Do No (Environmental) Harm: Q&A with Gregg Furie, MD

Do No (Environmental) Harm: Q&A with Gregg Furie, MD

Medical Director for Climate and Sustainability Gregg Furie, MD, MHS

This spring, the Brigham announced the creation of a new position: Medical Director for Climate and Sustainability. Gregg Furie, MD, MHS, took up the mantle and has been working to further climate change and sustainability education and curricular development within the institution, clinical practice interventions to increase sustainability, and the long-term development of climate champions across the Brigham. Furie is also a Brigham primary care physician and a member of the Mass General Brigham Sustainability Committee, a founding member of the Brigham Sustainability Working Group, and a member of the Brigham Climate Action Council.
Furie sat down with Clinical & Research News to discuss his new role, the impact of climate change on human health and what health care systems can do to address their contributions to the climate crisis.

Can you tell us about your new role as medical director of climate and sustainability?

GF: This position was established to address fundamental issues within health care related to climate change and sustainability. Climate change is felt by many to be one of the greatest public health crises of our time, if not ever. We’re already seeing effects on our patients and we need to be prepared to provide appropriate care. So part of the role is focused on trying to help clinicians adapt their clinical practices to address current and emerging health impacts from climate change. We also know that the health care sector is a major contributor to a broad variety of adverse environmental impacts, including climate change. In fact, the U.S. health care sector produces nearly 9 percent of total U.S. greenhouse gas emissions. So, the role is also focused on finding ways to reduce our environmental impact, with a specific emphasis on clinical operations.

Why should health care systems invest in sustainability?

GF: There are many reasons for health care systems to invest in sustainability. First and foremost, it’s consistent with our mission and values. In our efforts to promote wellness and health, we’re actually adversely affecting human health via the impacts of our clinical operations on the environment and climate. And furthermore, those impacts on human health are disproportionately affecting disadvantaged and vulnerable populations. So it’s a moral issue. We need to find ways to continue to provide outstanding clinical care while minimizing deleterious effects on the environment. But investments in sustainability have other benefits as well, from enhancing health care system resiliency, to cost savings, to promoting staff engagement.

Can you tell us more about what’s happening here at the Brigham?

GF: There is quite a lot happening at the Brigham right now, although there is no shortage of work to be done at all scales across the institution. One of the most exciting projects we are working on is preparing for a comprehensive environmental assessment that will quantify the total greenhouse gas emissions associated with our operations, from the production of the electricity and steam we consume, to the energy used in the production and distribution of the products we purchase, to the disposal of the massive amount of waste we produce, to the energy consumed in staff and patient travel. This will serve as a starting point for understanding where we can make the greatest impacts.

We know from studies of other health care systems that approximately 80 percent of greenhouse gas emissions are associated with our supply chain. So, we’re exploring how, as an institution, we can leverage our position as a purchaser to influence our suppliers to enhance the environmental performance of their operations and products. This work builds on that of the EcoGreen Team at the Brigham, which for many years has been focused on enhancing environmental performance through our purchasing decisions.

At the level of clinical operations, there are ongoing projects in anesthesia to minimize use of anesthetic agents that are potent greenhouse gases with far greater heat trapping potential than carbon dioxide. And one of the surgical residents is leading an intervention to reduce regulated medical waste (red bag waste) in the operating rooms. We’re currently developing mechanisms to encourage similar innovative approaches to reducing the environmental impact of clinical care.

Much of our work is focused on education and engagement. We’ve hosted a series of grand rounds within various divisions in the Department of Medicine to raise awareness of these issues and identify individuals interested in partnering with us in this work. We’re expanding this to other departments in the hospital, both clinical and non-clinical.

A group of internal medicine residents has been working to develop a curriculum focused on climate change and health that we hope can serve as template for parallel efforts in other departments and a model for resident education on climate and health at other institutions.

Who do you work with at the Brigham on these projects?

GF: At the Brigham, I work closely with the Brigham Climate Action Council, which is co-chaired by Bernard “Bernie” Jones, EdM, vice president of Public Policy, and Douglas Carney, AIA, MBA, senior vice president of Real Estate, Facilities, and Operations. The Climate Action Council is tasked with coordinating our strategy and efforts around addressing climate change and sustainability. Recognizing that this is a cross-cutting issue that touches all parts of the institution, the council consists of representatives from across hospital leadership, including facilities and operations, research, education, community health, Diversity, Equity and Inclusion as well as clinician representation.

I also work with a small group of clinicians, both attendings and residents, called the Brigham Sustainability Working Group that formed organically as a number of us sought ways to use our voice as physicians to effect change within the institution in order to address the climate crisis. And the more we go out and talk to people about it, the more we discover there is tremendous interest in these issues. We’re trying to identify people and engage them in this work, because it’s really going to be about shifting the culture and the way people think about clinical care and how we should be responsible for the environmental impacts of what we’re doing in clinical medicine. We’re interested in working with anyone in the institution who shares our commitment to enhancing sustainability and addressing the impacts of climate change on the populations we care for.
Beyond the Brigham, we work closely with our counterparts at MGH, which recently established the Center for the Environment and Health. In fact, much of the work I mentioned above is being done in coordination with that group and others at the Mass General Brigham level as we recognize these issues are not unique to the Brigham.

Can you tell us more about your background and your interest in this area? How did you come to be where you are today?

GF: I’ve always been interested in the environment and, since studying ecology in college, associations with human health. In residency, I became interested in climate change and its health impacts as well as ways in which certain interventions to promote health can also have positive effects on the environment, so called co-benefits. I knew that I wanted to focus my energy in this area, so as a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program I worked on a number of projects at the intersection of climate change, human health, and sustainability. When I moved back to Boston, I sought out opportunities to engage in these issues at the Brigham and was fortunate to connect with a group of likeminded colleagues who are committed to effecting change within the institution and beyond.

Do you see the impact of climate change on your patients’ lives?

GF: I do and there are many. As an example, we know that climate change is having an impact on the production of environmental allergens. With warming temperatures, pollen season starts earlier and ends later and pollen counts are higher. So we’re seeing people with more severe allergy symptoms and across a longer season. That also has relevance for my patients with pulmonary diseases like asthma, which can be triggered by environmental allergens.

But my clinical work also reminds me that intersections between climate and health are varied and broad. For example, I have a patient from Puerto Rico who requires dialysis three times per week. He was forced to move to Boston after hurricane Maria because, with the prolonged power outage, he wasn’t able to receive dialysis. As extreme weather events become more frequent and severe, I suspect these types of situations will become more common and the indirect consequences of climate change on our patients’ health will become only more pronounced.

Given the magnitude of the climate crisis, how do you remain optimistic?

GF: As with all large, existential threats, it can be challenging. However, I think we’re seeing reason for hope in a number of ways. One is that we’re seeing a sea change in people’s attitude about climate change, particularly as the effects are felt more locally. Even in the past year or so when people have been appropriately distracted by COVID, we’ve seen rapidly growing interest in sustainability and efforts to address climate change at the corporate level. We now have an administration that takes the science seriously and has signaled a commitment to addressing the problem with the gravity it deserves. And there are technological advancements that permit renewable energy to compete with fossil fuels, the primary source of global greenhouse gas emissions.

Within health care, it’s similar. People are so much more aware of this issue than they were even five years ago. The number of health care systems that are beginning to take on sustainability as a core part of their mission is growing rapidly. And I think we’re quickly identifying tangible opportunities to reduce our impact. So I think there’s hope because we know there are interventions that we can make that will begin to address the problem – and hospital staff and institutional leaders can really make a difference.

Are you seeing that happening here?

GF: Yes — the Brigham and MGH, and Mass General Brigham in general, have, to their credit, been progressive in this field. There’s still much work to be done, but they have been at the forefront of the health care sustainability movement for a while. And we’re seeing real enthusiasm among staff and trainees as well. So we have momentum. Our task is to harness that energy to drive change within our own institution and use our position as a leader in the health sector to pave the way for other health care systems going forward.

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