ACR Bulletin

Covering topics relevant to the practice of radiology

The Essential Role ESG Plays in a Healthy Future

Radiologists need to rethink the specialty's approach to environmental, social and governance issues to help foster planetary health. 
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November 01, 2023

During the COVID-19 pandemic, supply chain and staff shortages emerged worldwide, placing unforeseen stresses on the healthcare sector. Most recently, the iodinated contrast shortage forced many institutions to conserve their supplies while continuing clinical services. Many institutions met this challenge by reducing the dose and switching to multi-use vials to mitigate disruption to clinical services. 

These are two of many examples where natural disasters and pandemics disrupted supply chains and impacted the delivery of medical care. As we look ahead to the emerging threat of climate change on our planet and its impact on human health, radiologists must proactively develop action plans to reduce waste and healthcare’s contribution to carbon emissions — the direct causes of climate change.

Many industries outside of healthcare have created sustainability teams in the past few decades to diversify supply chains, reduce waste and decarbonize their business, and to report these metrics to their employees and investors. These sustainability efforts are referred to as environmental, social and governance (ESG). ESG programs improve employee retention and recruitment, reduce operating costs and improve the overall health of the organization. More than 90% of S&P 500 companies now publish ESG reports in some form, and surveys have found that over 70% of S&P 500 companies tie executive compensation to ESG performance. 

Furthermore, new rules have been proposed by the U.S. Securities and Exchange Commission (SEC) that would require detailed disclosure of climate-related risks and greenhouse gas (GHG) emissions. While these SEC requirements are still up for public comment, they will likely result in cascading events that will affect private and public companies, including those in the healthcare sector. Government regulations and societal need for addressing climate change will inevitably dictate that healthcare, both academic and private, participate in ESG reporting and meet benchmarks.

As we look ahead to the emerging threat of climate change on our planet and its impact on human health, radiologists must proactively develop action plans to reduce waste and healthcare's contribution to carbon emissions — the direct causes of climate change.

—Cameron E. Henry, MD

Healthcare is fundamentally grounded in social concepts such as beneficence, non-maleficence, autonomy and justice. In the United States, we apply these concepts to individual health and often ignore the impact of our decisions on overall population and environmental health, or planetary health. 

Planetary health includes addressing the upstream social and environmental determinants of disease that cause or increase morbidity. As an example of how separating individual health from planetary health worsens health outcomes, consider that healthcare produces 8.5% of the carbon emissions in the U.S. Carbon emissions directly decrease cardiopulmonary health (such as increased asthma, cardiovascular disease and lung cancer) among many other diseases.

Patients with asthma seek medical treatment to relieve their symptoms and receive several tests to monitor their disease. In addition to missing work or school to receive their medical care and recover from their symptoms, they also are more likely to succumb to respiratory infections. Yet, we return them to the environment that causes and exacerbates the disease. All of this care contributes to carbon emissions and waste, and it further drives up healthcare costs. This cycle should cause us to rethink our strategy for healthcare delivery to include planetary health.

The disproportionate impact of the COVID-19 pandemic on racial minorities illustrates the importance of the environmental and social pillars of ESG on health. Similarly, our vulnerable populations are disproportionately affected by the diseases related to climate change. In addition, by reducing waste — for example, reducing unnecessary imaging and reducing scan times — we are increasing access because facilities could use those appointment slots to include more patients in need. Therefore, transparent ESG efforts and reporting simultaneously addresses both climate change and health equity.  

The final pillar of ESG is governance. Radiologists are central to the delivery of healthcare. We are in a unique position to lead these efforts. ESG improves retention and recruitment of employees and reduces costs, so it is essential for organizations to initiate ESG programs.

To that end, Vanderbilt University Medical Center (VUMC) has established a Planetary Health Action Group to address the impact of healthcare on the environment and population health. We will seek to implement strategies from outside the healthcare sector to decarbonize our department and train the next generation of radiologists to think from a planetary health perspective.  

The Planetary Health Action Group will use the Plan-Do-Study-Act (iterative design approach in our work to move beyond pledges and promises that often prevent action and progress. To promote transparent dialogue on our efforts, we will publish our work in journals and on our group’s website. We will also share resources and experiences we’ve accumulated with other institutions interested in delivering responsible health care. 

We aim to make ESG efforts and reporting standard practice, similar to quality improvement initiatives, with the addition of transparency and accountability. Our lives depend on it.

Author By Cameron E. Henry, MD, a chest/cardiovascular imaging fellow at Vanderbilt University Medical Center; Reed A. Omary, MD, MS, a professor of radiology and radiological sciences and a professor of biomedical engineering at Vanderbilt University Medical Center; and John R. Scheel, MD, PhD, MPH, a professor of radiology and radiological sciences and the vice chair global health and sustainability at Vanderbilt University Medical Center