By Nicholas Schou
If Planet Earth were to be subjected to a diagnosis, it’s fair to say that its current condition would be considered life-threatening. This is bad news for the 7.9 billion people who live here, many of whom are already suffering from the effects of climate change induced illnesses and natural disasters, as well as other human caused environmental health impacts.
It is perhaps no coincidence that within the healthcare professions, a movement is growing to conceptualize this diagnosis while also helping to create a more sustainable future for our planet and its human inhabitants. Helping to lead that effort is the world’s largest qualified profession: nurses, whose cohort of 27 million people means that it will be on the front lines of any successful effort to heal or at least stop degrading the planet’s health.
One of the visionaries in the emerging movement to reimagine nursing as an environmental health-focused profession is Beth Schenk, executive director of environmental stewardship for Providence St. Joseph Health, a Catholic non-profit healthcare system based in Renton, WA that operates 51 hospitals on the West Coast. Schenk, who doubles as an assistant research professor at Washington State University, is based in the Pacific Northwest, which has experienced a spate of climate emergencies that helped steer her to action, including a devastating series of regional forest fires and a historic heat dome the likes of which had never been seen before.
Humanity’s increasing vulnerability to the symptoms of planetary malaise could hardly have been clearer to Schenk. “It was 116 degrees in Portland and 108 in Seattle,” she recalls. “Up here, hospitals are not equipped for that, so wings of buildings had to be shut down. Emergency rooms from Canada to California were overwhelmed.” Seeing how climate change directly impacted nearby hospitals reminded Schenk of how she first became aware of the healthcare industry’s negative contribution to our planet’s health 30 years ago.
…hospitals are not equipped for 116 degree heat – wings had to be shut down.
Beth Schenk
“When I was first a nurse, I was horrified about the amount of waste I saw in nursing,” says Schenk, who in 1993, as an ICU nurse at St. Patrick Hospital in Missoula, MT helped launch the hospital’s first successful recycling program. “We threw so many things away and created so much waste,” she adds. “When you throw something ‘away’ there is no ‘away.’ It goes someplace and getting it to the right place is our responsibility.”
Today, the health sector produces 8.5 percent of U.S. greenhouse gases such as carbon dioxide, methane and ozone – roughly twice the impact compared to the global average of less than 5 percent. Half of those U.S. emissions are estimated to come from hospitals alone.
“U.S. healthcare is very resource-intensive, more so than most countries so we are a big part of that problem,” says Schenk. “People come to us from around the world for health services, and in the process, we create a lot of pollution that causes trauma and disease around the world. The circle is not helpful, and we want to break the circle that causes that unwitting harm.”
Mark Lazenby, dean of UCI Sue & Bill Gross School of Nursing, hopes to break that cycle as part of an ambitious five-year strategic framework for the institution. A goal of the nursing school within that framework is to become not just carbon neutral but also a leader in the critical effort to create a new cadre of nurses who will function as advocates and change agents for Earth’s future health and habitability.
Ensuring that future nurses understand the data on the human-inflicted disease now impacting patient earth is critical to Lazenby’s vision. To accomplish this, hiring a professor who works in the field of environmental health and informatics is an important strategic priority. “We have a crew here that works in informatics, and I’d like to round that out with informatics and environmental health,” says Lazenby. “That’s my concrete vision here at the school.”
Diagnosing Earth’s condition as critical thanks to human activity may sound hyperbolic, but the data are clear. Since the industrial revolution of the late 19th century, global temperatures have risen by an average of 0.14° Fahrenheit per decade, or a total of about 2°, according to the National Oceanic and Atmospheric Administration. However, the rate of warming since 1981 is more than twice as rapid: 0.32° F per decade. Heatwaves have become more frequent and intense, posing significant human health risks such as heat exhaustion, heatstroke, and cardiovascular complications to populations that have never experienced such emergencies.
Extreme weather events such as hurricanes, cyclones, floods, and wildfires have also become regular occurrences, along with major droughts in highly populated areas from Africa and Southern Asia to the Southwestern United States. In June 2023, for the first time ever, code “purple” emergencies were declared along the U.S. Eastern seaboard thanks to massive plumes of smoke from late spring wildfires in Canada, with outdoor events cancelled hundreds of miles from the conflagration areas. This impact on humans is nursing’s concern.
Given the nature of their practice, nurses tend to think in terms of systems-oriented solutions, a process that theoretically can lend itself not just to solving the underlying health issues faced by human individuals, but the planet as a whole. “Systems thinking is a hallmark in nursing; it always has been,” observes Schenk. “It is so natural and is part of our solution: being able to really think about health and wellness and delivery of care differently.”
It’s a notion similar to what the late nursing legend Donna Diers, the former dean of Yale University’s nursing school articulated thusly: “caring for the sick, the potentially sick, and the dying and tending the environment in which that care happens.” In effect, the argument goes, what the world needs now are nurses who also think and act like climate activists. One such person is Teddie Potter, a clinical nursing professor at the University of Minnesota. Potter directs the school’s planetary health division, an initiative to mobilize health care professionals to lead the fight against climate change and environmental destruction. The program brings together various disciplines to promote a holistic approach to the underlying issues affecting global health.
“Climate change is just one of the many crises that are hitting us all at the same time,” Potter, who is also a longtime climate activist, says. “A treatment based approached to the problem isn’t going to happen fast enough: this is a systems issue. It’s not just doing additional research into the nature of the problem; it’s looking at how do we develop solutions that will help improve the health of the planet.”
Potter describes the program’s operating vision as seeking to ensure “optimal health and wellbeing for all people on the planet.” In setting up the curriculum, she and her program colleagues reviewed the teaching essentials required for accreditation by the American Association of Colleges of Nursing. “There was only one competency for climate change and one for planetary health [the term for the health of all earth’s systems that support life, including biodiversity and climate], so we added a concept for planetary health,” she says. “We are using that concept to thread content into a curriculum that we will share that with any school that asks us.”
The University of Minnesota is one of 350 universities, nongovernmental organizations and government agencies that make up the Planetary Health Alliance. On July 1, 2023, Potter and other climate activist nurses met in Montreal at the International Council of Nurses, where she helped to lead a symposium on nursing for planetary health and well-being.
“ICN has adopted planetary health as a global concern,” says Potter. “We met with the executive team of the ICN and have been working with a team of nursing experts to teach the international nursing community about how to apply planetary health to research, teaching, policy, and practice.”
NGO public health officials in Kiribati, one of the world’s most vulnerable nations to climate change (WHO).
Also working to organize nurses into an effective environmental activist contingent is Katie Huffling, executive director of the Washington, D.C.-based Alliance of Nurses for Healthy Environments. The organization was created 15 years ago during a meeting of several major U.S. nursing organizations, labor unions and environmental groups.
“So many of the areas that we work on – clean air, clean water, toxic chemicals, household sustainability – those issues are all related to climate change,” Huffling says. “Looking at a hospital, a lot of our nurses are appalled by all the plastic waste, which is made up of petroleum products coming from fossil fuel extraction. So, we are really thinking about our purchasing power as educated consumers in our workplaces.”
Dele Ogunseitan, professor of population health and disease prevention at UCI, is convinced that healthcare professionals are uniquely placed to steer institutions with large carbon footprints to do a better by the planet. Ogunseitan serves as the school’s representative for the University of California Center for Climate, Health, and Equity. The organization is currently working to organize climate ambassadors from all the health sciences schools in the UC system to develop curricula on the topics of climate change and planetary health.
“I think most of the professions, including basic sciences and engineering, have been addressing climate change as an imminent threat for three decades at least,” Ogunseitan says. “The evidence is increasingly overwhelming, and now I think the health sciences in general have a role to play in not only educating the public, but increasingly in responding to climate disasters, including forest fires that cause air pollution and respiratory diseases and for young people mental health issues about a future that may be up in flames.”
Teddie Potter
Every community we care about lives in and is connected to the environment.
Because of the nature of their profession, nurses are perfectly suited to provide the perspective necessary to tackle the interrelated issues of planetary and human health. “I think nursing is in a very unique position to lead this movement,” says Potter. “We have always been systems thinkers: You can’t nurse by just thinking about the minutiae. The patient has a history that comes with them and we nurse in the context that comes with them. Every community we care about lives in and is connected to the environment and we also need to nurse that. Knowledge and leadership, ways of being and thinking are needed now more than ever.”
In her role at Providence, Beth Schenk is supervising a radical campaign announced on Earth Day 2021 to make the hospital chain not just carbon-neutral but carbon-negative by 2030. Providence has pledged to reduce greenhouse emissions by 70 percent and cut in half the volume of waste it sends to hazardous materials and landfill dumpsites by purchasing less single use packaging, while also using recycled water and local food sources to reduce its impact on natural resources.
UCI is also playing a leading role in weaning the U.S. healthcare industry off greenhouse emissions. In 2010, the university joined 150 other campuses, hotel chains and factories to participate in then-President Obama’s Better Building Challenge by pledging to improve its energy efficiency by 20 percent by 2020. “We did it by the end of 2013,” says Wendell Brase, UCI’s Associate Chancellor for Sustainability.
UCI Medical Center has implemented recycling and employee commuter programs to help reduce its carbon footprint, while also investing in energy-saving infrastructure that helps minimize its use of fossil fuels. According to Joe Brothman, director of facilities and general services at UCI Health, all electricity used by the facility is purchased from 100 percent sustainable sources.
Additionally, Brothman says, UCI Health’s newest hospital in Irvine, scheduled to open in 2025, will be even more environmentally friendly. “It will be a fully electric campus, producing all the energy we can on campus through solar, and the rest by purchasing sustainably produced electricity, so that it will be a green facility with no carbon powering its operation.”
All these commitments are positive steps toward reducing the healthcare industry’s negative impact on planetary health. For those seeking to reimagine the way healthcare professionals and nurses in particular can help heal the planet, it’s long overdue. A philosopher turned nurse, Dean Lazenby frames the challenge within a basic recognition of patient earth’s ontological status as a moral entity.
“The planet has a moral status of its own,” Lazenby says. “It is harmed when I do something harmful to it and benefits when I do something good to it. It hurts and regenerates and does all the things that a living, breathing creature does. A lot of working nurses don’t see this concept, and what we want to do for them is make it visible, not just in the curriculum but how we conduct ourselves in our daily lives, in our practice, and in this nursing school building.”
