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Health Care Sustainability and Public Health

The Yale Program on Health Care Environmental Sustainability (Y-PHES) within the Center on Climate Change and Health is dedicated to improving the environmental performance of health care itself through basic and implementation research, public policy and advocacy, and education. We are a transdisciplinary body of the health professional Yale Schools of Public Health, Medicine and Nursing, in partnership with the Yale Schools of the Environment, and Management, and with the Yale-New Haven Health System.

Climate change has profound implications for human health, today and in the future. The 2019 Lancet Commission on Health and Climate Change concluded that:

  • The effects of climate change are being felt today, and future projections represent an unacceptably high and potentially catastrophic risk to human health.
  • Tackling climate change could be the greatest global health opportunity of the 21st century.
  • The health community has a vital part to play in accelerating progress to address climate change.
  • The US health sector accounts for 4.6% of global carbon dioxide emissions, a value that is continuously increasing across most major economies.
  • Though the number of countries offering climate services to the health sector has increased from 55 in 2018 to 70 in 2019, this progress is inadequate.
  • Globally, children are among the most affected by climate change. Children born today experience a world that is “more than four degrees warmer than pre-industrial average,” increasing the likelihood of child malnutrition (due to lower crop yields) and susceptibility to severe effects from illnesses such as diarrheal disease and dengue fever.

The US health care sector is a leading emitter of greenhouse gas and non-greenhouse gas pollution.

  1. If the US health sector were a nation itself it would rank 13th in the world for greenhouse gas emissions in 2013. It produces nearly 10% of national greenhouse gases.
  2. US health sector non-greenhouse gas emissions contribute to acid rain (12% of the national total), photochemical smog (10%), and criteria air pollutants (9%).
  3. Public health damages from exposure to non-greenhouse emissions alone were estimated at 405,000 disability-adjusted life years (DALYs) annually. Greenhouse gas emission may contribute to an additional 209,000 DALYs per year.

Pollution: A Global Crisis

The health care sector itself is a major driver of environmental pollutants that adversely affect human health. US health care is a $3.5 trillion industry, one-third of which has been deemed wasteful or of no added value. Each year, the US health sector produces nearly 10% of the nation’s greenhouse gas emissions, equivalent to 614 million metric tons of carbon dioxide. These emissions have increased by more than 30% within the last decade. Though currently unaccounted for, the disease burden from healthcare greenhouse gas and non-greenhouse gas pollution is as commensurate in magnitude as medical errors, as first reported by the Institute of Medicine in To Err is Human.

Building quality into health systems includes avoiding injuries to patients through care that is intended to help them, improve efficiency, and avoid waste. Reducing health care pollution entails addressing excessive or inappropriate resource consumption and minimizing the environmental footprint of health care activities. Striving towards these measures will translate into higher value care and improved population health.

Our Mission

Our mission is to develop and support efforts that measure and mitigate pollution, uniquely focusing on health care delivery. This requires interdisciplinary collaboration between health professionals, bioinformatic scientists, sustainability scientists and engineers, health economists, public policy and legal experts, business management and health care administrators, entrepreneurs, and innovators.

Our Vision

Aligning with the United Nations Sustainable Development Goals, our vision is to transform the health sector into a sustainable, circular economy that is safe, effective, and equitable for patients and communities today and in the future. We aim to:

  1. Conduct scientific research that focuses on applying sustainability science to health care practices.
  2. Advocate for health and environmental policies that reduce excessive waste and pollution, including those that require disproportionate risk assessment of individual patients (e.g. infection control) at the expense of public health.
  3. Educate health professionals and students about how resource conservation and protection of public health is essential to the duty to do no harm.


Spring 2020

EPH 556/F&ES 956b: Health care Environmental Sustainability Practicum
Course description available here
For more information about year-round research and educational opportunities, please contact:

As mandatory carbon reduction looms on the horizon, this three-part symposium provides an overview of the current state of health care sustainability accounting, and seeks global lessons that can be adopted by the US health care delivery sector to guide mitigation and resilience strategies. 

Part 1: Sustainability in the US health care delivery sector.
May 27, 2021, 11:00 am-3:30 pm EDT
Presented with the Yale Center for Business and the Environment.

Part 2: Lessons from the Greener NHS Initiative: challenges and opportunities on the road to net zero health care. 
June 3, 2021, 11:00 am-3:30 pm EDT
Presented with the University College London Energy Institute, the Lancet Countdown and the Northeastern University College of Engineering.

Part 3: Lessons from the Nordic sustainable health care experience.
June 10, 2021, 11:00 am-3:30pm EDT
Presented with the Nordic Center for Sustainable Health Care.

This workshop brought together experts in engineering, sustainability science, clinical care and health systems management to tackle the issue of resource consumption and environmental emissions associated with medicine and health care services.

Inhaled anesthetics are potent greenhouse gases. Waste anesthetic gases (WAGs) are routinely vented off facility rooftops, where their emissions to the outdoor environment are currently not controlled. Several simple strategies can reduce these emissions, and serve to protect public health, without compromising patient care. Project Drawdown aims to benchmark facility-level inhaled anesthetic carbon footprints, as well as per-case averages, to compare and inspire performance improvement efforts. 

Select References

  • Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386(10006): 1861-914.
  • Eckelman M, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health, PLoS ONE 2016;11(6)
  • Vollmer M, Rhee T, Rigby M, Hofstetter D, Hill M, Schoenenberger F, Reimann S. Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere. Geophys Res Lett 2015 March;42(5):1606-11
  • Sherman J, Le C, Lamers V, Eckelman M. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg. 2012; May;114(5):1086-90
  • Carbon Footprint from Inhaled Anesthetic Gases, National Health Service England and Public Health England, Sustainability Development Unit,
  • Thiel C, Eckelman M, Guido R, Huddleston M, Landis A, Sherman J, Shrake S, Copley-Woods N, Bilec M.: Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States. Environ Sci Technol 2015;49:1779-1786
  • Ryan S, Nielsen C. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010 Jul;11(1):92-8
  • Feldman, JM. Managing fresh gas flow to reduce environmental contamination. Anesth Analg. 2012; May;114(5):1093-101
  • McGain F, Sussex G, O'Toole J, Story D. What makes metalware single-use? Anaesth Intensive Care 2011; 39: 972-3
  • Eckelman M, Mosher M, Gonzalez A, Sherman J: Comparative Life Cycle Assessment of Disposable and Reusable Laryngeal Mask Airways. Anesth Analg 2012; 114: 1067-1072
  • McGain F, Jarosz K, Nguyen M, Bates S, O'Shea C. Auditing Operating Room Recycling: A Management Case Report. A A Case Rep 2015 Aug 1;5(3):47-50
  • McGain F, Algie C, O’Toole J, Lim T, Mohebbi M, Story D, Leder K. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014 Apr;69(4):337-42
  • Sherman J, Ryan S. Ecological responsibility in anesthesia practice. Int Anesthesiol Clin. 2010 Summer;48(3):139-51