--- description: The U.S. health care industry is one of the world’s worst polluters, causing many of the deaths it seeks to prevent. title: How U.S. Hospitals Undercut Public Health image: https://static.time.com/v3/assets/bltea6093859af6183b/blte669ffcdc9e8b90a/698a411147ca385b333bb33e/hospitals-public-health-climate-change.jpg?branch=production&width=2400&quality=75&auto=webp&crop=16:9 --- * [Ideas](/section/ideas/) ## Ideas Update your preferences in [Account Settings](/account/preferences/) Close * [health](/tag/health/) ## health Update your preferences in [Account Settings](/account/preferences/) Close # How U.S. Hospitals Undercut Public Health ## Video: What's At Stake With the Kaiser Permanente Heath Care Strike [Watch (HLS stream): What's At Stake With the Kaiser Permanente Heath Care Strike](https://cdn.jwplayer.com/manifests/lXJFUcvn.m3u8) (1:31)  _Published 2023-10-04. More than 75,000 unionized Kaiser Permanente health care workers walked off the job on Oct. 4 in the largest health care industry strike in U.S. history._ Oct 6, 2023 2:47 PM CUT  If U.S. health care were its own country, it would rank 11th worldwide in GHG pollution. If U.S. health care were its own country, it would rank 11th worldwide in GHG pollution.Robert Alexander—Getty Images by [David Introcaso](/author/david-introcaso/) ## David Introcaso Update your preferences in [Account Settings](/account/preferences/) Close Oct 6, 2023 2:47 PM CUT _This article was originally published in_ [_Undark Magazine_](https://undark.org/ "undefined")_._ Health care in the United States — the [largest industry](https://www.ibisworld.com/united-states/industry-trends/biggest-industries-by-revenue/ "undefined") in the world’s largest economy — is notoriously [cost inefficient](https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ "undefined"), consuming substantially more money per capita to deliver far inferior outcomes relative to peer nations. What is less widely recognized is that the health care industry is also remarkably energy inefficient. In an [era](https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196%2820%2930305-3/fulltext "undefined") of tightening connections between environmental destruction and disease, this widely neglected reality is a major cause behind many of the sicknesses our hospitals treat and the poor health outcomes they oversee. The average energy intensity of U.S. hospitals is more than [twice that](https://www.mdpi.com/1996-1073/12/19/3775 "undefined") of European hospitals, with no comparable [quality advantage](https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ "undefined"). In recent years, less than 2 percent of hospitals were [certified](https://www.energystar.gov/buildings/certified%5Fbuildings%5Fand%5Fplants "undefined") as energy efficient by the U.S. Environmental Protection Agency’s Energy Star program, and only 0.6 percent, or 37 in total, have been certified for 2023\. As a result, in 2018, the U.S. health care industry emitted approximately [610 million tons](https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01247 "undefined") of greenhouse gases, or GHGs — the equivalent of burning [619 billion pounds](https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator "undefined") of coal. This represented 8.5 percent of U.S. GHG emissions that year, and about 25 percent of global health care emissions. If U.S. health care were its own country, it would [rank](https://worldpopulationreview.com/country-rankings/co2-emissions-by-country "undefined") 11th worldwide in GHG pollution. If every nation produced an equivalent per capita volume of health care emissions, it would immediately consume nearly the entire [global carbon budget](https://www.nature.com/articles/s41591-023-02351-2 "undefined") required to limit global warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) by 2030\. Without even considering their [global impact](https://undark.org/breathtaking/ "undefined"), air pollution from U.S. emissions accounts for an estimated [77,000 excess deaths](https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196%2818%2930147-5/fulltext "undefined") annually in the U.S. alone. And according to one [2016 study](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014 "undefined"), emissions from the U.S. health care system lead to the loss of more than 400,000 years of healthy life among Americans. This level of harm is commensurate with the [tens of thousands of deaths](https://pubmed.ncbi.nlm.nih.gov/31965525/ "undefined") attributable to [medical errors](https://pubmed.ncbi.nlm.nih.gov/25077248/ "undefined") each year, around which a massive patient safety movement has been organized in response. But despite these human costs — along with sizable [financial costs](https://www.nrdc.org/sites/default/files/costs-inaction-burden-health-report.pdf "undefined") — there has been no parallel policy movement to address the health care industry’s [role](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014 "undefined") in undermining health through its GHG emissions. **Read more:** [_Tackling Climate Change Can Save Hospitals Money_](https://time.com/6289409/hospitals-money-climate-impact/ "undefined") The [climate](https://time.com/section/climate/ "undefined") crisis is not just another problem among many. It is instead a meta-problem that layers onto countless other problems, exacerbating their consequences for health. [Research](https://pubmed.ncbi.nlm.nih.gov/30419235/ "undefined") suggests that particulate matter resulting from burning fossil fuels can [damage](https://undark.org/2017/07/06/air-pollution-study/ "undefined") every organ in the human body. In light of this, efforts to improve public health, health care quality, and patient safety without confronting the role of emissions are, at best, compromised once one accounts for the health care industry’s substantial contribution to a climate crisis that is driving an ongoing and accelerating [sixth mass extinction](https://www.pnas.org/doi/10.1073/pnas.1704949114 "undefined"). In addition to the general disaster this presents for global public health, it also constitutes a specific problem for U.S. health policy, as the health harms associated with GHG emissions disproportionately harm the populations who constitute Medicare and Medicaid’s roughly 145 million beneficiaries, including the 30 million patients treated at community-based Federally Qualified Health Centers. These care systems are meant to protect poor and vulnerable populations, but the means by which they attempt to do so are causing the very harm they seek to address. Consistent with what Ivan Illich described in his 1975 book “Medical Nemesis: The Expropriation of Health” as [cultural iatrogenesis](https://jech.bmj.com/content/57/12/928 "undefined") — a phenomenon by which the supposed means of treating disease under capitalist health care regimes becomes not a cure but rather a cause of the debility it claims to alleviate — what we are seeing now is a form of environmental iatrogenesis. Largely because of fossil fuel combustion, nearly the [entire global population](https://www.who.int/news/item/04-04-2022-billions-of-people-still-breathe-unhealthy-air-new-who-data "undefined") now breathes air that exceeds the World Health Organization’s air quality limits, but exposure to unhealthy air and associated health risks are not evenly distributed. In the U.S., Medicare beneficiaries, who are 65 and older and far more likely to suffer chronic lung disease, are particularly threatened by bad air quality. This is inseparable from the fact that fossil fuel-related air pollution, the [leading environmental cause](https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2816%2931679-8.pdf "undefined") of human mortality, accounts for [58 percent](https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196%2818%2930147-5/fulltext "undefined") of excess annual U.S. deaths, which joins [8.7 million](https://www.sciencedirect.com/science/article/abs/pii/S0013935121000487 "undefined") — or one in five, prior to Covid-19 — excess deaths globally, according to a 2021 study. Beyond breathing polluted air, Medicare seniors, already compromised by higher incidence of comorbidities, are also at [greater risk](https://health2016.globalchange.gov/ "undefined") of serious outcomes from climate-related arthropod-borne, food-borne, and water-borne diseases. The climate crisis can exacerbate the spread of [over half](https://www.nature.com/articles/s41558-022-01426-1 "undefined") of known human pathogens. And [risk from extreme heat](https://www.bostonreview.net/articles/heat-death/ "undefined") is especially severe: Globally, over the past 20 years, heat-related mortality among seniors has increased by over [50 percent](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2820%2932290-X/fulltext "undefined"). Children, 46 percent of whom are Medicaid beneficiaries, are also especially vulnerable. Fine inhalable particles resulting from burning hydrocarbons, called PM 2.5 (particles 2.5 micrometers or less in diameter), are particularly harmful because children breathe more air than adults relative to their body weight, giving these particles more opportunity to diffuse into their bloodstreams and throughout their bodies. [Research](https://www.nejm.org/doi/full/10.1056/NEJMra2117706 "undefined") published last year found that climate-related adverse health effects to fetuses, infants, and children include low birth weight, death, hypertension, kidney and lung disease, immune-system dysregulation, structural and functional changes to the brain, and a constellation of behavioral and mental health diagnoses. Furthermore, evidence published by UNICEF in 2016 indicates that air polluted by fossil fuels contributes to more than [half](https://www.unicef.org/media/60106/file "undefined") of the 1 million annual pneumonia deaths worldwide among children aged five and younger. **Read more:** [_American Health Care Is Broken. Major Hospitals Need to Be Part of the Solution_](https://time.com/6281957/american-health-care-is-broken-major-hospitals-solution/ "undefined") With respect to racialized and economically dispossessed groups, a [study](https://www.science.org/doi/pdf/10.1126/sciadv.abf4491 "undefined") published in 2021 found that racial and ethnic minorities, regardless of income and geographic location, are disproportionately exposed to higher levels of 11 of 14 sources of particulate air pollution. In a United Nations [report](https://digitallibrary.un.org/record/3810720 "undefined") titled “Climate change and poverty,” Philip Alston concluded that governments “have failed to seriously address climate change for decades,” and that “climate change threatens to undo the last 50 years of progress in development, global health and poverty reduction.” The health care industry’s environmental disregard can be explained in part by what three bioethicists recently termed “lifeboat ethics framing.” In their book “[Bioethics Reenvisioned: A Path toward Health Justice](https://uncpress.org/book/9781469671581/bioethics-reenvisioned/ "undefined"),” Nancy King, Gail Henderson, and Larry Churchill argue that bioethics has operated in a way such that any problem outside the lifeboat — that is, beyond the hospital bedside — is dismissed as irrelevant. U.S. health officials have often exhibited the same narrow, clinically focused [tunnel vision](https://www.thenation.com/article/society/fix-public-health-argument/ "undefined") when it comes to health care emissions and the climate crisis. Public health’s widespread takeover by [narrow medical mentalities](https://www.statnews.com/2023/02/24/fixing-public-health-systems-revolution-physicians-take-backseat/ "undefined") that sideline root-cause analyses and associated policy action is now one of the most pernicious threats to health. To add insult to injury, it is in the health care industry’s financial interests to decarbonize. New solar and wind energy are now the [most affordable source](https://rmi.org/energy-transition-in-2022/ "undefined") of generating electricity in 96 percent of the world and cheaper than existing fossil fuels in 60 percent of the world. It is [more expensive](https://energyinnovation.org/publication/coal-cost-crossover-3-0-local-renewables-plus-storage-create-new-opportunities-for-customer-savings-and-community-reinvestment/ "undefined") to continue to operate 99 percent of U.S. coal-fired power plants than to build and operate entirely new solar or wind energy generating stations. Today, it is cheaper to save the climate than continue to destroy it. But federal policymakers and health care leaders continue to allow the industry to contribute to the climate crisis, which in turn is harming or killing those who are the most vulnerable. And if not stopped, GHG emissions could irreversibly undermine the possibility of health for all. Health care institutions should take a leading role in implementing immediate change to their own energy-use practices. As a core part of their ethical obligation to care, they should also use their enormous lobbying power to demand broader policy action to stop the environmental destruction to which they have been world-leading contributors. ```json [{"@context":"https://schema.org","@type":"OpinionNewsArticle","@id":"https://time.com/6321357/how-us-hospitals-undercut-public-health/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/6321357/how-us-hospitals-undercut-public-health/"},"headline":"How U.S. Hospitals Undercut Public Health","datePublished":"2023-10-06T14:47:44.000Z","dateModified":"2026-02-24T16:30:20.494Z","description":"The U.S. health care industry is one of the world’s worst polluters, causing many of the deaths it seeks to prevent.","url":"https://time.com/6321357/how-us-hospitals-undercut-public-health/","keywords":["health","climate change","healthscienceclimate"],"thumbnailUrl":"","author":[{"@type":"Person","name":"David Introcaso","jobTitle":null,"url":"https://time.com/author/david-introcaso/"}],"articleSection":"Ideas","image":[],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/ideas/","name":"Ideas"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/health/","name":"health"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/6321357/how-us-hospitals-undercut-public-health/","name":"How U.S. Hospitals Undercut Public Health"}}]},{"@context":"https://schema.org","@type":"VideoObject","name":"What's At Stake With the Kaiser Permanente Heath Care Strike","description":"More than 75,000 unionized Kaiser Permanente health care workers walked off the job on Oct. 4 in the largest health care industry strike in U.S. history.","thumbnailUrl":"https://cdn.jwplayer.com/v2/media/lXJFUcvn/poster.jpg?width=720","uploadDate":"2023-10-04T21:21:46.000Z","contentUrl":"https://cdn.jwplayer.com/manifests/lXJFUcvn.m3u8","embedUrl":"https://time.com/6321357/how-us-hospitals-undercut-public-health/","duration":"PT1M31S","potentialAction":{"@type":"SeekToAction","target":"https://time.com/6321357/how-us-hospitals-undercut-public-health/?jw_start={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"}}] ```