Climate change represents the major global challenge of our time. Spurred by concerns regarding climate change risks, the private sector has become an increasingly important stakeholder in discussions regarding mitigation. Yet, little attention has been paid to the challenges and opportunities that climate change presents to healthcare systems in the United States (US). This is problematic because (1) hospitals and healthcare systems will bear a disproportionate burden of caring for victims of extreme weather events and (2) hospitals and healthcare systems are major consumers of energy and uniquely vulnerable to fluctuations in price given historically small profit margins.1
Partners Healthcare (Partners) is the largest non-profit healthcare system in New England. Founded by Brigham and Women’s Hospital (BWH) and the Massachusetts General Hospital (MGH), Partners has grown to include seven community hospitals and 21 community healthcare centers and accounts for $11.7 billion in revenue in 2015.2 Climate change presents several challenges for Partners.
First, Partners will face increasing demand for healthcare services in the setting of increasingly frequent extreme weather events – storms, heat waves, cold spells and coastal flooding – despite limited additional capacity to meet this demand. In the winter of 1998 in eastern Canada, a major ice storm “led to widespread power outages and surges of patients at hospitals with a wide range of injuries and acute illnesses such as fractures, hemorrhages, hypothermia, and carbon monoxide poisoning.”3 In August 2003, temperatures across Europe rose to 20-30 percent above seasonal averages for more than 20 days, resulting in an incremental 30,000 deaths across affected European countries, with the elderly disproportionately impacted.4 In New England, current estimates suggest that average summer temperatures could rise 12-14 degrees Fahrenheit by the end of the century, resulting in an estimated 20 days with temperatures greater than 100 degrees Fahrenheit every summer.5 Large temperature rises such as these will disproportionately increase rates of heat-related emergency department presentations and hospital admissions which will stretch hospital resources given legacy hospital designs, near 100 percent bed occupancy and limited ability to expand emergency department or inpatient bed capacity given space-constrained urban environments.
Second, US hospitals and healthcare systems are major consumers of energy, accounting for $8.8 billion in energy use in 2015, 10% of all US commercial energy use.6 Importantly, hospitals incur the second highest energy use per square foot of any commercial building type with the exception of fast-food restaurants, largely due to operating 24 hours a day and employing energy-intensive technologies.7 Although Partners does not report annual energy costs, its known real estate footprint (10 million square feet) and estimated energy cost per square foot per year ($6.82 in 2016 US dollars) suggest that energy costs are likely to approach $70 million annually, and potentially substantially more given reported cost over-runs of $20 million for energy expenditures in 2008.7-9 These substantial energy costs are concerning in the setting of small operating margins. In the third quarter of 2016, Partners reported an operating margin of $57 million (2.3%), in line with recent quarterly performance.10 These data suggest that hospitals are both important contributors to climate change and uniquely vulnerable to energy cost increases arising from carbon pricing regulation.
Given the above challenges, Partners developed a 10 year strategic plan in 2009 aimed reducing energy consumption by 25% by 2015.11 Specific initiatives included (1) developing an energy utilization monitoring and alarm system to provide alerts for high utilization events, (2) reconditioning HVAC systems in hospital settings to improve energy efficiency, (3) co-generation of heat and electricity at the new Spaulding Rehabilitation Hospital to capture thermal energy produced by electrical production and (4) increasing purchasing of renewable energy to 25% of total energy costs. These goals had been met as of 2015.
In addition to these efforts, the organization should consider several additional initiatives both to help reduce the likelihood of and prepare for worsening global climate change. First, as a premier healthcare system, Partners has an opportunity to set an example for the healthcare community by setting an aggressive target to further reduce energy use by 25% and source 50% of all energy from renewable sources by 2020. Second, Partners should develop a forum for best practices sharing among US hospitals to reduce energy use. The US Department of Energy has released a compendium of tactics for US hospital to reduce energy use that should serve as a first step in this direction.12 To address the effects of extreme weather events, Partners will need to ensure that their primary care clinics coordinate with various stakeholders in the social safety net (MassHealth, Home Care nursing, Elder Services, etc.) to ensure that vulnerable populations are kept safe (i.e. have functioning heating systems in the winter). Further, Partners will need to repurpose existing contingency plans for mass casualty events to address the unique elements of injuries due to extreme temperature exposure (799 words).
1World Health Organization, Fact Sheet on Climate Change and Health. Available at http://www.who.int/mediacentre/factsheets/fs266/en/. Accessed November 2nd, 2016.
2Partners Annual Report, 2015. Available at: http://www.partners.org/Assets/Documents/About-Us/Partners-HealthCare-Annual-Report-2015.pdf. Accessed November 2nd, 2016.
3Paterson J, Berry, P, Ebi K, Varangu L. Health care facilities resilient to climate change impacts. International Journal of Environmental Research and Public Health. 2014. 11: 13097-13116.
4United Nations Environmental Program, Impacts of summer 2003 Heat Wave in Europe. Available at:
http://www.unisdr.org/files/1145_ewheatwave.en.pdf. Accessed November 2nd, 2016.
5The Select Committee on Energy Independence and Global Warning, Global Warming in New England. Available at: http://www.markey.senate.gov/GlobalWarming/impactzones/newengland.html. Accessed November 2nd, 2016.
6U.S. Department of Energy. Energy Department’s Hospital Energy Alliance Helps Partner Save Energy and Money. Available at: http://energy.gov/articles/energy-department-s-hospital-energy-alliance-helps-partner-save-energy-and-money. Accessed 11/3/16.
7U.S. Energy Information Administration. 2012 Commercial Building Energy Consumption Survey: Energy Use Summary. Available at ttps://www.eia.gov/consumption/commercial/reports/2012/energyusage. Accessed November 2, 2016.
8Hospitals shift from fossil fuel to renewable energy sources. Modern Healthcare. November 8, 2014. Available at: http://www.modernhealthcare.com/article/20141108/MAGAZINE/311089981. Accessed November 2, 2016.
9Developing a plan for reducing energy expenditures in hospitals. Publication of the Healthcare Financial Management Association. Available at: http://hcinstitute.info/download/developing-plan-to-reduce-hospital-energy-costs-hfma.pdf. Accessed November 3, 2016.
10Partners Healthcare has a plan for using less energy to improve the lives of our patients, staff and the environment. Available at: http://www.partners.org/Innovation-And-Leadership/Better-Together/Sustainability-Story.aspx. Accessed November 3, 2016.
11Partners Healthcare reports third quarter 2016 financial results. Available at: http://www.partners.org/Newsroom/Press-Releases/Q3-2016-Financial-Results.aspx. Accessed November 3, 2016.
12Advanced Energy Retrofit Guide for Healthcare Facilities. U.S. Department of Energy. Available at: https://buildingdata.energy.gov/cbrd/resource/1325. Accessed November 3,, 2016.