Essential hospitals can access funds for climate readiness — but they need to act now
By Robert Biggio, Gary Cohen, and Kalpana Ramiah
As we turn the page on the hottest year in recorded history, it’s clear that the climate crisis is a health crisis. Deadly heat domes, catastrophic floods, and choking wildfires take a growing toll on lives and health. Health care facilities are increasingly at risk from climate disruption and are struggling to adapt. Fortunately, funding is readily available to build infrastructure resilience — if hospitals take action now to access it.
Essential hospitals are critical first responders in the climate crisis
Leading medical journals have declared climate change the “greatest threat” to public health and that threat is unfolding in emergency rooms and health clinics nationwide. Clinicians face an ever-larger caseload of climate-related illnesses, from heatstroke to worsening chronic disease. Last fall, floods in Tennessee turned hospital corridors into whitewater rapids, while patients were rescued from the roof by helicopter. And extreme weather, along with chronically underfunded utility grids, has caused a dramatic increase in power outages in recent years. During these outages, lifesaving medicines go bad, electronic health records are inaccessible, and essential medical equipment — including ventilators — shuts down.
Essential hospitals are especially hard hit. Because climate change reveals — and exacerbates — social inequities, the people served by essential hospitals are also those most vulnerable. These facilities play an indispensable role in the health care system by treating people who can’t afford to pay due to economic hardship and by serving rural and historically underserved and marginalized communities. This critical role doesn’t come without cost. In 2023, essential hospitals provided nearly $9 billion in free or reduced-cost care and US communities faced 28 weather and climate disasters that each resulted in $1 billion in damages.
The good news is that essential hospitals — and the rest of the health care sector — can better serve patients and prepare for climate disruption by investing in sustainability and resilience. For example, efficiency upgrades can dramatically reduce energy use, freeing financial resources for patient care. Solar panels augmented with battery storage can keep the lights on — and the ventilators running — when the larger grid goes down. Also, the health care sector accounts for an estimated 8.5 percent of total US greenhouse gas emissions and hospitals are the second most energy-intensive facilities in the country. So, reducing hospitals’ energy use and emissions will lower climate risks for everyone.
Capital is available for resilience investments and the ROI is significant
Funding is available to make hospitals more sustainable and resilient. For many hospitals, strategies to better leverage existing real estate assets combined with funding from sources like utility grant programs and the Inflation Reduction Act (IRA) can unearth the capital needed for infrastructure and energy efficiency upgrades. The IRA made historic investments in climate solutions, prioritizing aid to low-income, rural, and marginalized communities. Essential hospitals, with their thin margins and vulnerable patients, have the most to gain from these investments. As of mid-January, $74 billion in IRA direct funds (i.e. grants) have been committed. Furthermore, many IRA programs and tax incentives remain available and popular, being successfully used for significant investments in districts all across the US and political spectrum.
Unfortunately, few essential hospitals have been able to access these funds, for three overarching reasons. First, implementing sustainability and resilience projects requires expertise in project development, engineering, and cost-benefit analysis — capacities most essential hospitals lack. Second, the IRA requires upfront investments toward project financing that may be prohibitive for essential hospitals. And finally, the IRA application process is complex to navigate, requiring finance and tax expertise that few of these hospitals have in-house.
A new partnership overcomes barriers to accessing funds
A new partnership aims to overcome these barriers. The partnership brings together Health Care Without Harm, a nonprofit that helps the health care sector reduce its environmental impact; Essential Hospitals Institute, which supports essential hospitals across the US; and Oakwell, a sustainability management and real estate optimization firm for the health care sector. With support from The Kresge Foundation, Commonwealth Fund and Wells Fargo Foundation, the partnership will conduct assessments for a cohort of essential hospitals to uncover opportunities for capital generation. It will then help those hospitals seek funding and financing opportunities, such as the IRA, to support their sustainability and resilience upgrades.
Boston Medical Center, an essential hospital that has made sustainability and resilience a centerpiece of its mission, shows what this effort could accomplish. Since 2011, BMC’s facility in Boston’s South End has lowered its energy use by about 35 percent and reduced carbon emissions from energy consumption by over 90 percent. It did so by undertaking more than 50 efficiency projects, installing a cogeneration plant, and purchasing solar energy, among other initiatives. Importantly, this reduced the health system’s costs by $500 million over the last 10 years while expanding its capacity to serve patients. One example of such a project is the BMC Brockton Behavioral Health Center, America’s first net-zero mental health facility.
The new partnership will expand this work to a broader group of hospitals nationwide. Leveraging Health Care Without Harm’s expertise on sustainability and the Essential Hospitals Institute’s network of health care institutions, the partnership is supporting an initial cohort of three essential hospitals: Grady Memorial Hospital, Henry Ford Wyandotte Hospital, and Jackson South Medical Center. The partners offer hands-on assistance to evaluate technical feasibility, viable clean energy projects, and connect cohort members with funding from the IRA and other sources. To implement the projects, Oakwell — founded by Boston Medical Center and Omicelo, a mission-driven investment firm — will bring expertise on project design, real estate optimization, and creative financing. Finally, the partnership will compile issue briefs, case studies, and key takeaways to disseminate the cohort’s learnings to other essential hospitals and the rest of the health care sector.
Climate change — and its attendant health crisis — is a long-term problem. But there is an immediate opportunity to invest in sustainable and operationally efficient health care that can — and should — be taken advantage of now. With modest philanthropic support, this partnership could leverage hundreds of millions in funding from the IRA and other sources to prepare essential hospitals — and their vulnerable patients — for a hotter and stormier future.
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Robert Biggio is Senior Vice President, Chief Sustainability and Real Estate Officer at Boston Medical Center; Gary Cohen is the President and Co-Founder of Health Care Without Harm and Practice Greenhealth; and Kalpana Ramiah, DrPH, is Vice President of Innovations and Director of Essential Hospitals Institute at America’s Essential Hospitals.
