Health, Sustainability, Environmental Justice, and Moving a Health System to Carbon Neutrality

( Dr. Shira Abeles is an Infectious Disease Specialist and Medical Director of Sustainability at UC San Diego Health. Dr Abeles opened with introducing the Environmental Justice Index (EJI). An interactive tool developed by the Centers for Disease Control (CDC) that gives ratings for the cumulative impact of environmental injustice on health for every census tract, The EJI uses data from the U.S. Census Bureau, U.S. Environmental Protection Agency, U.S. Mine Safety and Health Administration, and the CDC. Each census tract is ranked on 36 environmental, social, and health factors.


We continued with an example from our local community: Barrio Logan. An area that is just south of Downtown San Diego and is home to both residential and industrial complexes. The EJI shows scores in comparison to the rest of the United States. For Barrio Logan, the community has a higher proportion of minorities than 89% of other US census tracts, a poverty rate higher than 90%, individuals with a lack of high school diplomas more than 96%, a population that speaks English “less than well” more than 97%. This primary minority community has high levels of diesel pollution from the port, shipyard, and a major highway, with the EJI showing Diesel particulate matter worse than 91% of US census tracts, air toxic cancer risk worse than 90%, and toxic release inventory sites worse than 86%. The EJI shows how this community of primarily low-income, low-education, non-English speaking individuals has been subjected to a, 85-95% higher cancer risk than the rest of the U.S.


It is important to note that this is not for lack of the community attempting to advocate for itself. In 2002, a chrome plating firm was shut down after years of effort when air pollution levels were found to be in toxic levels. The EJI, allows us to put into context the environmental burdens that affect the health of our patients.



You can explore the EJI for your communities online here:


Dr. Abeles then switched gears to discuss the environmental impact of the healthcare industry in the United States. She shared the staggering statistics that the US healthcare system accounts for 8.5% of US greenhouse gas emissions. To put this into perspective, if US health care was a country, would be 13th highest emitter in the world. Further, hospitals general over 29 pounds of waste per bed, per day, with the operating room as a high generator of waste.


By decreasing the negative impact of the healthcare system on the environment, we can improve the health of the public, promote equity, and build resilience for the future. As the Medical Director for Sustainability at UCSD, she explained that there are multiple areas that health systems must focus on to improve sustainability. Seen below, are the areas of focus. image-1.jpg 

Looking towards the future, The Joint Commission (TJC) president and CEO in a recent interview with the New England Journal of Medicine shared plans to “initiate a directional standard that encourages health systems to address reducing their own carbon footprint” as climate change is having a “direct and inequitable effect on the health well-being of people globally.”

Further, the White House launched the Health Sector Climate Pledge with goals to reduce emissions by 50% by 2030 and achieve net zero by 2050, this pledge had over 100 signers, including UC Health.

Lastly, Dr. Abeles stressed that providers should be driving change. This can be done through reducing waste in practices (such as supporting green OR practices and efficiency/prudence with lab and radiologic resources), patient education, clinic/division/department sustainability metrics, and through advocating for sustainability in national conferences and associations.

Presented by: Shira Abeles, MD, Associate Professor of Medicine, Infectious Diseases, Medical Director of Sustainability at UC San Diego Health

Written by: Michelle Leach, MD, PGY3 Urology Resident Physician at UC San Diego, during the 2023 Urology for Social Responsibility Meeting January 14-15, 2023

1. “Environmental Justice Index.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 Aug. 2022,

2. Perlin, J, Lee, T. Conversations, The New England Journal of Medicine. (2022). Health Equity, Environmental Sustainability, Workforce: The Joint Commission's Three Strategic Priorities