Delivering health care without degrading health: Factors associated with hospital commitment to environmental sustainability

In delivering health care, hospitals contribute to climate change, which adversely impacts human health. Given this paradox, there are mounting efforts to encourage environmental sustainability in hospitals.

With growing attention on the environmental impact of hospitals and the adverse health effects of climate change, the purpose of this study is to examine factors that influence the likelihood of hospital commitment to environmental sustainability.

Using data on U.S. hospitals in 2022, the study estimates logit models to predict the likelihood of signing The White House Health Sector Climate Pledge.

Health system size is positively associated with the likelihood of hospital commitment to environmental sustainability and when interacting with nonprofit control this association strengthens. The delivery of uncompensated care increases the likelihood of commitment, but commitment declines at high levels of uncompensated care. Contrary to expectations, hospitals operating in communities that experience the most harmful health impacts from climate change are less likely to commit to sustainability.

A hospital's priorities and structure facilitate attention toward environmental sustainability, but external factors that draw attention to the need for environmental sustainability do not stimulate, and instead stifle, sustainability commitment.

Hospital leaders, advocacy groups, and policymakers should not assume the experience of adverse climate-related health outcomes leads hospitals to make commitments to environmental sustainability, but rather focus should be on actively building coalitions, starting with nonprofit, larger system-affiliated hospitals, already predisposed to prosocial behavior, in order to rally broader commitment toward environmental sustainability in the health care sector.