“The greatest threat to our planet is the belief that someone else will save it.” – Robert Swan, explorer and environmentalist.
The healthcare industry is vital but also has a big environmental impact. It’s responsible for nearly 5% of global net emissions, similar to 514 coal-fired power plants. This shows we need green healthcare, eco-friendly facilities, and sustainable practices to cut down its carbon footprint.
In this article, we’ll look at how healthcare can become more sustainable. We’ll cover energy-saving buildings, better waste management, and green procurement. These strategies can make healthcare a leader in environmental care.
Key Takeaways
- The healthcare industry is a significant contributor to global greenhouse gas emissions, responsible for nearly 5% of annual net emissions.
- Hospitals and medical facilities can implement energy-efficient practices, sustainable waste management, and green building design to reduce their carbon footprint.
- Adopting renewable energy sources, water conservation strategies, and environmentally-conscious supply chain management can further enhance the sustainability of healthcare operations.
- Engaging healthcare professionals as sustainability champions and promoting disease prevention and health promotion can drive meaningful change.
- Innovative models of care, such as telemedicine and sustainable anesthetics, can improve the environmental impact of healthcare delivery.
Understanding the Environmental Impact of Healthcare
The healthcare sector has a big environmental footprint. It leads to greenhouse gas emissions, waste, and uses a lot of resources. Knowing how big this problem is and where it comes from is key to fixing it.
Carbon Footprint and Greenhouse Gas Emissions
The healthcare industry is a big source of carbon emissions and greenhouse gases. Studies show that the healthcare sector in the United States is responsible for 8.5% of the country’s total greenhouse gas. Worldwide, healthcare emissions are up to 4.6% of global totals.
In the US, healthcare emissions have gone up by 6% from 2010 to 2018. This shows we need to act fast.
Hospital care is the biggest source of carbon emissions in healthcare, making up 36%. Physician and clinical services and prescription drugs also play a big role. The carbon footprint of the NHS in the UK is almost 25 million tonnes of carbon dioxide, making it the largest of any single public sector body. If all healthcare systems worldwide were together, they would be the fifth largest country in terms of carbon footprint.
Waste Generation and Resource Consumption
Healthcare facilities also generate a lot of waste, including hazardous materials. They use a lot of resources too. Endoscopy departments in hospitals, for example, produce a lot of water per bed-day, making them one of the biggest emitters.
Fixing the environmental impact of healthcare is important. It helps fight climate change and protects the health of vulnerable people. They are often hit hard by environmental damage.
“The healthcare sector has a substantial environmental impact, with hospitals, drugs, and devices being major sources of carbon emissions and greenhouse gases.”
Principles of Environmentally Sustainable Healthcare
Sustainable healthcare aims to lessen the healthcare industry’s environmental footprint. It focuses on social sustainability and economic sustainability. These principles guide efforts to cut healthcare’s carbon footprint while keeping patients’ needs and costs in mind.
Social Sustainability and Patient Well-being
Socially sustainable healthcare boosts patient experience and fairness. It uses patient-centered care to improve well-being and meet the needs of all patients. This approach ensures quality care while reducing environmental harm.
Economic Sustainability and Cost-Effectiveness
Economically sustainable healthcare aims for cost-effectiveness and financial stability. It uses energy-saving tech, optimizes resources, and looks for new funding ways. It’s key to balance environmental, social, and economic goals for a sustainable healthcare system.
Principle | Key Objectives | Benefits |
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Social Sustainability |
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Economic Sustainability |
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Healthcare organizations can lessen their environmental impact by following these principles. They can improve patient care and find cost-effective solutions. This approach is vital for a sustainable and environmentally-aware healthcare system.
Strategies for Reducing Carbon Footprint
Healthcare facilities need to cut their carbon footprint to be more sustainable. They can do this by using energy-efficient building design. They also need to work on making their operations greener to use less energy and cut down on emissions.
Energy-Efficient Building Design and Operations
Healthcare places can lower their carbon footprint by being more energy-smart. Here are some ways to do it:
- Using renewable energy like solar panels or geothermal systems.
- Choosing energy-saving lights, HVAC systems, and building materials.
- Keeping facilities running well by fixing and updating equipment and using digital tools for patient care.
- Working with local businesses and government to use waste heat and steam for heating and cooling.
Sustainability Metric | Impact |
---|---|
Health care emissions | Account for as much as 4.6 percent of global emissions, with the U.S. health care sector contributing closer to 8.5 percent. |
Emissions from healthcare by 2050 | Predicted to reach six gigatons per year, equivalent to emissions from approximately 1.26 billion cars. |
Spending on Medicare overuse | May be as high as 29 percent of total spending, with two-thirds of prescribed medications going unused, costing the system over $2.4 billion annually. |
By using these energy-saving methods, healthcare places can greatly reduce their carbon footprint. This helps them run more sustainably.
“Reducing greenhouse gas emissions can lead to cost savings in health care operations and contribute to hospitals’ resiliency against extreme weather events.”
Waste Reduction and Sustainable Procurement
Healthcare facilities use a lot of energy, leading to a lot of carbon emissions. To tackle this, healthcare groups are working on reducing medical waste and buying green supplies. This is a big step towards a more sustainable healthcare system.
Using eco-friendly materials and products is a key strategy. It helps reduce waste and supports a greener healthcare system. By choosing green supplies, healthcare places can lower their carbon footprint and help the planet.
- In the 2020s, federal policies aimed to cut down greenhouse gas emissions in healthcare.
- Groups focused on reducing GHG emissions often have strong leadership and long-term goals.
- Health plans can change how they pay to encourage energy efficiency and sustainable choices.
Green building design and operations are also crucial. Green buildings use natural light, air, and sound to create better patient environments. Starting sustainable healthcare efforts can save money for hospitals and providers. It’s a smart and cost-effective move.
“Sustainable healthcare practices can attract patients who care about the environment. This can lead to more loyal and retained patients.”
However, adopting sustainable practices in healthcare comes with challenges. Costs and technology barriers can be obstacles. But, the benefits of less waste and green procurement are clear. Governments and private groups can offer financial help to support healthcare in going green.
Healthcare organizations can make a big difference by focusing on waste reduction and green procurement. This not only helps the environment but also improves patient care and satisfaction. Moving towards a sustainable healthcare system is a wise choice that benefits everyone.
green healthcare, carbon footprint reduction, sustainable practices
The healthcare industry faces big challenges from climate change. It needs to adopt green healthcare practices and reduce its carbon footprint. The sector’s environmental impact is huge, making up over 5% of global emissions.
Healthcare facilities are now taking steps to lessen their environmental impact. They focus on energy efficiency, like using solar panels and energy-efficient infrastructure. For example, the University Hospitals of North Midlands NHS Trust saved nearly £300,000 by installing solar panels.
Choosing sustainable products is also key. The healthcare sector’s supply chain is a big source of carbon emissions. By adopting a circular economic model and making sustainable procurement choices, healthcare can reduce waste and support biodiversity.
Sustainable Healthcare Practices | Impact |
---|---|
Renewable energy adoption | Potential to reduce 29% of healthcare’s carbon footprint |
Sustainable procurement decisions | Transition to a circular economic model, reduce waste |
Telemedicine and remote consultations | Decrease environmentally damaging patient travel |
Innovative care models like telemedicine and remote consultations are also important. They can cut down on patient travel and its environmental impact. By adopting these practices, healthcare can help fight the climate crisis and protect community health.
“Sustainable healthcare contributes between 1% and 5% of the world’s particulate matter, nitrogen oxide, sulphur dioxide, nitrogen runoff, and water use.”
As healthcare evolves, integrating green healthcare, carbon footprint reduction, and sustainable practices is crucial. This will help create a more environmentally aware and resilient healthcare system. It will be ready to face future challenges.
Prioritizing Disease Prevention and Health Promotion
The healthcare industry is focusing on sustainability, with a big emphasis on disease prevention and health promotion. This shift from treating illnesses to preventing them can improve health and reduce environmental harm.
Investing in disease prevention and health promotion fits well with sustainable healthcare. It helps people and communities live healthier lives, reducing the need for costly medical treatments. This can lead to many benefits, like less pollution and better use of natural resources.
- The World Health Organization says up to 36% of deaths in children are due to environmental causes. This shows we need to act fast with public health measures.
- The healthcare sector has a big environmental impact, including pollution and waste. Preventive care is key to reducing these problems.
- Climate change is causing health issues like disease shifts and water problems. This makes disease prevention and health promotion even more crucial for strong healthcare systems.
By focusing on disease prevention and health promotion, healthcare can do more for patients and the planet. This change, along with new ideas and partnerships, can lead to a greener, more resilient healthcare system.
“The health care sector needs to address health inequities exacerbated by climate change by understanding vulnerable patient populations and geographically expected climate impacts.”
The healthcare industry’s journey to sustainability highlights the importance of disease prevention and health promotion. By taking this holistic approach, healthcare can improve patient care, lessen environmental harm, and help create a sustainable future for everyone.
Engaging Healthcare Professionals as Sustainability Champions
Healthcare professionals are key in making the industry more sustainable. By training them to use green practices, we can make healthcare better for our planet. This training helps healthcare move towards a greener future.
Education and Training on Sustainable Practices
Teaching healthcare workers about green practices is essential. Healthcare systems need to offer detailed training. This should include topics like:
- Measuring and reducing the carbon footprint of clinical operations
- Implementing waste reduction and recycling initiatives
- Promoting energy-efficient building design and operations
- Adopting sustainable procurement and supply chain management
- Integrating virtual care and telemedicine to minimize patient travel
With the right training, healthcare workers can lead the way in sustainability. They can help their organizations make big changes.
“Healthcare systems currently contribute more than 4.4% of global emissions. Engaging healthcare professionals as sustainability champions and providing them with the right education and training can play a crucial role in reducing the environmental footprint of the healthcare industry.”
Actions like waste audits and sustainable supply chains show the impact of healthcare workers. Clinical leaders are especially important in promoting green practices. They help the team work towards a sustainable future.
By focusing on training healthcare professionals in sustainability, we can speed up the use of green practices. This makes healthcare more sustainable and resilient for the future.
Innovative Models of Care for Sustainability
Healthcare systems are working hard to lessen their environmental impact. New care models are showing promise. They focus on green practices without sacrificing patient care. Telemedicine and integrated care are leading the way towards sustainable healthcare.
Telemedicine: Reducing Patient Travel and Resource Use
Telemedicine lets doctors care for patients from afar. It uses digital tools to cut down on the need for in-person visits. This reduces travel and the carbon footprint that comes with it.
It’s good for the planet and makes healthcare more accessible. It helps those in rural or hard-to-reach areas get the care they need.
Integrated Care: Optimizing Resource Utilization
Integrated care brings together different healthcare services under one roof. It streamlines care and cuts down on resource duplication. This leads to better use of resources and less waste.
It also means less need for big buildings and equipment. This results in lower energy use and less environmental harm.
Innovative Care Model | Key Benefits for Sustainability |
---|---|
Telemedicine | Reduced patient travel, lower carbon footprint |
Integrated Care | Optimized resource utilization, decreased physical infrastructure |
As healthcare evolves, adopting green care models is key. These models help tackle environmental issues in healthcare. By using them, healthcare providers can help create a sustainable future while still offering top-notch care.
“Implementing sustainable practices in healthcare can lead to substantial cost savings, demonstrating the added value that this approach can bring to the industry.”
Virtual Care and Telemedicine
Virtual care and telemedicine can greatly reduce healthcare’s environmental impact. They cut down on patient travel and the resources needed. These models help make healthcare more sustainable by using resources wisely and lowering carbon emissions.
Studies show that virtual care and telemedicine can cut carbon emissions. For instance, a study found that telemedicine can save between 0.70–372 kg CO2e per visit. The savings depend on how far patients don’t have to travel.
In the UK, the NHS had a carbon footprint of 25.0 megatons of CO2e in 2019. Shifting 15% of hospital visits to telemedicine could cut emissions by 533,535 kg CO2e annually in the West Midlands.
There’s a clear link between less travel and lower carbon emissions. A review of 65 studies showed a strong positive correlation. It also noted that different telemedicine types have varying carbon savings, from 0.70–3.55 kg CO2e per visit.
Virtual care and telemedicine offer more than just environmental benefits. They improve healthcare access, reduce resource use, and boost patient and provider satisfaction. As healthcare evolves, these models will be key in reducing its environmental impact.
“Telehealth services, including video and telephone consultations, reduce the need for patients and providers to travel, resulting in environmental benefits, including a reduction in emissions associated with disposables and consumables.”
Region | Average Travel Distance Saved | Carbon Footprint Reduction per Consultation |
---|---|---|
California | 1,387 km | 372 kg CO2e |
London | 15 km | 2.93 kg CO2e |
Ontario | 901 km | 220 kg CO2e |
Sustainable Anesthetics and Surgical Services
The healthcare sector is key in tackling environmental issues. In the United States, healthcare is responsible for about 10% of greenhouse gas emissions. Operating rooms, in particular, use a lot of energy, sometimes six times more than the rest of the hospital. They also produce over half of the waste in healthcare facilities.
Healthcare providers are now looking for green alternatives. Anesthetic gases, like desflurane, have a big carbon footprint. Switching to greener options can cut carbon emissions by up to 80% during surgeries.
Minimally invasive surgeries use less energy and produce less CO2 than traditional methods. However, robotic surgeries might use more energy and create more waste. This could balance out some of the environmental gains.
Sustainable Surgical Approach | Environmental Impact |
---|---|
Minimally Invasive Procedures | Reduced CO2 emissions |
Robotic Surgical Techniques | Higher energy usage, increased solid waste |
Waterless Surgical Scrubs | $2,233 annual savings, 2.7 million liters of water preserved |
Proper Waste Disposal Education | $694,141 annual savings, 30% reduction in medical waste |
Green healthcare goes beyond the operating room. Teaching staff about waste and using waterless scrubs saves money and water. A holistic approach to sustainability helps healthcare facilities reduce their environmental impact.
Healthcare professionals must focus on environmental sustainability. By choosing sustainable anesthetics and surgical methods, we can lower our carbon footprint. This also improves patient care and makes healthcare systems more efficient. A greener future in healthcare depends on our commitment to eco-friendly solutions.
Environmentally Conscious Supply Chain Management
The healthcare supply chain has a big impact on the environment. Using sustainable supply chain management can help reduce this impact. This includes sustainable procurement and improving logistics.
One big challenge is the mining of 3TG minerals for medical devices. This mining causes greenhouse gas emissions and harms the environment. Also, single-use medical supplies make up 80% of the healthcare industry’s carbon footprint.
Hospitals and healthcare systems can use several strategies to be more sustainable. They can:
- Choose sustainable procurement for medical supplies and equipment. This means picking eco-friendly and energy-efficient options.
- Improve logistics and distribution to cut down on emissions. This includes using more efficient transport and better delivery routes.
- Start waste reduction initiatives. This includes better inventory management and recycling programs for medical supplies and packaging.
- Work with suppliers, stakeholders, and regulatory agencies to promote sustainable practices in the healthcare supply chain.
By using these sustainable supply chain practices, healthcare organizations can reduce their environmental impact. They can also save money and improve their reputation as responsible entities.
Key Sustainability Metrics | Potential Impact |
---|---|
Reduction in greenhouse gas emissions | Up to 75% decrease in energy consumption and carbon footprint |
Waste diversion and recycling rates | Significant cost savings and conservation of natural resources |
Sustainable procurement of medical supplies | Reduced environmental impact from production and transportation |
By focusing on environmentally conscious procurement and supply chain management, healthcare organizations can be key players in sustainability. They can help address the environmental challenges in the industry.
“Sustainability is no longer a ‘nice-to-have’ for healthcare organizations, but a strategic imperative to address the climate crisis and meet the evolving expectations of patients, staff, and the broader community.”
Water Conservation Strategies in Healthcare
Water conservation is key in sustainable healthcare. Healthcare places use a lot of water, affecting the environment. By using new water-saving methods, healthcare can lessen its environmental footprint and help the industry be more sustainable.
Rainwater Harvesting and Efficient Use
One good way to save water is through rainwater harvesting. This means catching and storing rainwater for uses like watering plants, cooling systems, and flushing toilets. It cuts down on the need for tap water and helps protect water sources.
Healthcare can also use efficient water use by installing water-saving devices and practices. This includes low-flow faucets, showerheads, and toilets. It also means using water wisely in medical procedures and cleaning.
- Rochdale Infirmary in the United Kingdom lowered reliance on potable water through rainwater harvesting systems.
- Sir Ganga Ram Hospital in India recycles 100% of wastewater for non-potable uses.
- Cleveland Clinic in the U.S. reduced water usage by 30% through various water conservation initiatives.
By adopting these strategies, healthcare can cut down water use, save money, and help the environment.
Renewable Energy Sources for Healthcare Facilities
Switching to renewable energy like solar, wind, or geothermal can cut down a healthcare facility’s carbon footprint. It makes healthcare more sustainable. Using renewable energy fits with green healthcare goals.
In 2019, 18% of U.S. electricity came from renewable energy. This number is rising. Wind power now makes up 7.3% of U.S. energy, and solar has seen big economic gains in the last ten years.
Places like Gundersen Health System have become “energy independent” with solar, wind, and biomass. These sustainable energy options lower environmental harm and save money on power.
Healthcare places should aim for 100% renewable electricity by 2030. They can use many ways to get there, like making power on site or buying it from community solar projects.
Choosing green energy shows healthcare’s dedication to the planet. It encourages other areas to go green too, for a better future.
“Solar and wind power provide the lowest-cost electric power globally, and wind turbines today can generate enough electricity to power more than 15,000 homes.”
Going for renewable energy helps the environment and supports sustainable healthcare. By picking green energy, healthcare can show the way to a greener tomorrow for everyone.
Green Building Design and Sustainable Materials
Using green building design and sustainable materials in healthcare facilities cuts down environmental harm. Pursuing LEED certification and following green building standards makes healthcare infrastructure more sustainable. It also sets a good example for the industry.
LEED Certification and Green Building Standards
Kaiser Permanente is a leader in sustainability, with over 10.1 million square feet of LEED-certified spaces. They have 82 LEED-certified buildings, with 13 at the highest LEED Platinum level and 34 at LEED Gold.
The San Marcos Medical Center saves enough energy to power 3,500 homes and saves 400,000 gallons of water monthly. The San Diego Medical Center is the world’s first double LEED Platinum hospital. It generates its own electricity, heat, and cooling, reducing emissions and water use.
The Santa Rosa Medical Offices are the first net-zero carbon emissions healthcare building in the U.S. They are powered by a parking lot solar installation.
Facility | LEED Certification | Sustainability Achievements |
---|---|---|
San Marcos Medical Center | LEED Certified | Saves energy equivalent to 3,500 homes, conserves 400,000 gallons of water monthly |
San Diego Medical Center | LEED Platinum | World’s first double LEED Platinum hospital, generates own electricity, heat, and cooling |
Santa Rosa Medical Offices | LEED Platinum | First net-zero carbon emissions healthcare building in the U.S., powered by a parking lot solar installation |
These examples show how green building design and sustainable materials help healthcare facilities get LEED certification. By adopting these practices, healthcare organizations can lower their carbon footprint and save natural resources. They also create healthier environments for everyone.
Conclusion
The healthcare sector is working hard to reduce its environmental impact. By adopting green practices, cutting down on carbon emissions, and using new, eco-friendly care models, it’s leading the way. This is crucial for tackling our big environmental problems.
Healthcare can cut down on energy use and pollution by using less resources. It can also focus more on preventing diseases and promoting health. This way, healthcare workers can be key players in making a difference.
Also, new tech like virtual care and telemedicine is helping. It cuts down on the need for patients to travel and use resources. By using these new ways of caring for patients, healthcare can play a big role in making our world better.
FAQ
What is the environmental impact of the healthcare sector?
The healthcare sector has a big impact on the environment. It’s responsible for 4.6% of Canada’s greenhouse gas emissions. Hospitals, drugs, and devices are the main culprits.
What are the key principles of environmentally sustainable healthcare?
Sustainable healthcare focuses on two main areas. It aims to improve patient well-being and fairness. It also looks for cost-effective ways to do things.
How can healthcare facilities reduce their carbon footprint?
Facilities can cut down on carbon emissions in several ways. They can design buildings to use less energy. They can also work smarter to use less energy overall.
What strategies can healthcare facilities use to reduce waste?
Facilities can reduce waste by choosing green, biodegradable supplies. This helps lessen the harm caused by medical waste.
How can healthcare professionals contribute to sustainability efforts?
Healthcare workers are key in promoting sustainability. They can lead by example and teach others about green practices.
What innovative models of care can reduce the environmental impact of healthcare?
New care models like telemedicine and integrated care can help. They reduce environmental harm while keeping patient care high.
How can the healthcare supply chain be made more sustainable?
Making the supply chain greener is possible. Using sustainable procurement and improving logistics can lessen healthcare’s environmental footprint.
What strategies can healthcare facilities use to conserve water?
Facilities can save water in many ways. Using rainwater and being efficient with water use are good steps.
How can healthcare facilities transition to renewable energy sources?
Switching to renewable energy is a big step. Using solar, wind, or geothermal power cuts down carbon emissions a lot.
What green building design principles can be applied to healthcare facilities?
Green building design is crucial for healthcare. Using sustainable materials and aiming for LEED certification can greatly reduce environmental harm.
Source Links
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6465872/
- https://healthcareclimateaction.org/action-guidance
- https://sustainableearthreviews.biomedcentral.com/articles/10.1186/s42055-024-00098-3
- https://www.commonwealthfund.org/publications/explainer/2022/apr/how-us-health-care-system-contributes-climate-change
- https://sustainablehealthcare.org.uk/blog/nursing-and-climate-change-how-reduce-your-environmental-impact
- https://www.ncbi.nlm.nih.gov/books/NBK596637/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4952075/
- https://www.philips.com/a-w/about/news/archive/features/2024/five-key-levers-for-sustainable-healthcare.html
- https://www.commonwealthfund.org/blog/2023/lowering-carbon-emissions-through-redesigned-health-care
- https://www.aamc.org/news/hospitals-take-creative-steps-reduce-carbon-footprint
- https://www.aha.org/system/files/media/file/2024/02/Sustainability-Executive-Toolkit.pdf
- https://www.commonwealthfund.org/blog/2024/time-now-how-us-health-plans-can-reduce-greenhouse-gas-emissions-save-planet-and-better
- https://www.linkedin.com/pulse/sustainable-healthcare-green-practices-medical-industry-al-surf
- https://www.moorhouseconsulting.com/insights/insights/sustainable-healthcare-guide/
- https://link.springer.com/article/10.1007/s11625-024-01487-5
- https://www.bma.org.uk/media/2570/bma-sustainable-and-environmentally-friendly-general-practice-report-june-2020.pdf
- https://climateandhealthalliance.org/wp-content/uploads/2018/02/Global-Green-and-Healthy-Hospitals.pdf
- https://www2.deloitte.com/us/en/insights/industry/health-care/climate-change-and-health.html
- https://healthcaresustainabilitychampions.com/
- https://www.bmj.com/content/387/bmj-2024-081284
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591295/
- https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-024-02197-0
- https://www.selondonics.org/wp-content/uploads/2022/06/5.-ICS-Green-Plan.-Sustainable-Models-of-Care.pdf
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8004323/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11137209/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289051/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9973446/
- https://www.facs.org/media-center/press-releases/2022/going-green-in-operating-rooms-reduces-cost-and-improves-environmental-impact/
- https://www.ghx.com/the-healthcare-hub/healthcare-supply-chain-sustainability-guide/
- https://trellis.net/article/health-care-innovations-sustainability-will-protect-both-patients-and-planet/
- https://www.fibrenew.com/blog/5-sustainable-business-practices-you-can-adopt-today/
- https://healthmanagement.org/c/hospital/News/green-care-implementing-sustainable-practices-in-healthcare-facilities
- https://www.mymcso.com/sustainable-healthcare-implementing-green-practices-in-medical-facilities.html
- https://practicegreenhealth.org/renewable-energy-sources-hospitals
- https://practicegreenhealth.org/tools-and-resources/procuring-renewable-energy-health-care-facilities
- https://about.kaiserpermanente.org/news/leading-in-sustainable-building-design
- https://safetyculture.com/topics/green-building/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576604/
- https://www.coloradohealthinstitute.org/research/sustainability-health-care