SGO Ethics Series: Health Care’s Moral Imperative to Respond to Climate Change | Alexa Kanbergs, MD, ScM, MS

This past summer, the United States was hit with a series of extreme weather events, underscoring the escalating impacts of climate change. Record-breaking heat waves ravaged vast regions, with Phoenix, Arizona, suffering an unprecedented 113 consecutive days of temperatures over 100°F. The Atlantic hurricane season was also destructive, with 18 named storms, including five major hurricanes. I personally experienced Hurricane Beryl, which made landfall in Texas as a Category 1 storm and then spawned a tornado outbreak across multiple states. As the world warms, these extreme weather events will likely become the new normal, rather than rare occurrences. For health care providers, the ripple effects of these disasters extend far beyond temporary disruptions in our lives—they affect the operations of our facilities, strain already vulnerable systems within our communities, and, most importantly, have real-life consequences for the patients we treat. 

As cancer care providers, we understand that the treatments we administer are time sensitive. Delays in surgery, chemotherapy, and radiation can negatively impact the disease trajectory of our patients. At my hospital following Hurricane Beryl, operations including the operating rooms and infusion clinics were closed for one day due to safety concerns. Thankfully, we saw little sustained damage from the storm and were able to reopen our operating rooms and infusion centers over the weekend to ensure patients received timely care. However, these weather events do not affect all communities equally. Communities of color and those of lower socioeconomic status face disproportionate impacts from climate change. Climate change exacerbates the inequities these communities already face due to decades of racial segregation and environmental injustice, unearthing layers of vulnerability that make it even harder for individuals to access essential services. Imagine trying to make it to a healthcare appointment when flooding and debris block the roads, or when your mode of transportation is rendered inoperable, or when your health care facility remains closed due to storm damage. Then consider this climate injustice on top of evidence that individuals of color or from lower socioeconomic status already experience disparate cancer outcomes.¹   

As health care providers, we must acknowledge that we are not only responders to climate-related health crises—we are also contributors to the problem. The US care sector accounts for and estimated 8.5% of greenhouse gas emissions,² a staggering figure for an industry devoted to health and well-being. So, what can we do?

1. Reducing the Health Care Carbon Footprint: There are numerous ways health care facilities and systems can reduce their carbon footprint while still providing excellent patient care. The simplest measures include optimizing the energy efficiency of our facilities, such as turning off electronics when not in use and investing in renewable energy sources like solar panels. As well as focusing on local and sustainable ingredients within our food services when possible. Operational changes can also play a key role in reducing waste. For example, a recent study by Slim et al. evaluated the environmental impact of the complete perioperative pathway with and without an enhanced recovery program (ERP).³ The findings revealed that ERP implementation reduced the environmental impact by 6% compared to conventional care. Similarly, a study from Stanford Health Care demonstrated that telemedicine appointments avoided 17,000 metric tons of greenhouse gas (GHG) emissions in 2021 alone.⁴ Furthermore, the environmental impact of end-of-life care is a critical consideration. A study estimated that intensive inpatient care in a U.S. hospital generates 7.1 kilograms of solid waste and 138 kilograms of CO2 equivalents per bed day.⁵ Avoiding treatments that do not align with a patient’s goals or offer meaningful medical benefit represents one of the most significant opportunities to reduce this environmental burden.⁶ Maintaining a strong focus on discussing and re-evaluating a patient’s goals of care, as well as streamlining hospice placement when desired, not only provides patient-centered care but also contributes to environmental sustainability.
2. Building Resilience in Health Care Systems: While implementing strategies to reduce our carbon footprint, we must also work to increase the resilience of our health care systems. This means developing plans for when services are suspended due to extreme weather or other climate-related events. Ensuring that we can continue to provide care during these disruptions requires flexibility, innovation, and a commitment to maintaining services despite external challenges. There should also be careful thought in how we can focus our resilience efforts on the communities that already suffer the most from health inequities.
3. Advocating for Climate-Smart Policies: As health care providers, we are leaders in our communities, and our voices can influence change. We must utilize both local and national forums to speak out about the climate impacts our patients face. It is crucial that we advocate for policies that address climate-related health disparities, ensuring that vulnerable populations are protected and supported during times of crisis.
4. Making Changes in Our Own Lives: Finally, it’s important for us to make changes in our own personal lives. While the immense waste generated by global industries can feel overwhelming, individual actions—when combined—can have a significant impact. Eating more plant-based meals, choosing to walk or bike instead of driving, and recycling are all small steps we can take to reduce our personal carbon emissions. No one is perfect, but small, consistent changes can add up.

 We took an oath to “do no harm,” yet the system we operate within inadvertently harms the very people we care for. The effects of climate change are not distant possibilities—they are here, reshaping the lives of our patients, our institutions, and our planet. The question is: how quickly can we step up to protect our patients? 

References

1. Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society’s report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin. 2024 Mar-Apr;74(2):136-166. doi: 10.3322/caac.21812 
2. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The United States: An Update. Health Aff (Millwood). 2020 Dec;39(12):2071-2079. doi: 10.1377/hlthaff.2020.01247.  
3. Slim K, Veziant J, Enguix A, Zieleskiewicz L. Environmental impact of the enhanced recovery pathway in colorectal surgery: A simulation study. Colorectal Dis. 2024 Nov 20. doi: 10.1111/codi.17247. Epub ahead of print. 
4. Thiel CL, Mehta N, Sejo CS, Qureshi L, Moyer M, Valentino V, Saleh J. Telemedicine and the environment: life cycle environmental emissions from in-person and virtual clinic visits. NPJ Digit Med. 2023 May 9;6(1):87. doi: 10.1038/s41746-023-00818-7. 
5. Prasad PA, Joshi D, Lighter J, Agins J, Allen R, Collins M, Pena F, Velletri J, Thiel C. Environmental footprint of regular and intensive inpatient care in a large US hospital. Int J Life Cycle Assess. 2021 Dec 4;27:38–49. https://doi.org/10.1007/s11367-021-01998-8 
6. Bein T, Koch S, Schulz C. What’s new in intensive care: environmental sustainability. Intensive Care Med. 2021 Aug;47(8):903-905. doi: 10.1007/s00134-021-06455-6.  

Alexa Kanbergs, MD, ScM, MS, is a Fellow-in-Training at MD Anderson Cancer Center in Houston, TX.