchers began to grapple with the scope of harm.

“It became very clear that the problem of greenhouse gases was much bigger than just heating the atmosphere,” he said. “There are impacts on how lands turn to desert, on rainfall and on wildfires, of course — as we’re seeing. With all the concrete and asphalt in urban environments without much tree cover, there are ‘heat islands’ in underserved communities right here in Los Angeles. And there are broader changes in patterns of infectious disease.”

Certain aspects of how hospitals contribute to this predicament seem intuitive. These are facilities that stay open 24 hours a day, every day, with high-powered machinery that’s crucial for care. As a result, the medical sector is a big consumer of energy.

Other aspects are less visible, in their way. Hospitals are also tied to the energy-intensive construction industry due to the frequency of building and renovating — lately to add ICU space to prepare for COVID-19 surges. But that connection also offers the chance to partner with builders in cutting carbon.

“The opportunity to incorporate sustainability practices in all of these construction plans is huge,” Hu said.

It turns out, however, that the largest part of the problem is close to invisible. The medical world incurs its greatest carbon debt through supplies, especially for single use, as well as pharmaceuticals, anesthetic gases and elements of their operations such as waste management. According to Hu, the approach for mitigation will require focus and widespread cooperation.

“You need to cross many disciplines to understand the carbon footprint of each of these activities,” he said. “It’s also going to take some deep diving.”

Indeed, he and collaborators in his department have joined forces with USC economics and architecture faculty in projects to get a handle on health care-derived carbon emissions and decarbonize the industry.

Priority one is health and well-being

To forestall any misunderstanding, Hu is crystal clear on one point.

“Quality of care is nonnegotiable,” he said. “We can’t ever fall into a trap where there’s some sense that we’re shortchanging patients. Every aspect of this movement is to optimize health. In fact, we can improve it while pursuing a sustainability agenda.

“For example,” Hu continued, “the 65-fold increase in telehealth that has occurred during the pandemic has actually improved access and some aspects of primary care and mental health services while forgoing the carbon emissions associated with transporting patients to medical centers.”

As another example, having a hospital fill all of its energy needs from renewable sources would have no conceivable downside for its patients. And that change would reduce harms to health from emissions at the same time.

Recently, Keck Medicine entered into a larger alliance for sustainable health care, Practice Greenhealth. This network of hospitals and medical centers are pursuing sustainability, using common measures to track their progress and sharing best practices.

Hu sees the opportunity for USC to have impact in the communities it serves as well as far beyond.

“We intend to use Keck Medicine’s evolution toward a sustainable health care enterprise as a sort of laboratory,” he said. “We’ll work with our colleagues to create innovative solutions to accelerate the whole movement toward sustainability.”

And, as with many initiatives to reduce or eliminate the human contribution to climate change, the time for inaction is well past.

Hu said: “We’re beyond the point of saying, ‘Geez, are carbon emissions bad?’ We need to figure out which best practices that will move the needle. In medicine, we have a moral obligation on some level to ensure that we’re not killing people while saving them because we’re adding to global warming.”

Sustainability in health care is one of many topics to be explored during Earth Week 2022 on the Health Sciences Campus, planned in collaboration with the Keck School’s Environmental Justice special interest group for students and the Master of Public Health Student Association. For more about Earth Week panels, events and social media initiatives, visit the USC Office of Sustainability.

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