Having worked in healthcare architecture for more than a decade, I’m aware there’s an irony we face every day. Hospitals are designed to care for population health. Yet these facilities, like all industries, have an environmental impact. And climate change has an impact on public health. It’s not surprising this is an issue, given how many healthcare facilities were built before modern energy-saving and other efficiency options were widely understood or adopted.

Creating ways to enable superb healthcare and reduce environmental impact is something we think about every day at DesignGroup. Because improving energy efficiency and lowering carbon emissions of the new and renovated facilities we design can significantly lower the industry’s environmental footprint. And that, in turn, helps improve public health.

And yet, there are a few challenges that make it hard to not just solve the problem, but recognize it as a priority in the first place.

It’s Not Always Easy to See

In 1952, the “Great Smog of London” choked the great city for five days, reducing visibility and penetrating indoor areas. Caused by use of coal and windless conditions, the blanket of soot killed an estimated 10,000 people due to breathing difficulties, lung cancer, and bronchitis. Because citizens could see and feel the crisis, it quickly led to changes in practices and regulations, including the UK’s Clean Air Act of 1956. (To see what I’m talking about, the Great Smog is brilliantly recreated in the fourth episode of Netflix’s The Crown.) As recently as November 2024, New Delhi faced hazy air pollution 50 times the safe limit, delaying flights and closing schools. These events felt urgent, even shocking.

But most of the time, our challenge is that greenhouse gasses aren’t visible, at least to the naked eye. And when you can’t see something, it’s hard to feel threatened by it – or respond to it.

That’s problematic, because the many challenges posed by climate change (wildfires, extreme temperatures, flooding, air pollution) have very real effects on health. Crop damage leads to food insecurity, increased allergens and pollen affect breathing, natural disasters intensify mental and stress-related disorders – the list goes on. 

And the U.S. healthcare sector contributes as much as 10 percent of all U.S. greenhouse gasses. (Much more than the aviation industry.) Of the many ways emissions are produced by healthcare facilities, more than half come from basic operations through the use of electricity, gas, and heating/cooling. The Advisory Board has acknowledged obligations in this area, declaring, “climate change is a healthcare issue.”

Architecture’s Role in a Solution

Architecture can play a part in lowering healthcare emissions. After all, that’s what we do every day – design solutions that improve human experiences! Here are three ideas that can make a difference.

1. Lower or remove the use of natural gas wherever possible.

Natural gas is about 80% methane and 25 times more potent as a greenhouse gas than carbon dioxide. Gas pipelines can be prone to leaking – it’s estimated leaking greenhouse gasses equal 2.4 million passenger vehicles driven for a year. When it leaks unburned from appliances, it contains benzene, a known carcinogen. And when it’s burned, natural gas produces carbon dioxide, which can lead to respiratory issues, chronic lung disease, and other health concerns (especially in children). The solution? Pipe less of it into buildings, replace gas cooking appliances with electric, and use these design choices as an opportunity to inform clients and visitors about these issues, so they adopt them in their lives outside work. A recent case study proved the point effectively: in choosing to avoid natural gas, a new medical office building reduced construction costs by 2% ($1M of $50M budget) and installed solar PV panels to shade the parking lot and produce electricity. A win-win solution.

2. Reduce operating room waste.

Operating rooms generate as much as 30% of total hospital waste. One contributor is the ventilation required to reduce risk of infection – and is estimated responsible for 12% of fuel consumption as U.S. hospitals. The Cleveland Clinic implemented a set-back system to reduce air changes when operating rooms are not in use, saving the system $2 million a year. Anesthetic gases also contribute to hospital emissions. Comparing gasses and exchanging them for more sustainable options can reduce emission and costs. (Cleveland Clinic saved another $2.5 million a year by changing all lightbulbs from fluorescent to lower-energy LEDs, which also improved light quality and reduced the time spent changing them, because they burn out less frequently. This Harvard Business Review article elaborates on these and other measures for reducing healthcare emissions.

3. Look for improvements in the supply chain.

Of course, greenhouse gases are created before products even arrive at the hospital. Kaiser Permanente implemented an environmentally preferable purchasing program (EPP) that identifies opportunities to reduce emissions across the supply chain. It requires current and prospective vendors to adhere to their EPP standards, which outline criteria about chemical use and waste. Implemented in 2017, it’s estimated the program has saved 2,400 tons of waste, 87 million Kwh of energy, and $63 million.

Now the Good News

There are many signs of progress. England’s NHS has already cut its CO2 footprint by about 30% since 2010 and is committed to carbon net zero by 2040, the first national health system to promise this. Its solution includes more home-based care delivery, low-emission ambulances, reductions in consumable waste, and new net-zero emission facilities.

In the U.S., use of coal and petroleum for generating electricity is in real decline for the first time. As renewable energy sources become less expensive than fossil fuels, wind and solar PV electric generation is growing around the world. Net-positive energy buildings are becoming a reality here, too, And funding mechanisms are available to help pay for sustainability improvements to healthcare facilities, such as Property Assessed Clean Energy financing, a lower-cost option in some states created specifically for energy-efficiency upgrades such as high-efficiency HVAC, LED lighting, energy management systems and controls, and more. Establishing a Revolving Green Fundis another creative way to help offset investment in sustainability.

We’ve been leaders in sustainable design for decades. We’re excited the industry is recognizing the need to change, and we’ll continue to seek new ways to improve what we do and how our clients serve their communities. It’s a challenge that will never go away, and one we’ll never give up.