Illustration by Larry Moore
ALI SANTORE
Chief advocacy officer, Providence
Every community around the world faces the existential crisis of climate change. As a direct result of this crisis, the negative impact to human health will affect current and future generations.
Air pollution, heat waves and extreme weather increasingly negatively influence human health, according to a December 2020 analysis by The Lancet.1 At the same time, the U.S. health care sector contributes 8.5% of all greenhouse gases produced in the nation.2 The health care sector's impact results from fossil fuel consumption, byproducts of chemical use and production of excessive waste. Scientists have indicated that climate change is the crisis of our time and swift change is of the essence. Prompt and prudent change made during the current decade will determine whether humans can limit global temperature rise to a manageable amount for generations to come.3
At Providence, we recognize our responsibility to act now and challenge others in our industry and beyond to do the same. We can only change the course of this crisis through collective action. Our vision of health for a better world calls us to care for the most vulnerable and our precious resources through environmental justice and stewardship. Core to Providence's plan is the dramatic reduction of our carbon footprint. Our goal: Providence will be carbon negative by 2030.
Providence is composed of 52 hospitals, more than 1,000 medical clinics, senior services, supportive housing and other health and educational services. Together with our partners we employ more than 120,000 caregivers serving communities across seven states — Alaska, California, Montana, New Mexico, Oregon, Texas and Washington with system offices in Renton, Washington, and Irvine, California. We have scoured operations and procedures to find opportunities to serve patients, employees and our communities for ways to reduce our footprint.
We acknowledge that this effort must be a perpetual commitment to improvement. We invite others to join us as we seek to improve the health of our planet and our communities.
THE VISION AND THE PLAN
In 2020, on the 50th anniversary of Earth Day, Providence announced the goal to become carbon negative by 2030. This announcement was particularly meaningful, as we are still on the front lines of fighting COVID-19 and seeing firsthand that climate change and the pandemic disproportionately impacts vulnerable communities.
Unquestionably, the most challenging part has been knowing where to start and then how to set not just well-meaning goals, but also to take action. In 2019, Providence leaders considered several approaches toward our climate action commitment. First, we examined a range of improvement and adjustment opportunities, including addressing the emissions associated with our electricity, energy and greenhouse gasses individually. In addition, we reviewed the span of our commitment. We considered addressing emissions from our 52 acute sites only, all our clinical sites (hospitals, ambulatory centers, home health programs, virtual health services) or from all aspects of Providence, including office buildings, companies we have developed and investments. We recognized that to have a meaningful impact and set an example, we needed to include the entire organization.
WE ACT: A FRAMEWORK FOR ACTION
This carbon negative commitment will require cultural transformation across our organizations. These efforts are represented in the WE ACT strategic framework, which outlines five focus areas: Waste, Energy/water, Agriculture/food, Chemicals and Transportation.
Waste: Our goal is to send less than 50% of total waste to landfills or incineration by 2030. We are actively conducting a waste optimization process to ensure that all sites send their waste into the correct disposal pathways. This focus includes the efforts to continually maximize recycling, composting and source reduction of waste.
Energy/water: We are maximizing the energy efficiency and minimizing water intensity of our buildings through conservation. Our infrastructure investment will include modernization of existing buildings and design of new buildings. The opportunity includes the reduction of greenhouse gas emissions from electricity by 96%, with more energy-efficient operations using renewable electricity sources. As the core of our mission is to serve the poor and vulnerable, many areas we serve are at risk for water supply shortages. We developed a water reduction plan that incorporates low-water landscapes, low-flow fixtures and water-saving technologies.
Agriculture/food: We have contracted with a large third-party vendor who is committed to our efforts to reduce waste, choose lower carbon-intensive foods and support local and sustainable foods. We believe we can decrease greenhouse gas emissions from our food services by purchasing foods that produce fewer greenhouse gases and by reducing waste during meal preparation and composting food waste.
Chemicals: Our clinical work in anesthetic use has already resulted in a 50% emissions reduction (and millions of dollars saved) from inhaled anesthetics. We are developing best practices for nitrous oxide delivery and monitoring. We believe we can reduce these emissions by 90%.
Transportation: Transportation is the largest contributor of greenhouse gases in the U.S. We are driving a more strategic and environmentally responsible approach to transportation. For example, we anticipate decreasing business travel emissions from a 2019 baseline by 50% by monitoring four aspects of business travel: flights, rental cars, hotels and reimbursed miles used in care delivery. We also are developing plans to electrify our fleet vehicles through purchase and lease. We plan to decrease emissions from commuting by 30% by supporting remote-work initiatives and alternative forms of commuting.
COLLABORATION AT EVERY LEVEL
We have worked hard to integrate this initiative into every facet of Providence, from grassroots-engaged caregivers to executive leaders. Our Environmental Justice Collaborative develops action plans to address the connection between the environment and health equity. Our Action Collaborative for Environmental Stewardship is a system-wide group that shares best practices and tracks metrics and outcomes to advance our efforts.
We educate and engage all caregivers to take actionable steps at their hospitals, clinics, warehouses and other properties. Caregivers also are involved in Green Teams, groups of volunteers who advance environmental stewardship efforts at the local level to address the WE ACT elements.
In the spirit of the Sisters of Providence, we also partner with other health systems to educate them as they develop sound stewardship practices. We are proud that many have adopted our approach across their organizations to achieve similar results.
MEASURE, TRACK, FOCUS
Our voice is always aimed at relieving injustices, especially for the poor and vulnerable. To better understand and reduce the impacts of climate change on vulnerable populations, we need access to complex data to track progress and measure outcomes.
Our program's effectiveness depends on access to reliable cost and consumption data. To that end, we are building the "WE ACT Data Scorecard" to bring insights to ministry leaders. This scorecard incorporates vendor reports and other data from each of the WE ACT categories. This database generates a monthly update of use, cost and carbon footprint for each acute care hospital.
To identify where to focus efforts, we measure and track many elements of our operations to meet benchmarks for improved performance. We examine issues in the communities and regions we serve, along with current solutions that may be in place. By cross-referencing health risks with available resources, we can identify where we can help.
Supply chain and procurement patterns drive a substantial amount of our estimated carbon footprint (38.4%). To tackle the challenge of decreasing emissions from procurement, we have developed an environmentally preferred purchasing policy. This system-wide policy instructs leaders across the organization to consider the environmental impacts of their purchasing decisions, using the WE ACT framework as a guide.
In addition, we are working with key vendors to understand emissions from the products they manufacture, sell or deliver. All new construction projects will be designed to estimate and reduce embodied carbon in buildings (greenhouse gases emitted from manufacturing, transportation and construction of building materials).4
PRIORITIZING PATIENTS AND THE PLANET
Transformation does not happen overnight. Our 10-year plan keeps us moving forward. We face the same competing priorities and financial pressures that ministries across this country face. No matter the challenges ahead, environmental stewardship remains a top focus. This requires persistence, commitment and teamwork. We have a responsibility to advance our healing ministry through care for our common home, on behalf of our patients and our communities. We support others engaged in this work, because we know that complacency is not an option.
ALI SANTORE serves as chief advocacy officer for Providence, Renton, Washington.
NOTES
- Wenjia Cai et al., "The 2020 China Report of the Lancet Countdown on Health and Climate Change," The Lancet Public Health 6, no. 1 (January 1, 2021): 64–81, https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30256-5/fulltext.
- Matthew J. Eckelman et al., "Health Care Pollution And Public Health Damage in The United States: An Update: Study Examines Health Care Pollution and Public Health Damage in the United States," Health Affairs 39, no. 12 (December 1, 2020): 2071–79, https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01247.
- D.R. Reidmiller et al., eds., "Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II," U.S. Global Change Research Program, 2018, https://nca2018.globalchange.gov.
- Henry Siegel and Larry Strain, "Embodied Carbon: What You Can Do Right Now," AIA California, March 5, 2020, https://aiacalifornia.org/embodied-carbon-definitions-and-facts/.