Sustainability in cardiovascular health care: The time to act is now
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Key takeaways:
- Cardiovascular prevention can be reframed as an emissions mitigation strategy.
- Environmental sustainability must become a priority to reduce the climate footprint of cardiovascular medicine and promote health.
Environmental sustainability is a critical global concern, as climate change and environmental degradation increasingly threaten human health and planetary well-being.
The U.S. health care sector is responsible for 8.5% of the nation’s greenhouse gas emissions and 27% of global health care-related greenhouse gas emissions. Academic health care organizations are likely to have even greater greenhouse gases per square foot than nonteaching health systems due to the high acuity of care, a large research infrastructure and a disproportionate share of low-income and underserved patients.
Ironically, these same populations likely will endure greater negative impacts from climate change and are the least likely to contribute to it. Cardiovascular practices contribute significantly due to extensive energy use, medical devices, pharmaceuticals, transportation and waste generation. Despite this, sustainability considerations are often absent in CV care. This review emphasizes the imperative for a transformation in CV care culture to minimize resource utilization and carbon emissions, but most importantly to improve CV health. Transitioning to sustainable practices requires commitment from the corporate suite as well as collaboration among CV specialists and health care personnel in the organization, many entities in the health care delivery chain and policymakers.
Substantial carbon footprint
The current health care model, especially in CV care, has a substantial carbon footprint.
Major emission sources include energy for lighting, heating, cooling and medical devices (Scope 1 and 2); transportation and food consumption (Scope 3); and medical supplies and pharmaceuticals (Scope 3).
Cardiac catheterization labs generate large amounts of single-use equipment and consume significant energy. CV operating rooms also have high energy use and emit greenhouse gases from anesthetics like desflurane and isoflurane.
Prolonged hospital stays add emissions from energy, transportation, food, waste and supplies.
Medical devices like stents, pacemakers and implantable cardioverter defibrillators also have environmental impacts from metal and plastic raw materials, manufacturing processes and transportation.
With increasing use of single-use disposable devices, the waste generated in cardiac catheterization labs and operating rooms has risen. Cardiac imaging can also have significant impact on the environment given energy use, radiation and contrast material.
Beyond the care delivery, the wide array of pharmaceuticals used in CV care has a significant carbon footprint due to raw material extraction, production, packaging and transportation.
The broader pollution footprint of health care
The broader pollution footprint of health care is often overlooked. The U.S. health care system is linked to the loss of about 388,000 disability-adjusted life-years annually, a burden similar to that caused by medical errors. This pollution footprint includes air pollution costs during health care delivery, but not other forms of pollution and their health effects. Future sustainability models must incorporate these costs into product pricing to promote sustainable practices.
Systems approach
Transitioning to sustainable CV care requires recognizing the interconnectedness of health, environment and society.
A systems thinking approach helps understand the complex dynamics and feedback loops contributing to sustainability. Reorganizing health care practices involves understanding their integration within larger networks involving payers, suppliers, social services, public health agencies and communities. Simple actions, such as reducing single-use devices and food waste, can significantly impact multiple systems. Promoting plant-based diets in hospitals can reduce carbon emissions and improve health. Preventing CV admissions through better population health management can reduce emission-intensive health care utilization.
Systems approaches also consider how hospitals can address social determinants like education, housing and community gardens to prevent chronic diseases and reduce resource utilization. Sustainability strategies should be harmonized across the health system, considering the interactions between facilities, food services, supply chain and the day-to-day delivery of health care. An umbrella cross-cutting organizational sustainability committee can align efforts and foster shared responsibility.
Building a culture of sustainability
Creating a lasting impact requires fostering a culture of sustainability. Leadership commitment is crucial — hospital executives and CV practice directors must integrate sustainability into their mission, set ambitious environmental goals, and allocate resources. Appointing sustainability officers and green teams provides the infrastructure for developing and implementing initiatives.
Raising awareness through simple measures like signs encouraging green habits, virtual training and sustainability discussions during onboarding can build motivation and skills.
Partnering with professional cardiology societies and advocating for policies that incentivize green health care delivery are key to removing barriers.
Payment reforms that reward prevention and appropriate resource utilization align with sustainability goals.
Embedding sustainability requires consistent reinforcement through words, actions and symbols, emphasizing environmental responsibility as integral to CV care.
Clinicians increasingly view climate action as their responsibility, which appeals to mission-driven younger staff and enhances recruitment. Public sustainability commitments can strengthen community trust and distinguish health systems. Clinicians should apply evidence-based green practices in clinical decisions, and clinical education should incorporate sustainability principles.
By adopting a systems view, CV specialists can drive large-scale transformation.
Prevention as a pillar of sustainable CV practice
Reframing CV prevention as an emissions mitigation strategy highlights its role in sustainable cardiology. Prevention reduces procedural interventions, hospital admissions, pharmaceutical use, clinic visits and medical devices, collectively lowering emissions and resource consumption. Promoting plant-based diets, physical activity, smoking cessation and self-care supports sustainable health practices. Prevention also addresses underlying socioeconomic and environmental drivers of CVD, requiring broad systems approaches that align with sustainability goals.
Overcoming challenges in sustainability
Currently, there is a lack of urgency in transitioning to sustainable health care and decarbonization. Decarbonization may have significant positive health impacts that are measurable and monetizable in the very communities that the health care organizations (HCOs) serve. However, the negative externalities of pollution are currently not monetized and baked into the economy and do not benefit health systems. Provision of monetary credits or other incentives would be a powerful way for HCOs to pave the way. Government regulations and organizational requirements to comply with carbon targets are essential. The participation of HCOs and physicians advocating for minimizing deleterious health impact of fossil fuels in their communities would send a powerful message.
Environmental sustainability must become a priority to reduce the climate footprint of CV medicine and promote health. Through collaboration, innovation, incentivization and reframing sustainability as integral to high-value care, a new paradigm focused on human and planetary health is achievable. The time to pave the way to a greener, healthier future is now.
References:
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For more information:
Sanjay Rajagopalan, MD, MBA, FACC, FAHA, is chief of the division of cardiovascular medicine and chief academic and scientific officer of University Hospitals Harrington Heart & Vascular Institute and Herman K. Hellerstein, MD, Chair in Cardiovascular Research at Case Western Reserve University. He can be reached at sanjay.rajagopalan@uhhospitals.org.
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