Healthcare Leaders on Institutional Response to Climate Change

Climate change is no longer an abstract future possibility, but today’s reality, and a warming world has increasing implications for human health.

The recent Climate Crisis and Clinical Practice Symposium in Boston brought together experts from leading health institutions to discuss the effects of the climate crisis on healthcare practice. The event was a multi-institution collaboration, with a list of heavyweight hosts, partners, and sponsors including the Harvard Global Health Institute and the New England Journal of Medicine, along with every major Boston-area teaching hospital.

A panel discussion on how healthcare leaders and institutions can support innovation and change in light of climate challenges featured Kate Walsh, CEO of Boston Medical Center Health System; Nicholas S. Hill, chief of Tufts University School of Medicine Pulmonary, Critical Care, and Sleep Division; Bernard Jones, vice president of public policy at Brigham and Women’s Hospital; and Patrice Nicholas, director of the Center for Climate Change, Climate Justice, and Health at the Massachusetts General Hospital Institute of Health Professions (IHP).

“Frankly, institutions are incredibly difficult to change,” said panel moderator Gina McCarthy, Harvard C-CHANGE advisory board chair and former U.S. EPA administrator, as she introduced the panelists. “These four have been able to do it.”

Their conversation shed light on how institutions can lead in several key ways, from implementing energy-saving measures to involving and empowering staff — who often are passionately concerned about the climate crisis — and fostering collaboration across disciplines and institutions.

Reducing hospital emissions

With 10% of U.S. greenhouse gases coming from the healthcare sector, an emergent theme from the discussion was healthcare institutions’ responsibility in energy efficiency.

“We are energy hogs, as an industry — lights are on, things are beeping, 24/7, 365 days a year. So it really is an imperative for us,” said Walsh. “If we [as a healthcare sector] don’t get this right, a lot of other people would have to do a lot of hard work.”

“The whole will be much greater than the sum of the parts if we address these issues and advocate as a collective of health systems, universities, great civic institutions who together agree that this is a huge problem.”
– Bernard Jones, vice president of public policy at Brigham and Women’s Hospital

Boston Medical Center (BMC) has conducted a recent major campus renovation effort that made energy efficiency and emissions reduction a core objective, including in projects like a green OR renovation, rooftop farm, solar power installation, and green bond financing. Beyond the economic opportunity for cost savings in energy spend, Walsh noted, BMC’s institutional prioritization of sustainability efforts stems from its responsibility as a safety-net provider, serving communities that often suffer more during weather disasters and take longer to recover afterward. The hospital’s cogeneration facility enables BMC to sustain itself as an “island” in a power outage, while also being of service to the city’s public health and emergency response teams, Walsh explained. Jones likewise mentioned significant investments in wind and solar to “green the energy supply” at the Brigham.

Empowering staff

The discussion also highlighted how institutions can lead by educating, encouraging, and empowering practitioners to be active messengers on climate change’s detrimental health impacts. Panelists noted the value of institutional leadership listening to staff and involving them in problem-solving around sustainability, patient education, and advocacy efforts rather than responding to the climate crisis with only top-down policies. McCarthy pressed for details, and Jones spoke of the Brigham’s Eco-Green Team and a climate action council populated by leadership, faculty, and clinicians.

“If it’s just a bureaucrat-driven initiative, you’re just not going to get things done,” he said. “But if it’s from the ground up, led by your faculty, led by your residents and your trainees and your own employees, you can almost get anything done.”

Nicholas described a hunger for such discussion among providers. When her group presents at area health institutions, she explained, the events are often standing-room-only.

“People at the point of care are really interested in this,” she said. “They’re anxious and so excited about the opportunity to bring their climate concerns to the workplace to better care for patients.”

Doctors could “turn up the volume” as everyday messengers and advocates, Hill agreed, adding that “We need to do more education, not only of our peers, but of the public.” Jones urged the clinicians in the room to voice their concerns and work to influence their institutions.

“As you think about ‘What more can I do?’, track down the government affairs folks or your CEO and say, ‘This is an issue that I care about. I do research in it. I do advocacy in it. Can you help me get in front of our elected officials to make this case?’ You’re likely to get in front of them, and you’re likely to make a big difference,” Jones said, emphasizing the power of healthcare practitioners as trusted sources of information, not only to patients, but to policymakers.

Collaborating as institutions

All agreed that to respond adequately to climate change, institutions and specialists must come together and collaborate.

“I’ve started a conversation with Kate [Walsh], and with others — interesting places like the Boston Public Library — about how we as large, well-resourced, highly visible civic institutions can advance the discourse and focus down on the practical solutions,” said Jones. “The whole will be much greater than the sum of the parts if we address these issues and advocate, not as the Brigham, or as BMC, or as Tufts, or as IHP, but as a collective of health systems, universities, great civic institutions who together agree that this is a huge problem.”

“The thing we need to avoid,” he added, “is that the partnership on this issue stops at the end of this symposium. I’m hoping it’s actually much more of a starting pistol.”

The Boston event was a starting point for a conversation that will continue around the U.S. and the world. Over the next 12 to 18 months, similar convenings are slated to occur at seven sites: the University of Washington, Emory University, Stanford University, the University of Colorado, the Cleveland Clinic Foundation, the University of Wisconsin, and Australian National University. During the week following the Boston symposium, the NEJM continued the conversation in an online forum discussion, “Health Care and the Climate Crisis: What Can You Do?” View the questions and answers at NEJM Resident 360.

A video of the full panel discussion is below.

Panelists in the second session of the Climate Crisis and Clinical Practice Symposium, held in in Boston on Feb. 13, discuss the role of institutional leadership in protecting the health of their patients and communities from the effects of climate change.