Accelerating climate-smart transformation of U.S. health care: A federal-first approach

Health Care Without Harm
4 min readFeb 2, 2022


By Antonia Herzog, Ph.D., Associate Director of Partnerships, Advocacy and Equity, Health Care Without Harm

Flooded parking lot with submerged van and trees in front of hospital building
ER entrance of the VA Hospital in New Orleans, post Hurricane Katrina. Image by Jh12 via Wikimedia Commons.

Our health care systems are facing the challenges of the COVID-19 pandemic and the growing threat to community health and resilience from the climate crisis. Climate-related disasters leave health care facilities vulnerable to suspended services, postponed procedures, evacuation orders, an inability to treat patients, and closure causing massive economic and human disruption. Nationwide the combination of these public health crises has strained hospital facilities, stressed staff, and depleted resources.

The Biden administration has demonstrated a clear understanding of the urgency of the moment, committing the nation to ambitious, science-based targets to reduce U.S. greenhouse gas emissions and joining 50 other countries in pledging to build a climate-resilient and low carbon health care sector through the COP26 Health Programme.

And just recently, the administration announced an executive order positioning our federal health care facilities in a leadership role for bold action on climate and health.

On December 8, 2021, President Biden announced Executive Order 14057 (EO 14057) requiring federal facilities, including 1,700 federal health care facilities, to decarbonize and set goals aligned with the administration’s overall climate goals. This includes achieving net-zero emissions across federal buildings, campuses, and installations. The order covers the Veterans Health Administration (VHA), which includes 176 medical facilities and over 1,500 outpatient, community living centers and domiciliaries, and the Defense Health Agency (DHA), a $51 billion entity that manages more than 50 hospitals and another 425 medical facilities.

Health Care Without Harm developed recommendations for federal health facilities on how to move toward low-carbon, sustainable operations and procurement and improve climate resilience and provide uninterrupted health care to the nation’s military and veterans. Through the implementation of EO 14057, federal facilities can model the essential transformation of health care to align with the administration’s climate goals and use their purchasing power to send important signals and shift the supply chain toward a more just, low-carbon economy.

The purchasing power that large facilities and institutions have at their disposal can be used to create sweeping changes, and the health care sector, with its mission to “do no harm,” is positioned to lead a shift in markets and supply chains.

US national health care greenhouse gas (GHG) emissions, 2010–18. SOURCES: Health Care Pollution and Public Health Damage in the United States: an Update; Health Affairs, Vol. 39, №12

Health care accounts for 18% of the U.S. GDP, and the federal government spends over $25 billion on general health care, drugs, and medical supplies, with additional billions of dollars to support the operation of buildings and purchasing products such as meat and poultry. This directly translates to substantial climate impact, with health care responsible for 8.5 percent of all U.S. greenhouse gas emissions. Therefore, the health care sector can have an outsized impact on a transition to a cleaner, more equitable economy.

Health Care Without Harm’s membership organization, Practice Greenhealth, provides sustainability guidance and support for health care that benefits patients, employees, communities, financial security, and the environment. There are currently over 200 VHA and U.S. Army Medical Command hospitals in our Practice Greenhealth membership program. Last year, approximately 175 of these federal facilities provided sustainability data to Practice Greenhealth for the organization’s annual awards and benchmarking programs.

Following through on these goals and commitments as outlined in EO 14057 for federal health care facilities is critical. Examples of key actions include:

  • Systematically tracking facilities’ progress toward meeting these goals across all scopes (1–3) of emissions
    Requiring federal health care facilities to utilize medical products and systems that reduce greenhouse gas emissions and prevent waste
  • Specifically, the U.S. Department of Veterans Affairs’ prohibition of the use of reprocessed single use medical devices in the VHA should be overturned. Reprocessed medical devices are safe and in widespread use, including by U.S. Department of Defense (DoD) health care facilities, and switching to reprocessed medical devices results in considerable cost and emissions savings.
  • Reducing the greenhouse gas emissions specific to anesthetic gases in federal health care facilities by 50% from a 2020 baseline by 2025
    Phase out desflurane and adopt technologies for the sequestration, distillation, and reuse of waste anesthetic gases, with the U.S. FDA reviewing all available evidence and, as appropriate, fast-tracking approval of these technologies

Furthermore, federal health facilities need to procure sustainable and healthy foods and adopt other food service strategies that reduce carbon and support equity and resilience. By using procurement strategies which align social, health, economic, and environmental values, we can support sustainable and regenerative production practices, bolster local farm economies, and ensure equitable access to markets for farms and food businesses owned by people of color while providing the resources they need to grow viable enterprises and create community wealth and resilience.

Following on EO 14057, we urge the Biden Administration to produce guidance, directives, and reporting requirements for federal health care facilities or federal agencies specific to sourcing locally, sustainably, and equitably produced foods and beverages, and reducing food supply chain-related greenhouse gas emissions.

Addressing the climate crisis as a core driver of disease must be central to the health sector’s mission today and in the future. As a fundamental sector in our society, and the only sector with healing as its mission, it makes sense for health care to lead the way to eliminate the use of fossil fuels, improve public health, and save billions of dollars in health costs in the process.

The Biden administration has a significant opportunity to develop policies and programs to accelerate this work in federal health care facilities that will in turn help move the entire health care sector.



Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.