State agencies work to minimize healthcare industry’s environmental impact on Washington


Shane Ersland


Experts discussed the many ways climate change affects the health of Washingtonians and the impact the healthcare industry has on the US’ carbon footprint at the 2024 Washington State of Reform Health Policy Conference last week. 

Dr. Christopher Chen, medical director for Medicaid at the Washington State Health Care Authority (HCA), said healthcare accounts for 18-19 percent of the American economy. 

“And all that economic activity has a carbon footprint,” Chen said. “Healthcare accounts for about nine percent of the nation’s carbon footprint, which amounts to 480 million metric tons of carbon dioxide a year. That’s more than the entire country of the United Kingdom. And we have to keep in mind that the US has the highest (per-capita) carbon footprint in the entire world.”

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Climate change affects people differently, and its impact largely depends on their surrounding environment and living situation. 

“From a sustainability perspective, over the last decade we’ve all come to recognize that social determinants have a major impact on health,” Chen said. “And climate change is a major driver of social determinants, one might say the ultimate social determinant.”

Rad Cunningham, senior epidemiologist at the Washington State Department of Health (DOH), discussed the 2021 heat dome in Washington, which saw temperatures between 98-118 degrees. It caused 157 deaths, along with many heat-related injuries. The extreme heat event had differing effects on the state’s residents, as many residents in Eastern Washington had air conditioning at the time, but that was not the case in Western Washington.

“What would you need it for in Forks?” Cunningham asked. “The maximum [temperature] is 70-some degrees, so those people are really vulnerable when you have extreme heat events. It was a big deal, and it gives us a chance to work on adaptation. These problems are solvable. I don’t want to say we just need more cooling systems, though some people do.”

Climate change has presented opportunities to improve health by requiring the need to meet greenhouse gas requirements, identify work needed to improve the state’s utility sector and transportation system, examine how residents heat their homes, and consider how healthcare centers are powered, Cunningham said.

“We need to change all of that. All of those things have structural racism that dates into them. And it’s an opportunity for us to right the wrongs of the past in targeting the communities that are hurt worst and first, undoing racist policies that led to where we cited our highways and freeways in the first place, and trying to improve the health outcomes in the areas where we made it worse through past policy.”

— Cunningham

Bradley Kramer manages the Climate and Health Equity Initiative at Seattle and King County Public Health. He said its countywide strategic planning action guide focuses on climate and health using the Foundational Public Health Services framework. 

“This is what funds a lot of public health across the state,” Kramer said. “We see climate in all health actions.”

The initiative is working to develop a climate data monitoring/surveillance system, Kramer said. 

“What that looks like is setting up a series of climate and health indicators, and then looking at those longitudinally and adding layers of vulnerability or adaptive capacity to better understand who is most impacted in our region,” he said. 

The department works with 10 hospitals and health systems to create Community Health Needs Assessments (CHNAs), which help them identify their greatest community needs and develop plans to address them, Kramer said. King County’s 2024-2025 CHNA includes health impacts of climate change.

“We’re one of the first (states) in the nation to do this,” Kramer said. “We could only find a handful of CHNAs that talk about climate.”

Chen noted that Gov. Jay Inslee is very passionate about climate change and has worked with the HCA on extensive initiatives for minimizing the state’s carbon footprint. 

“I think there’s a lot of potential in data analysis and understanding the impacts of climate change on health. There’s ongoing work at the HCA to do that. We’re partnering with the University of Washington to develop some tools to understand climate change, and try to cross that with our Medicaid claims data and understand the impact and vulnerability.”

— Chen

The Bree Collaborative—which was established by the legislature in 2011 to identify and recommend evidence-based strategies in areas where there is unnecessary change in the way care is delivered and/or increased care that isn’t improving outcomes—includes a climate change topic for 2024, Chen said.

“I think this is the first Bree topic specifically related to climate change,” he said. “We’ll be talking about the health impacts of extreme heat. We’ll be looking at priority populations, clinical protocols, and emergency preparedness. No matter what industry you’re in, the ability to talk about climate change and normalize the conversation so it’s not a fringe topic (is important) so we can all accept it’s happening, and have the space to think about what to do about it. Because everyone has a part.”

The DOH will be distributing money through several grants for climate change purposes, Cunningham said.

“We have Environmental Justice and Climate Change grants for community-based organizations and tribal organizations, so we’re trying to get that money out,” he said. “We have an occupational health grant for workers who work outside and are impacted by climate change. That will be coming out soon. And we have a $38 million Community Budgeting for Decarbonization and Resilience grant coming soon.”

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