The Great
Health-Climate Paradox:
How Climate Change Impacts Health and the Health Sector Impacts the Environment

Published on July 27, 2022

Written by Robyn RothmanRobyn Rothman is a Vice President at M Booth Health and believes conversations and connections can create a healthier, more equitable world.

Written by Madison Hill-GloverMadison Hill-Glover is a Junior Associate at M Booth Health who enjoys contributing to conversations about environmental health and health equity.


The U.S. health care system is familiar with contradictions. Health care institutions and companies have a mission to heal, treat and cure disease, and improve health, yet health care is also a business, with competing demands, responsibilities, and regulations. The U.S. spends more money on health care than any other country, yet consistently ranks behind other countries in health outcomes, access, and equity. But perhaps the greatest paradox is health care’s role in climate change.

The U.S. health sector is responsible for 8.5% of all U.S. greenhouse gas emissions – meaning health care operations directly contributing to environmental harms that affect patients. Hospitals and pharmaceutical companies are some of the biggest drivers of these emissions. Hospitals operate as mini-cities, with high energy and water-intensive needs and huge supply chains ranging from medical supplies to meals. A 2019 study found that the pharmaceutical industry is more emissions-intensive than the automobile production industry.

Climate change is the greatest public health threat of this century and its effects are ubiquitous. The health effects of climate change vary from allergies to cardiovascular disease, malnutrition to Lyme disease. Underserved communities, communities of color, and low-income communities face disproportionate harms. People who live in poverty-stricken areas are more likely to be exposed to harmful air pollution and toxic waste sites. Historically redlined communities are now sweltering urban heat islands, sometimes up to 13 degrees warmer than other parts of the same city. Climate change is a threat multiplier to every social determinant of health.

“Climate change is a threat multiplier to every social determinant of health.”

Addressing greenhouse gas emissions is also an opportunity to build better health care. In the late 1990’s, when the industry realized the extent that medical errors were contributing to patient injury and deaths, it sparked major industry transformation. Similarly, health care has the opportunity to take action to address its emissions, while building a stronger system that is better able to respond to and continue operating while facing a changing climate. Climate-caused events impact health care facilities, care delivery, and complex supply chains, interfering with health care organizations’ ability to provide care during extreme events when people need it most. 

Billion-dollar climate and weather disasters have been steadily increasing, and the costs for health systems not being prepared for extreme events is significantly higher than what the upfront investments would cost. Yet despite these potentially severe and costly interruptions to the business of health care, most institutions and organizations are not doing enough to become more resilient and ensure continuity of care. 

“Most institutions and organizations are not doing enough to become more resilient and ensure continuity of care.”

Some health organizations are proactively taking action to address these issues. Kaiser Permanente is a national leader in sustainability in the health care industry. They have a long history of environmental stewardship and were the first U.S. health system to be certified carbon-neutral in 2020. Now, aligning with climate science, they are committed to reducing all of their emissions, as part of their overall mission to advance health equity and address upstream determinants of health that are affecting people right now. Pharmaceutical companies like Roche, Johnson & Johnson, and Pfizer all have strong, ongoing efforts to reduce their carbon footprints as part of their mission to improve health. But these companies are the exception, rather than the norm, among the American health industry.

National momentum is shifting to get healthcare more involved and responsive to climate change. The National Academy of Medicine launched the Grand Challenge on Climate Change, Human Health, and Equity last year, a multi-year initiative to protect health and equity, starting with a new Action Collaborative on Decarbonizing the U.S. Health Sector. Following the U.S. government’s commitment to the groundbreaking COP26 Health Programme, the U.S. Department of Health and Human Services announced its Health Sector Climate Pledge on Earth Day 2022, announcing the first cohort of health companies and organizations committing to this work in late June. But only 61 health organizations joined. To put that in context, there are around 6,000 hospitals in this country, and the health systems who committed to reducing their emissions via the pledge represent only 650, or 10% of them. 

While COVID-19 has fundamentally disrupted normal health care operations, and finances, if anyone knows how to walk and chew gum at the same time, it’s health care. The industry has never had the luxury of focusing solely on one health problem at a time, especially during an emergency. And heat records are flooding emergency rooms across the globe.

“The industry has never had the luxury of focusing solely on one health problem at a time, especially during an emergency.”

Health care’s mission to improve health, eliminate health disparities, and treat illness and disease must include also taking action now to stop the worst impacts of climate change, starting with reducing the emissions of their own operations. To remain true to their intrinsic goals, health care stakeholders must acknowledge their contribution to climate change and work towards building more sustainable operations in order to provide better, greener, health care.