On a cloudy Thursday morning, Tom Cavender walks around the WakeMed North Hospital in Raleigh, explaining how the building is designed for energy efficiency.
"Healthcare is such an energy hog. The best thing we can do is develop our facilities so that they operate [as] effectively and efficiently [as possible]," said Cavender, the vice president of Facilities and Construction at WakeMed.
Hospitals need uninterrupted electricity. In case of emergencies, such as hurricanes, all healthcare facilities have backup generators.
He stands by the main entrance of the hospital and points up toward the windows.
“On this elevation, which is the south elevation, you can see that we have sunshades above every window," said Cavender. "That orientation, and the angle of those sunshades, reflect the height of the sun in the summer and then that washes the patient windows with shade, instead of sunshine. In the wintertime, when the sun is lower, it goes below the shades, and we... get the solar gain of the heat.”
Every side of the hospital has different shaped windows — some wider, some smaller. All of them are designed to maximize sunlight depending on the season and which way they’re facing. This helps conserve energy and save money.
“Some of our newer facilities that we've built over the last five to 10 years — we're probably operating at about 50 to 75 cents a square foot less than what we were in the past," Cavender said. "And that's taken into consideration the rate increases."
WakeMed also uses grey water for its irrigation systems. Grey water is leftover, untreated water that has already been used, including water from washing machines, bathtubs and bathroom sinks.
"We are probably saving half a million dollars a year in water expenses," Cavender said.
At the moment, WakeMed does not know how much carbon emissions its hospitals emit a year. Cavender says figuring that out will be part of a sustainability plan he hopes to have done by the end of next year.
Duke Health and UNC Health are in similar positions. Neither have specific climate action plans at the moment, but both also focus on energy efficiency in their facilities. In contrast, Duke University and UNC Chapel Hill do have sustainability plans and goals.
“I think all of this needed to happen yesterday," said Tavey Capps, executive director of climate and sustainability for Duke University. "There is a broadening recognition that the impact of the health system and the connection of health and climate is so key."
Capps points to grassroots efforts happening at Duke Health.
“Doctors, practitioners, staff, [and] students... have formed Green Teams [and] participated in the university’s green workplace [and] green labs certification," said Capps. "I’ve worked with graduate students doing projects [looking at] how they can be thinking more deeply about climate and sustainability.”
Some of those graduate students, including Jennifer Craft, Natalia Jaffee, Megan Lundequam, and Rebecca Sauer, published a report earlier this year analyzing Duke Health’s carbon emissions. The report found that Duke University Hospital emitted approximately 104,000 metric tons of CO2 from July 2018 through June 2019.
This report was shared with senior leadership in Duke Health, including outgoing Duke Health President Eugene Washington, who formed a Climate Change Health Equity Committee to talk about sustainability efforts.
Duke Health intends to start work on a climate action plan once a new president is in place.
“We are in the early stages of planning sustainability initiatives, working closely with our colleagues on the campus side as well as leaders and frontline employees in our clinical enterprise," a Duke Health spokesperson said in an emailed statement.
UNC Health did not make anyone available for an interview with WUNC. In an emailed statement, spokesperson Alan Wolf said UNC Health is still in the early stages of discussions about broad sustainability efforts.
"We are looking at various initiatives related to waste management, energy use, water use, and food. And we have some great work underway. For example, we are consistently getting high marks for recycling," Wolf said. "Several new facilities … are LEED certified based on sustainable energy and carbon-based emissions."
LEED is a building system that stands for Leadership in Energy and Environmental Design. The U.S. Green Building Council (USGBC), a non-profit that promotes sustainability in building designs, runs the program. LEED certified buildings "improve efficiency, lower carbon emissions" and help address climate change, according to USGBC.
Several Duke Health and WakeMed facilities are also LEED certified.
Similar to Duke Health, there are grassroots efforts happening in the UNC School of Medicine. Hope Gehle, a third-year medical student, is leading efforts for CLEAN Med UNC, a student organization whose main focus is pushing for a healthcare sustainability curriculum.
"[UNC is] in the midst of adapting the curriculum already," Gehle said. "[Faculty and staff] are really receptive."
The organization also publishes a Planetary Health Report Card, an international "metric-based tool for evaluating and improving planetary health content in health professional schools." This year's report suggests UNC should make a dedicated planetary health academic program and investigate the carbon footprint of UNC Health, which has not been done.
"I have not been in any conversations with [UNC Health]," Gehle said. "They're a little bit harder to get a hold of, honestly."
Gehle works closely with Carolina Advocates for Climate, Health and Equity (CACHE), a group of healthcare workers calling for climate solutions in the industry.
Kathleen Shapley-Quinn is the executive director of CACHE and a practicing family physician.
"It is such a paradox that the institutions that we count on to make us better, in some ways are really making us a lot worse," Shapley-Quinn said. "Health systems do a pretty good job [at taking care of] an individual who has had an injury or illness. But at the same time, they're worsening the climate of the environment."
CACHE plans to reach out to healthcare systems, providers and organizations early next year to talk about sustainability efforts. Shapley-Quinn says she'd like to see all healthcare systems in North Carolina take a federal pledge to be carbon neutral by 2050.
Atrium Health in Charlotte signed onto that pledge.
"We've always believed there's been this link between health and the environment. When the opportunity presented itself, we wanted to be a part of that commitment," said Jennifer Sellers, director of business operations for environmental sustainability at Atrium.
According to its website, Atrium has reduced its annual energy consumption by 30% compared to 2012 levels.
Sellers says some ongoing initiatives include reducing single use plastics and consolidating their vehicle fleet. But there are challenges, like trying to gather metrics on carbon emissions from vendors in their supply chain.
“There's no one size fits all with it. It's not like it's going to this magic dashboard or anything like that," Sellers said. "We're trying to figure out - how can we gather this information? How can we take a value out of it?”
Another extraneous factor is that all these healthcare systems get at least some, if not most, of their electricity from Duke Energy.
A state law passed last year requires Duke Energy to be carbon neutral by 2050. The North Carolina Utilities Commission is expected to release that carbon plan by Dec. 31.
