Operating room (OR) personnel who rethink how they deliver surgical care to focus more on sustainability interventions could substantially reduce hospital costs and decrease their ever-growing carbon footprint, according to a new study published as an "article in press" in the Journal of the American College of Surgeons.

The health care industry accounts for about 10% of all greenhouse gas emissions in the United States, with operating rooms considered to be the main energy consumers and waste producers. ORs can use up to six times more energy than the rest of the hospital and put out more than half of the waste across the hospital.

Recognizing the impact the climate crisis has on public health, the Agency for Healthcare Research and Quality, part of the United States Department of Health and Human Services, released a primer earlier this year to help health care organizations reduce greenhouse gas emissions and protect communities from climate threats.

"Surgeons have an opportunity to really be leaders in this space. Mainly because the single biggest producer of waste is indeed the operating room," said Mehul V. Raval, MD, MS, FACS, study coauthor and pediatric surgeon at the Ann & Robert H. Lurie Children's Hospital, Chicago.

"The opportunity to reduce our carbon footprint falls squarely on us, and I see surgeons taking a prominent role in leading efforts, not just locally with their green implementation teams, but in setting national standards and policies that will move this effort forward for an overall sustainable way of approaching health care delivery."

He explains that the aim of this analysis was to answer the question: which interventions have been most effective at both reducing costs and having a positive environmental impact?

"There's a lot of enthusiasm around this topic, and people are excited to start some of these initiatives at their institution. From making sure that waste is deposited into the proper bins to wider adoption of recycling programs at hospitals, surgeons can start small. If we can come together just to think about what we are using, we can lower the amount of waste that we are producing overall, and reduce our emissions," said Gwyneth A. Sullivan, MD, MS, lead study author and surgical resident at Rush University and a research fellow at Northwestern University Surgical Outcomes & Quality Improvement Center, both in Chicago.

The study design was a retrospective review of 23 studies involving 28 quality improvement initiatives that incorporate what is known as the "triple bottom line" framework into operating room management. This framework considers the combined impact of environmental, financial, and social interventions.

Because sustainability goes beyond just reducing trash and recycling, studies were then categorized by five approaches of sustainability: refuse, reduce, reuse, repurpose, and recycle. The researchers identified peer-reviewed, quality improvement initiatives that both reduced environmental impact of the operating room and cut costs.

Key findings

• The 28 interventions identified involved 11 "refuse" initiatives, eight "reduce" initiatives, three "reuse" initiatives, and six "recycle" initiatives. No interventions were identified in the repurpose category. All quality improvement initiatives reviewed were implemented.
• All interventions demonstrated cost savings. For example, one quality improvement initiative at a hospital saved $2,233 per year by implementing an intervention that transitioned an operating room from a traditional to a waterless surgical scrub (a sterile technique in which clinicians use a waterless surgical scrub formulation to provide a comparable antiseptic effect). The environmental impact of this effort saved the hospital 2.7 million liters of water annually.
• The intervention that showed the greatest cost savings was a simple education initiative: $694,141 was saved annually by educating staff on how to properly consolidate and throw away medical waste, which is more expensive to dispose of than regular trash. The environmental impact amounted to a 30% reduction in medical waste in the hospital.

Other shifts to become greener and trim costs included powering down lights and equipment overnight and decreasing the frequency of washing non-contaminated anesthetic equipment. Over one-third of the studies were identified in the "refuse" category. With this approach, surgical teams use fewer supplies or alternative supplies of a specific item.

Today, surgeons use premade packs of gowns, gloves, and surgical equipment for cases. Interventions in this category included altering practices and removing unnecessary disposable items from premade packs.

"At the end of every day and every case, it's disturbing how many bags of trash we are throwing away, especially with the use of disposables and plastics that we see growing in use as time goes on," Dr. Raval said.

Where to go from here

Researchers also identified specific gaps in the literature that they believe might inspire researchers to conduct future studies. For example, anesthetic gases make up about half of greenhouse gas emissions of operating rooms; studies evaluating interventions that reduce these and other sources of emissions could make a substantial impact. This current outline can be used as a roadmap for surgeons to start implementing some of these interventions and investigating the impact of their greener efforts.

"There is increasing national awareness of the role of the health care system in its contribution to emissions. We need experts in this area to help formulate strategies to reduce emissions from hospitals and the health care system overall," Dr. Sullivan said. "In the future, we hope to see all operating rooms having a green OR team with a sustainability focused group of surgeons, nurses, and anesthesiologists, working alongside the supply chain team, environmental services, and hospital management to make decisions using this multi-faceted approach."

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Historic burning by Native American tribes in the American Southwest shielded landscapes from prior episodes of climate-induced wildfires, a new study has found. 

Deliberate use of fire by Apache, Navajo and Jemez communities between 1500 and 1900 protected large swaths of their desert homelands from destructive climate-induced fires, according to the paper published on Wednesday in Science Advances.

During that period, the Southwest saw patterns of a few years of above-average rainfall followed by a year of significant drought, the scientists found. 

But in areas where local communities practiced regular low-intensity burning, this pattern was largely broken, the study’s authors, from Southern Methodist University, explained in a statement. 

Old trees from regions managed by the Apache, Navajo and Jemez don’t display the characteristic scars from the wet-dry fire cycle of the unmanaged regions, according to the study. 

This strongly suggests that regular low-intensity fires — used by all three groups to aid grazing and hunting — kept away more infrequent and more serious ones, the scientists found.

“What’s remarkable is that this impact of Native American fire management was evident across hundreds of square kilometers,” lead author Christoper Roos said in a statement.  

“That is across entire mountain ranges,” Roos added.

Welcome to Equilibrium, we’re Saul Elbein and Sharon Udasin. Today we’ll check in on the results of the unprecedented West Coast wind energy auction, followed by why some investors want stricter protections for nature. Plus: How shifting to a “circular bioeconomy” could make the plastics sector more sustainable.

West Coast’s first offshore wind sale tops $750M

The first-ever auction for wind development off the country’s Pacific coast concluded on Wednesday — raking in a total of $757.1 million after two days of fierce bidding.  

A milestone moment: The auction, which was the third major offshore lease sale this year, will enable five companies to develop about 4.6 gigawatts of offshore wind capacity, according to the Department of the Interior.  

• That’s enough to power more than 1.5 million homes. 
• The sales mark a significant leap forward in efforts to promote wind energy by President Biden, who set a goal of deploying 30 gigawatts of total offshore wind capacity by 2030.    

Another significant first: The auction was also the first-ever U.S. sale to support the development of commercial-scale floating offshore wind, which is a relatively new technology. 

• The Biden administration has set a goal of deploying 15 gigawatts of floating offshore wind by 2035. 
• Because West Coast waters deepen more quickly than those of the East Coast, using floating infrastructure is more practical than attaching foundations to the seafloor.    

Sustainable future ‘within our grasp’: “Today’s lease sale is further proof that industry momentum — including for floating offshore wind development — is undeniable,” Interior Secretary Deb Haaland said in a statement.  

“A sustainable, clean energy future is within our grasp,” Haaland added. 

Sprawling opportunity: The auction, conducted by the Bureau of Ocean Energy Management, offered five lease areas covering 373,268 total acres off the shores of Northern and Central California.  

The lease sales included multiple credit programs for bidders who pledged to engage in workforce training programs, domestic supply chain development and discussions with impacted communities and tribes. 

North Coast: The winners in the Northern California zones, located off the coast of Eureka: 

• California North Floating, LLC, with the highest bid of $173.8 million, for the 69,031-acre zone OCS-P 0562.   

• RWE Offshore Wind Holdings, LLC, with a bid of $157.7 million for the

  63,338-acre OCS-P 0561.   

Central Coast: The winners in the Central California zones, located off the coast of Morro Bay: 

• Central California Offshore Wind, LLC, at $150.3 million, for the 80,418-acre OCS-P 0564.  

• Invenergy California Offshore LLC , with a bid of $145.3 million, for the

  80,418-acre OCS-P 0565, situated in that same zone. 

• Equinor Wind US, LLC, at $130 million, for the 80,062-acre OCS-P 0563.  

For more on the results of the auction and future of U.S. offshore wind, click here.

VIRTUAL EVENT INVITE

The Hill’s A More Perfect Union 2022 — Dec. 7-9 — Daily programming starts at

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The Hill’s second annual multi-day festival explores and celebrates America’s best big ideas through the lens of American Reinvention. We will convene political leaders, entrepreneurs, policy innovators and disruptors, and thought provocateurs to debate and discuss some of the most urgent, challenging issues of our time. No Labels chief strategist Ryan Clancy, former Rep. David Jolly (R-Fla.), former New Jersey Gov. Christine Todd Whitman, Forward Party co-chair Andrew Yang, American Enterprise Institute CEO Robert Doar and more will join. RSVP now.

Business leaders want clearer COP15 protections

Business leaders and investors are calling for clearer and more stringent regulations around how to treat nature at the U.N. biodiversity summit (COP15) in Montreal.

• Business leaders are pushing representatives at the summit, which started Wednesday, to deliver concrete specifics, including what goals to focus on.
• In particular, investors want more detail on how to mandate risk reporting and how to regulate corporate activity — so that they can avoid moral and financial risks from supply chains that harm nature. 

Target-rich environment: “We want to see a framework that’s really providing clear targets, clear definitions to enable action to be taken,” Tamsin Ballard, of the U.N.-backed Principles for Responsible Investment network, told Reuters. 

That is the first step to implementing “a pipeline of nature-positive projects and investments,” Ballard added.

Top goal: One of COP15’s headline goals is to see the extent of “nature” — which has been in a long period of decline for most of settled human history — begin to increase again by 2030, according to a draft agreement signed in June.

• That will require substantial new sums of money, as well as a recasting of the very idea of what constitutes a financial asset. 
• “Nature needs to be thought of as an asset – and we invest in assets,” Tony Goldner, of the Taskforce on Nature-Related Financial Disclosures, told Reuters.

By the numbers: According to financial news site Morningstar, only $1.6 billion in funds are invested directly into biodiversity and natural capital. 

UNREALISTIC GOALS?

The COP15 headline goals — of reversing nature’s decline by 2030 — may not be realistic, an international group of scientists wrote in in the journal OneEarth. 

• They said that the earliest date possible to reverse biodiversity loss is likely 2050 — a date by which the Montreal conference already expects humans to be living “in harmony” with nature. 
• Even a 2050 target to reverse nature loss is “based on the most simplistic assumptions, it doesn’t even accommodate climate change,” David Obura at Coastal Oceans Research and Development in the Indian Ocean told New Scientist. 

Necessary ambition: But further delaying biodiversity goals simply contributes to risks of world governments “kicking the can down the road in terms of the fundamental systemic change we need,” E.J. Milner-Gulland at the University of Oxford told New Scientist. 

“Even if we can’t make it, we need to start to put serious effort into trying, and I don’t believe that a delayed target will provide the urgency that we need,” Milner-Gulland added. 

To read more about what international business leaders want to see from COP15, please click here.

Blasting BlackRock over ESG ‘hypocrisy’

A leading activist investment firm is calling on BlackRock’s chief executive to resign over his “apparent hypocrisy” in the use of sustainability goals. 

• The chief investment officers of the U.K.-based Bluebell Capital Partners accused CEO Larry Fink in a letter on Tuesday of repeatedly failing to live up to his stated sustainability commitments. 
• Bluebell’s chief investment officers, Giuseppe Bivona and Marco Taricco, slammed BlackRock for increasing its rhetoric around sustainability while continuing to fund fossil fuels.

Bluebell is concerned about “the gap between what BlackRock consistently says on ESG and what they actually do,” Bivona told CNBC, referring to environment, social and governance-focused (ESG) investing. 

“We see BlackRock endorsing a number of bad practices from a governance, social and environmental perspective which is not actually in tune with what they say,” Bivona added. 

Tough timing: The letter comes amid a widespread reaction from U.S. Republicans against ESG investing in general and BlackRock in particular.

To read more about why BlackRock’s attempts to thread the sustainability needle have made both progressives and conservatives unhappy, please click here. 

‘Circular bioeconomy’ could transform plastics sector

The plastics sector’s environmental impacts could be drastically reduced by shifting to a so-called “circular bioeconomy,” a new study has found. 

Becoming a ‘carbon sink’: Such closed-loop systems — fueled by bio-based raw materials — could help transform the industry by allowing it to absorb more carbon than it releases, according the study, published Wednesday in Nature. 

• “They could theoretically act as a medium or long-term carbon sink,” lead author Paul Stegmann wrote in his Utrecht University doctoral thesis, the basis for the Nature article. 
• Thus far, none of the pathways to achieve global climate targets have considered the potential of carbon storage in products, according to Stegmann, who is now at the Netherlands Organization for Applied Scientific Research. 

Enormous emitter: Today’s plastics sector is already responsible for about

4.5 percent of global emissions, while production is expected to triple by 2100, Stegmann and his colleagues warned. 

Circular isn’t enough: Representatives of the plastics industry have long touted the merits of what’s known as a “circular economy.”  

• This is a system in which plastic products retain their value through multiple uses and higher-quality design. 
• But while acknowledging the merits of a circular economy, the study authors argued these efforts would still fail to achieve global climate targets. 

Why existing plans won’t work: By the year 2050, there would not be enough plastic waste available from recycling to meet the growing demand for the material, according to the researchers. 

• In addition, plastic’s capacity for carbon storage would also be underutilized — limiting an opportunity for further emissions reductions. 
• Using bio-based raw materials, however, would maximize this possibility. 

How so? By sequestering carbon within biological materials — or keeping carbon in plastic products for long-term use, Stegmann explained in his thesis. 

Taking such an approach would prevent the release of about 275 gigatons of carbon dioxide —equivalent to nine times current annual energy-related emissions, according to the study. 

To find out how the researchers drew these conclusions, click here for the full story.

Worker Wednesday

Workplace fumes may raise the risk of rheumatoid arthritis, climate risk extends to worker health and a pivotal union election comes to a major electric vehicle (EV) plant.

Inhaling workplace fumes may increase rheumatoid arthritis risk: study 

Probing how climate risk extends to US worker wellbeing 

• A prominent British-American insurance and brokerage advisor, Willis Towers Watson, has expanded its tools for managing climate risks to include U.S. employee health and wellbeing. The tool highlights how social and clinical needs of families may be affected by a changed climate across the country, a statement from the group said.

Ultium workers to vote on a union 

• Workers at a Cleveland-area EV-battery plant began voting on Wednesday over whether to join the United Auto Workers union, Reuters reported. The plant — which is dedicated to producing the standardized Ultium drivetrain — is part of a joint venture between General Motors and LG Energy, according to Reuters.

Please visit The Hill’s Sustainability section online for the web version of this newsletter and more stories. We’ll see you tomorrow.

For the latest news, weather, sports, and streaming video, head to The Hill.

A bill sponsored by Councilman James Gennaro to provide financial assistance to qualified homeowners for the purchase and installation of backwater valves to mitigate flooding was unanimously passed by the City Council on Wednesday, Dec. 7. 

Gennaro is the bill’s first sponsor and Brooklyn Councilman Justin Brannan authored the bill. A total of 18 council members sponsored the legislation ahead of the slated meeting on Dec. 7. The legislation will provide much-needed relief to homeowners across the city, Gennaro said. 

“This is welcome news for my constituents – many of whom repeatedly experience property damage as a result of backflow during heavy rainfall. Backwater valves are a crucial tool to mitigate damage from wastewater backing up into homes,” said Gennaro, chair of the City Council’s Committee on Environmental Protection. 

Brannan said he can’t wait for the program to get up and running and to start making a difference in neighborhoods.

“Government is at its best when it reaches towards big, bold action while, at the same time, sweating the small stuff that makes a difference in the lives of hardworking New Yorkers,” Brannan said. “The idea of making these flooding-protective valves more accessible and affordable for homeowners came as much out of the hyperlocal concerns of my neighbors as it did out of my former citywide role as Waterfronts & Resiliency chair.”

The bill (Intro 0076-2022) requires the city Department of Environmental Protection (DEP), in consultation with other agencies as designated by the mayor, to complete a study that evaluates where backwater valves should be installed to mitigate flooding damage due to extreme weather events. 

A backwater valve is a backflow prevention device used to prevent outbound water through a dwelling’s drain pipes from reentering — ‘back flowing’— into a home. The valve contains a flap that allows water to exit the home, but closes to prevent backflow into the home. 

Data from this study would ultimately determine which homeowners would qualify for the financial assistance program. The study must be completed by Dec. 1, 2024, and the financial assistance program (subject to appropriation) must be set up no later than April 1, 2025.

This bill would also require DEP to prioritize neighborhoods regularly affected by backflow events and conduct outreach and education to property owners about the benefits of backwater valves.

In addition to mitigating damage in homes, backflow prevention devices prevent contaminated water or chemicals from flowing back into the public drinking water supply system. Certain types of properties are legally mandated to install and operate back flow prevention devices. 

For very small buildings (1-story), installation should cost between $3,000 and $5,000. For small buildings (2-story), installation should cost between $3,750 and $5,500. 

For small to midsize buildings (car washes, laundromats, small manufacturers), installation should cost between $5,000 and $7,000. For mid-size buildings (office complexes, large manufacturers or department stores), installation should cost between $7,500 and $13,000. And for large buildings (high rises, hospitals), installation should cost between $14,000 and $34,000.

For Leticia Nogueira, it started with the frogs.

As a grade schooler visiting her grandfather’s farm in her native Brazil, she and her family would stay up listening to the amphibians croak through the night. By the time she was a teenager, those trips to the farm were notable only for their profound silence.

“We couldn’t hear frogs anymore,” said Nogueira, who’s now a researcher with the American Cancer Society. “I would ask around and it seemed that it was a very well known fact that the climate was changing and it was impacting the environment and the living creatures around it.”

So began a lifelong interest in climate change that has, in recent years, taken a twist: Nogueira is part of a cohort of scientists working in behavioral medicine who are urging their peers to study potential linkages between the adverse health effects of climate change and long-standing inequities in patient care driven by factors such as bias, income inequality and structural racism.

Nogueira is aware that those areas of study don’t have a long history of interacting, but she believes that may change once researchers begin to see connections in what at first may appear to be tenuous links.

“More people understand and then they can connect with their lived experiences,” Nogueira said in a recent interview. “Then you can galvanize people to act, which is why I do what I do. I want to walk the talk. So I will show the data because it activates researchers.”

One example of increasing that understanding through data, according to Nogueira, is the study of the lingering effects of redlining—the decades-long practice through which banks denied home loans to Black Americans who lived in certain neighborhoods. Loan officers often identified those communities by marking them off with red lines on their maps.

“Those maps became a clear map of how historical racist practices have long-term effects,” Nogueira said. 

Those effects, she said, include the undervaluing of real estate in Black neighborhoods, racial residential segregation, and disinvestment in infrastructure, including green space, housing stock, road maintenance, transportation services, public education, garbage collection and employment.

Those issues, she said, led to a concentration of psychosocial stressors and created barriers in access to health resources, including increased exposure to alcohol and tobacco outlets and lower access to healthy foods.

That, in turn, led to an increased prevalence of chronic diseases in these communities, she said, including diabetes and cardiovascular diseases.

“Those chronic health conditions can make you just more vulnerable to the threats of climate change,” she said.

Just as one can trace an arc from redlining to chronic disease to climate change vulnerability, Nogueira said that her current research involves exploring links between the effects of climate change and cancer diagnoses.

Nogueria said she was laughed at when she told people she was researching climate change and cancer. But at an annual symposium hosted by the University of Pennsylvania’s Center of Excellence in Environmental Toxicology last month where she presented some of her research examining Hurricane Harvey and the flooding of refineries in Houston, she received applause.

Researchers and community members said the event—called “Climate Change and Human Health”—and symposiums like this one bring people together to sit to discuss the biggest health threat facing humanity, according to the World Health Organization. 

Trevor Penning, director of the center, said that while climate change has established itself as a central aspect of the national conversation about public policy, it is still not adequately discussed as a matter of public health. 

“What is on people’s radar screen is really being looked at from the issue of reducing the carbon footprint, the issues of sustainability, which are all important things,” Penning said. “But the connection between climate change and health is not getting as much publicity as it needs.”

Changing that, Penning said, may require researchers to begin reframing the discussion about climate change from a macro-level conversation about the effects of climate change on the planet, to a more granular examination of how global warming can impact an individual’s physical and emotional health.

That means more scientists investigating how the human body adapts to extreme heat or ways to help people become more resilient to the stress and anxiety caused by natural disasters or the toll of prolonged exposure to carcinogens after flooding.

Penning’s center is housed in the university’s medical school, and that’s no accident. The goal, he and others at the center said, is to bring together experts from across the health sciences.

One colleague, Marylin Howarth, director of community engagement for the center, said she believes it is also critically important to include community voices in this conversation because “we know that not everyone experiences climate change in the same way.”

“The lack of resilience in those communities, financial and otherwise, really puts them at a disadvantage,” Howard said, “and really highlights the need for governmental and other public support to allow them to feel whole in this process as they experience climate change disasters.”

Penning said climate change already affects people who live in the university’s backyard.

“You could say to them, ‘Well, why don’t they just move?’ And it’s not so easy,” he said. “I mean, what value does their property now have?” 

Who is going to buy a home, Penning asked hypothetically, after it has been flooded 10 times? How can one appraise a house located in the middle of a heat island?

“The property values are decreasing in vulnerable populations already and we need to fix their problems for them,” he said.

Meeka Outlaw, an organizer in the South Philadelphia neighborhood of Grays Ferry attending the symposium, said that her neighborhood was forgotten for many years. She cried as she talked about how she would leave the city for trips to the suburbs as a child, and how thick the air seemed when she returned. She would point to the flames and big clouds of steam from the refineries her community was sandwiched between, but her mom was not as excited as she was at the sight. 

She talked about how she has asthma and so do many others in her community. Then there’s the neighbors who have been diagnosed with cancer or died of the disease. 

This past summer Outlaw, who is a teacher and founded her own advocacy organization, took part in an effort to measure heat in urban heat islands.

“Grays Ferry is home,” said Outlaw, whose group is called Residents Organized for Advocacy and Direction. “It’s been my home for 44 years. It’s been the only home I have ever known.

“I don’t know what the pill is to fix it. But something has to be done.”

Three United States lawmakers have introduced legislation that would direct the Environmental Protection Agency (EPA) to report on the energy usage and environmental impact of crypto miners.

In a Dec. 8 announcement, California Representative Jared Huffman and Massachusetts Senator Ed Markey said they were “sounding the alarm” on the energy use from crypto mining in the United States, claiming that Bitcoin (BTC) miners accounted for roughly 1.4% of the country’s electricity consumption. Together with Senator Jeff Merkley, the lawmakers introduced the Crypto-Asset Environmental Transparency Act, which would instruct the EPA to report on mining activity consuming more than five megawatts.

“Granting this industry impunity to inflict such environmental harm runs counter to numerous federal policies, and we need to understand the full harm this industry presents,” said Huffman. “My bill with Senator Markey will require cryptomining facilities to report their carbon dioxide emissions, as well as a detailed interagency study on crypto’s environmental impacts — finally pulling the curtain back on this industry.”

Markey and Huffman cited concerns over climate change as part of their reasons to act expeditiously to regulate the crypto industry. A draft of the bill included claims of “noise and water pollution” caused by miners.

Scott Faber, the Environmental Working Group’s senior vice president for government affairs, voiced support for the legislation, calling proof-of-work cryptocurrencies “wasteful by design” and claiming BTC and other tokens would incentivize miners to use more electricity:

“The recently completed ethereum merge and past code changes show that transformation by the bitcoin community is possible — the way we’ve all adapted to new ways of powering our homes and cars and how we grow our food. [...] Every industry, including the financial sector, can reduce its electricity use and greenhouse gas emissions. Adding more electricity demand – as proof of work mining will ultimately require – sends us in the wrong direction.”

Related: BTC energy use jumps 41% in 12 months, increasing regulatory risks

Despite the Ethereum blockchain transitioning from proof-of-work to the less energy-intensive proof-of-stake in 2022, many U.S. lawmakers have continued to target cryptocurrencies for electricity consumption. In October, Massachusetts Senator Elizabeth Warren joined six other members of Congress in requesting information from the head of the Electric Reliability Council of Texas on the energy usage and potential environmental impact of crypto miners.