Sustainability in Healthcare

Industry Overview

Healthcare is a paradox: an industry dedicated to human wellbeing that simultaneously contributes significantly to the environmental conditions that threaten it. If the global healthcare sector were a country, it would rank as the fifth-largest emitter of greenhouse gases on the planet. In the United States alone, healthcare accounts for approximately 8.5% of national GHG emissions—driven by energy-intensive facilities, complex supply chains, and enormous volumes of single-use materials.

The COVID-19 pandemic exposed both the sector's fragility and its wastefulness. Hospitals consumed unprecedented quantities of disposable PPE, generated mountains of infectious waste, and ran facilities at maximum energy intensity. But the pandemic also demonstrated healthcare's capacity for rapid operational change—a capacity that sustainability advocates argue should be directed toward decarbonization and resource efficiency.

The business case is increasingly clear. The U.S. healthcare system spends over $4.3 trillion annually, with energy and waste representing significant controllable costs. Health systems that have invested in sustainability—Kaiser Permanente, Cleveland Clinic, NHS England—report material savings alongside emissions reductions. As climate-related health impacts increase (heat-related illness, vector-borne disease, respiratory conditions from wildfire smoke), healthcare organizations face a dual imperative: reduce their own environmental impact while building resilience to serve communities facing climate-driven health crises.

Key Sustainability Challenges

Energy-Intensive Operations

Hospitals operate 24/7/365, with HVAC systems maintaining precise temperature and humidity controls, surgical suites requiring high air-change rates, and diagnostic equipment drawing substantial power. A typical U.S. hospital uses approximately 2.5 times more energy per square foot than a commercial office building. Decarbonizing these operations without compromising patient care or infection control requires careful engineering and phased investment.

Medical Waste and Single-Use Culture

The healthcare sector generates approximately 5.9 million tons of waste annually in the U.S., with regulated medical waste representing only a fraction—most hospital waste is similar to municipal solid waste but gets treated as hazardous due to conservative waste segregation practices. Single-use devices, surgical draping, and pharmaceutical packaging contribute to an enormous waste stream. Shifting toward reprocessed devices, reusable textiles, and reduced packaging encounters resistance rooted in infection control concerns, even when evidence supports the safety of alternatives.

Pharmaceutical and Supply Chain Emissions

The pharmaceutical supply chain is carbon-intensive, involving chemical manufacturing, cold-chain logistics, and global distribution networks. Scope 3 emissions from purchased goods and services typically represent 60-70% of a health system's total footprint. Engaging pharmaceutical companies, medical device manufacturers, and distributors on emissions reduction requires purchasing leverage and consistent demand signals that individual health systems rarely possess alone.

Regulatory Landscape

Healthcare sustainability regulation is emerging but unevenly applied. The NHS in England has committed to reaching net-zero by 2040 for direct emissions and 2045 for its supply chain—the first national health system to set such targets, backed by regulatory requirements for NHS trusts. The EU's CSRD applies to large healthcare companies, requiring comprehensive sustainability reporting.

In the U.S., federal regulation is limited, but state-level action is growing. California's SB 1075 restricts certain fluorinated anesthetic gases due to their extreme global warming potential. Multiple states regulate pharmaceutical waste disposal, and EPA regulations govern medical waste treatment and air emissions from hospital incinerators. The Joint Commission and CMS conditions of participation include environmental management requirements, though these are primarily focused on safety rather than sustainability.

The Inflation Reduction Act provides healthcare facilities access to direct-pay clean energy tax credits (Section 48 and 179D), enabling tax-exempt hospitals and health systems to benefit from incentives previously available only to taxpaying entities.

Opportunities

Energy efficiency represents the largest near-term opportunity. ENERGY STAR benchmarking data shows that top-performing hospitals use 30-40% less energy than median performers, suggesting significant headroom for improvement. LED lighting, variable-speed drives, heat recovery systems, and building automation upgrades deliver strong returns. Combined heat and power (CHP) systems are particularly well-suited to hospitals' simultaneous need for electricity, heating, and cooling.

Waste reduction and diversion generate both cost savings and environmental benefits. Health systems implementing comprehensive waste segregation programs, reprocessing of single-use devices, and food waste reduction initiatives report 20-40% reductions in waste disposal costs. The FDA-cleared single-use device reprocessing market saves hospitals approximately $500 million annually while diverting thousands of tons from landfills.

Climate resilience is an increasingly urgent investment area. Hospitals that invest in backup power, flood protection, supply chain redundancy, and heat-resilient design protect both their communities and their financial viability. Climate-resilient facilities maintain operations during extreme weather events that can shutter unprepared competitors.

How Council Fire Can Help

Council Fire works with health systems, hospital networks, and healthcare companies to develop sustainability strategies that respect the sector's unique constraints. We conduct facility-level energy audits and portfolio carbon assessments, develop decarbonization roadmaps aligned with science-based targets, and design waste reduction programs that maintain clinical safety standards. Our team understands healthcare's regulatory environment, infection control requirements, and the operational realities of 24/7 clinical facilities.

We support health systems in engaging their supply chains on sustainability, building internal governance structures, and reporting under frameworks relevant to healthcare including GRI, CDP, and the Healthcare Climate Council's guidance. For health systems accessing Inflation Reduction Act incentives, we provide technical guidance on project qualification and implementation.

Frequently Asked Questions

How can hospitals reduce energy use without compromising patient care?

Start with systems that don't directly affect clinical operations: lighting, building automation, plug load management, and central plant optimization. Many hospitals achieve 10-15% energy reductions through retro-commissioning—ensuring existing systems operate as designed. For deeper savings, consider ventilation optimization in non-clinical areas (lobbies, offices, storage) and demand-controlled ventilation in spaces with variable occupancy. ASHRAE Standard 170 provides evidence-based ventilation rates for healthcare facilities that, when applied correctly, can reduce energy use while maintaining appropriate air quality.

Is reprocessing of single-use medical devices safe?

Yes, when performed by FDA-regulated reprocessors. The FDA regulates reprocessed single-use devices under the same quality standards as new devices. Third-party reprocessors like Stryker Sustainability Solutions must validate cleaning, sterilization, and functional testing for each device type. Over 10,000 hospitals in the U.S. use reprocessed devices. Studies published in peer-reviewed journals have found no difference in clinical outcomes between new and reprocessed devices across multiple device categories.

What is the Healthcare Climate Council and should we join?

The Healthcare Climate Council, convened by Health Care Without Harm, brings together leading health systems committed to climate action. Members include Kaiser Permanente, CommonSpirit Health, Mass General Brigham, and other major systems. Membership provides access to peer learning, technical resources, and collective advocacy. For health systems serious about sustainability, it offers a structured framework for benchmarking progress and learning from peers. There's no membership fee, but participation implies commitment to setting and pursuing emissions reduction targets.