Climate change and excess length of stay: A call to action for health equity and environmental sustainability

Over 6340 million metric tons (MMT) of CO2 equivalents (CO2e) of greenhouse gas (GHG) emissions were produced in the United States in 2021,1 with 8%–10% of these emissions directly attributable to the US healthcare sector.2-4 A 2019 report from Health Care Without Harm showed annual per-capita healthcare climate footprints of 0.03 tons of CO2e per person in India, 0.25 tons CO2e per person in China, and 0.49 tons CO2e per person in the European Union with a global average of 0.28 tons CO2e.5 By contrast, the United States is the highest per-capita producer, at 1.72 tons of CO2e per person.

Healthcare-associated GHG emissions and pollution contribute annually to over 500,000 disability-adjusted life years of health damages in the United States alone and may contribute to three times that number globally.4 These detrimental effects from the healthcare sector are comparable in scale to that of the 44,000–98,000 annual deaths caused by medical errors, which spurred national action on quality improvement and patient safety.6 Despite report after report reiterating the critical health consequences of further global warming, we have not seen the systemic and economic alignment needed to create sustainable changes.7-10

The US Department of Health and Human Services endorses an urgent goal of reducing the healthcare sector's GHG emissions in half by 2030 and achieving net-zero emissions by 2050.11 Yet the current discussion around environmental impacts of the vast and complex US healthcare system has largely centered on strategies for individual physicians or hospitals to achieve lower emissions.12-15 Our sector will not be able to meet these targets without coordinating the “decarbonization of healthcare” with concerted efforts from all healthcare sector stakeholders to reduce unnecessary or low-value healthcare.16

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