Hospitals Can Save the Environment and Your Health — Or At Least Not Make Them Worse

The provision of healthcare is responsible for roughly 8.5 percent of total carbon emissions in the United States. In turn, carbon emissions cause climate change and harm human health. So, why aren’t healthcare institutions like hospitals more focused on reducing their carbon emissions to reduce harm to the communities they serve?

In our article, “Private Health Governance and the Environment,” Vanderbilt Climate Governance Fellow Ethan Thorpe and I argue that hospitals are harming the very people and communities they have a duty to serve. Incremental changes to improve efficiency and reduce emissions are affordable, achievable, and necessary.

Private Environmental Governance Is Not Dead Yet

Private Environmental Governance (PEG) describes actions that private organizations take to protect the environment because the government cannot — or will not. Congress is increasingly sidelined by political gridlock and a lack of consensus, in addition to the expansion of executive power. One form of PEG, the Environmental, Social, Governance (ESG) movement, encourages businesses to adopt policies that help the environment and reduce social inequality. 

Even though many in the press claim that ESG is dead, it appears instead to have merely gone undercover with greenhushing. Businesses do not want to become a political target by publicly adopting and touting environmentally friendly policies or to be accused of inflating their sustainability efforts, or greenwashing, so they refuse to talk about them. The public relations aspect of ESG policies has undoubtedly changed in recent years. But corporate America generally does not have the same duty to improve the environment or protect health that hospitals do.

Private Health Governance

PEG can readily be applied to the healthcare system, and my co-author and I call this Private Health Governance. As a matter of federal law, hospitals must be accredited through an organization like the Joint Commission to receive CMS reimbursement. Accreditors have the power to adopt standards that promote efficiency and reduce waste and emissions. The absence of government can be a selling point here since the usual partisan battles over the environment and funding healthcare are largely absent when a private actor is responsible for regulation.

Private Health Governance can be highly effective in the absence of government action. Many scholars have been skeptical of arguments that corporations should or will seek to mitigate societal harms (including harms that they contribute to) rather than focusing solely or mainly on shareholder primacy, meaning maximizing shareholder profits regardless of the impact on others. But with business entities that own hospitals, their duty to advance the health of patients, who tend to live in nearby communities, instead of only their investors is well-established. Among other fiduciary obligations, hospitals have a duty to maintain safe facilities that do not injure patients. Although this typically applies when the public enters the hospital, I argue that the duty should apply equally when the hospital harms the surrounding community because of its environmental footprint.

When the environment is harmed, people are harmed. Wildfires and higher temperatures kill people. Pollution kills people. Toxic waste sickens people. And high levels of carbon emissions only make climate change and pollution worse and accelerate the ongoing harms. The smoke from recent Canadian wildfires that spread through the United States is a striking example of how the environment has a concrete impact on health.

Though a solution that takes place outside of public governance may appear to be undemocratic, government dysfunction leaves no choice but to fill the gaps with private governance. Private Health Governance allows additional actors to help solve important enviro-health problems. 

Hospitals and their accreditors should focus on energy efficiency, waste reduction, green buildings, and enhancing hazard vulnerability and community health needs assessments. Low-cost, high-impact actions like turning off imaging machines such as MRIs or moving them to low-power mode when not in use can have a big impact in the aggregate. There is also still a lot of private, state, and local funding for green initiatives such as financing to improve the physical plants of hospitals, which can save hospitals money in the long term. 

Valuing Human Lives

The overlap between environmental and health advocacy provides strength to each side’s efforts. This may be why the Trump administration, which has significantly rolled back protective environmental and health regulation, is trying to break these links. In early 2026, the Environmental Protection Agency (EPA) published a rule stating that it will no longer include health benefits among the economic benefits considered when setting air pollution targets because of the “uncertainty” of such calculations. The EPA is now effectively valuing a human life at “zero dollars.”

I have written previously about how refusing to count or quantify health harms has the practical effect of making certain health harms and even groups of people disappear from policy debates. During the COVID-19 pandemic, for example, more than a million excess deaths occurred beyond those predicted by existing mortality models, and many were never attributed to the virus even though it was likely a contributing factor. In the age of big data, only the people and health harms included in the numbers are seen. In this case, the refusal to count health benefits when considering air pollution targets hides the very real health consequences of climate change and environmental degradation. 

Private Health Governance can make the link between environmental and health harms more apparent by using evidence to support new standards in hospital care and also by demonstrating the long-term cost savings for hospitals from improving their environmental impact. Acknowledging that hospitals are currently harming health because of inefficiency and emissions can be paired with identifying concrete solutions that show how hospitals can improve both environmental and public health.