Health care climate alliances concentrate on state-level change in California, Washington

April 2021


"Climate change is no longer a distant threat," says Rachelle Reyes Wenger, system vice president, public policy and advocacy engagement for CommonSpirit Health. "We already are experiencing extreme weather events, disastrous wildfires and elevated levels of greenhouse gas emissions and pollution."


Wenger adds that communities of color and those most vulnerable to air pollution are disproportionately impacted by the climate crisis, but no one will escape its effects. "The nexus between climate and health is very real and very personal for all," she says.

As part of its commitment to advance social and environmental justice, Dignity Health joined with three other large health systems in 2018 to form the
California Health Care Climate Alliance. (Dignity Health merged with Catholic Health Initiatives in 2019 to form CommonSpirit.)

Firefighters battle an August wildfire during a scorching California heatwave.

"Caring for the Earth is not only a moral imperative but also fundamental to our healing mission," Wenger explains. "We cannot do this work alone. Stewardship of creation calls all of us to do our part to protect the health of people and planet, particularly now."

Raising the volume
In conjunction with Health Care Without Harm, Dignity Health, Providence St. Joseph Health, Kaiser Permanente, the University of California Health and Sutter Health created the legislative advocacy coalition that works with policy makers in Sacramento to support the state's climate goals.


"These health care systems represent 122 California hospitals serving more than 20 million patients. Working together in advocacy makes their voices louder," says Robyn Rothman, attorney and associate director of state policy systems at Health Care Without Harm, an international nonprofit organization dating to 1996, when the U.S. Environmental Protection Agency identified medical waste incineration as the leading cause of dioxin emission and a large percentage of mercury pollution.

Health Care Without Harm believes the health care industry has a responsibility to "address its own environmental footprint as well as become leaders in society in supporting a sustainable economy and healthy communities."

Health Care Without Harm has influenced policy in a number of areas, including environmentally preferable purchasing and the phasing out of mercury in hospitals and medical devices using polyvinyl chloride. It's been influential in developing greener hospital and medical buildings and providing healthier food for patients and health care employees.

Arguably one of its most important initiatives, however, has been in playing a leading role in rebranding climate change as a public health issue and supporting the health care sector to lead by example in reducing its carbon footprint.

"Health care contributes 13% of California's economy, so the work of the alliance can play a key role in helping the state meet pollution reduction targets and prepare for the worst impacts of climate change," says Rothman. She adds: "Alliance members have committed to deeply reducing their greenhouse gas emissions and to driving California's transition to 100% clean energy."

Unified front
Just a year after the California Health Care Climate Alliance was formed, Health Care Without Harm helped initiate the Washington Health Care Alliance in 2019. It includes Providence St. Joseph Health, MultiCare, Seattle Children's Swedish Health Services, UW Medicine and Virginia Mason Franciscan Health. Together members represent 40 hospitals in Washington state, 1,000 health care facilities and 9 million patients. They bring their expertise and trusted voices to the legislative and regulatory process to advocate for climate-smart policies related to energy, transportation, food, waste, infrastructure and community resilience.


"We greatly feel the need to join with others to raise awareness of the connection between the health of our patients and the health of the planet," says Ali Santore, senior vice president of government affairs and social responsibility for Providence St. Joseph Health, a founding member in both the Washington and California alliances.

Santore says Providence is called to environmentalism by its mission to improve the health and quality of life in its communities. She points to both Pope Francis' 2015 papal encyclical, Laudato Sí, which highlighted the crisis posed by climate change and its unfair burden on the world's poor and vulnerable, and to President Donald Trump's 2017 decision to withdraw from the Paris climate accord as having lent even greater urgency to the work.

"We realized the need to stay in the game by focusing on a state, rather than federal, level," she says.

Walking the talk
Both alliances, staffed by Rothman, have similar models. Members digest government research, they talk strategy and analyze bills, regulations and state code changes, and they vote on what to support as coalitions.

And though legislative and regulatory progress slowed in 2020 due to the coronavirus pandemic, Rothman points to several successes. Among them:

  • House Bill 1257, commonly referred to as the Clean Buildings bill, signed by Washington Gov. Jay Inslee in 2019. The objective of this legislation is to lower costs and pollution from fossil fuel consumption in the state's existing building stock, especially large commercial buildings greater than 50,000 square feet, which includes many hospitals.
  • Washington Clean Fuel Standard legislation, under debate again this current legislative session. It calls for a 20% reduction of the carbon intensity of fuels by 2035 over a 2017 baseline.

The California Alliance supported setting zero emission goals for medium- and heavy- duty vehicles by 2045, prior to Gov. Gavin Newsom's groundbreaking executive order calling for the same. Transportation currently accounts for more than 50% of the state's greenhouse gas emissions.

"In addition to our advocacy work on the state level, we, as health care providers need to have fearlessness in the positions we take internally," says Santore. "At Providence, for instance, we are focused on becoming carbon negative by 2030, and realize that industries need regulatory flexibility and economic incentives to achieve similar goals."

Adds Wenger: "If anything, given where we are now in terms of multiple viral and economic pandemics, civil unrest and racial inequities, our alliance must use its voice and size to weigh in on meaningful policy solutions. Health care and its focus on social determinants cuts across all of it, bringing home the message of an inextricable connection between health and environment."

For its part, Health Care Without Harm would like to replicate its state alliance model elsewhere in the U.S. Massachusetts launched a structurally more informal model in 2018, says Rothman, working within health care facilities to prioritize policies. But the recent increase in the number and destructiveness of natural disasters — fires in California, Colorado and Oregon, hurricanes and flooding along the Gulf Coast — are evidence that global warming requires global initiative.

"A broad-based, national and international coalition of health care organizations," says Rothman, could help both amplify, and codify, reform.

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