I remember the moment the room changed.

I was sitting at a board table, going through the usual agenda. Quality. Safety. Workforce. Capital. Supply chain. Then someone raised a question about extreme weather and the strain it was putting on operations. There was a pause. A little shifting in chairs. A few skeptical looks.

Then the data went up on the screen.

Higher heating and cooling costs. More disruption risk from flooding. More missed appointments and delayed procedures when storms hit. More respiratory visits when smoke settled in. Even shifting patterns of pathogens that changed what clinicians were seeing and treating.

The surprise in the room was real. So was the recognition. This was not a side conversation anymore.

Former FDA Commissioner Dr. Mark McClellan moderates a discussion on healthcare and climate risk with National Academy of Medicine President Dr. Victor Dzau, former U.S. Senate Majority Leader Dr. Bill Frist, and CEO of the Joint Commission, Dr. Jon Perlin. The group was addressing medical and business students at Duke University in the fall of 2025.

Bill Frist, MD

Over the past five years, I have watched a remarkable shift in how health care leadership, at the board level and the management level, is approaching the environmental impact of a warming climate and the operational reality of more frequent, more intense weather disruptions. Awareness became attention. Attention became responsibility.

Not because someone gave a better speech. Not because a new term caught on.

It changed because leaders began to feel it in the work itself. In staffing. In budgets. In patient flow. In the daily math of keeping the doors open. When extreme heat drives up emergency visits, when wildfire smoke worsens respiratory illness, when storms disrupt power and supply deliveries, the conversation stops being theoretical. It becomes about whether you can deliver timely, affordable, high-quality care when conditions are unstable.

I have seen this change play out across multiple boards, in both public and private organizations. Climate-related risk is now being discussed alongside patient safety, enterprise risk, supply chain reliability, and financial stewardship. In other words, it is moving into the category of issues boards are expected to anticipate, manage, and govern.

This is not political. It is operational. It is fiduciary. It is mission critical.

And once leaders accept that, the next question is refreshingly practical. What do we do about it, and how do we do it in a way that is measurable, scalable, and aligned across a complicated system?

A new set of expectations, inside and outside health care

What helped accelerate the shift was a growing set of real-world expectations that made leadership responsibilities explicit. We have seen that guidance come externally from government and internally from the private sector.

One example was the US Department of Health and Human Services Health Sector Climate Pledge, offered from 2022 to 2024. It asked organizations to commit to clear targets, publicly report progress, name an executive lead, complete a supply chain emissions inventory on a defined timeline, and build a resilience plan for continuous operations.

Those are not vague aspirations. That is governance language.

While that pledge has not continued under President Trump, it still set in motion changes at the organizations that signed on. As of April 2024, 139 organizations representing 943 hospitals had joined. Many of those commitments became internal habits that do not simply disappear when a program changes.

You can see it in the practical steps some systems took. Penn Medicine, for example, worked to phase out desflurane, an anesthetic gas that remains in the atmosphere for 14 years. It also reprocessed certain single use devices and diverted more than 10 tons of waste from landfills in 2023 alone. Those are concrete operational choices. They reduce emissions, reduce waste, and in some cases reduce cost. They also reinforce a simple idea clinicians understand instinctively.

Do no harm.

A National Academy of Medicine discussion paper published in late 2024 made a related point that resonates with anyone who has tried to lead change in a complex system: “as an increasing proportion of the nation’s health care system gains knowledge and experience in tracking its [greenhouse gas] emissions, its ability to take actions to reduce them will also grow.” The increase in knowledge and experience will then spread to parts of the sector that have not yet started.

That is how change scales. Not by perfection on day one. By learning, measuring, and improving.

When quality institutions raise the bar, boards pay attention

At the same time, accountability began to show up through institutions that shape how hospitals define quality and credibility.

The Joint Commission’s Sustainable Healthcare Certification did something important for leaders who are trying to move from intention to action. Announced in September 2023 and effective January 1, 2024, it created a framework with structure, rigor, and public recognition. It stated plainly that it is designed to help hospitals begin, continue, or expand their decarbonization efforts.

The moment a highly trusted accrediting body puts a framework on the table, the conversation changes in the boardroom and the C-suite. It becomes less about whether this belongs in strategy and more about how quickly you can build the internal capabilities to do it well.

I have spoken with Joint Commission leadership about this directly. The level of interest has been significant, from both domestic and international health systems. That is a signal. When the world of quality measurement starts to treat climate readiness as part of modern health care excellence, the issue stops being optional.

The role of the National Academy of Medicine

This is where the National Academy of Medicine can play a unique role.

The NAM is a private, independent, nonprofit academy that convenes experts and leaders to provide objective guidance and trusted leadership on health, medicine, and policy. In a moment when climate has become politically noisy, that kind of trusted convening is not a luxury. It is an operating necessity.

During the NAM’s 50th Anniversary “Big Idea” initiative (2018–2019), it became clear that the “health of the planet” had become a systems-level issue connected to community resilience, scalable innovation, and long-term sustainability, and there was a growing field of committed leaders across disciplines looking to engage.

In October 2020, NAM president Dr. Victor Dzau formally launched the Climate Grand Challenge: a multi-year global initiative that’s among the most ambitious the Academy has ever embarked. Its aim is straightforward and urgent: protect human health and well-being by transforming the systems that both contribute to climate change and are impacted by it.

Launched within this broader climate and health work was the Climate Collaborative, a public private partnership and neutral platform convened by the NAM. It brings together leaders across the health system to align on shared goals and practical actions that lower health care’s environmental impact while strengthening sustainability and resilience.

For the past two years, I have had the privilege of co-chairing the Climate Collaborative with former Cardinal Health CEO George Barrett and Dr. Dzau. Together, we have helped formalize a rigorous process for producing evidence-based resources for health organizations that want to respond to and prepare for extreme weather and climate-related disruption.

In my view, the Collaborative serves as a bridge between what I have seen in boardrooms and what teams need on the ground. It links leadership responsibility with execution.

Even in the constraints of the current environment, steady progress has continued, which NAM recently detailed in a new report.

During Phase 1 alone, the Collaborative brought together over 100 leaders, engaged more than 85 organizations, and produced more than 30 resources for the field. In a sector as fragmented as health care, no single system can solve measurement, supply chain alignment, clinical practice change, and financing on its own.

You need a shared place to align, learn quickly, and move together.

Tools that make progress real

The most important work is often not flashy. It is the work that removes friction.

One major barrier leaders face is the lack of standardization. If every health system asks suppliers different sustainability questions, suppliers drown in reporting and buyers cannot compare apples to apples. That slows everyone down.

That is why the Health Sector Climate Action Survey matters. It creates a shared baseline for how suppliers report climate and sustainability information. It is not glamorous. It is high leverage infrastructure. It helps turn good intentions into consistent practice, especially in the supply chain where so much of health care’s footprint resides.

The Collaborative has also produced practical roadmaps that help organizations move step by step.

The Climate Journey Map is one example. It meets organizations where they are and helps them progress from getting started, to measuring, to sustained improvement. It also makes it easier to see the connection between clinical care, operations, purchasing, and resilience.

The Key Actions resources are another. They translate broad goals into practical levers clinical leaders recognize and can quickly incorporate into their own medical practices and care decisions. Building energy use. Anesthetic gases. Inhalers. Waste and single use plastics. Food services. Transportation. These are real decisions. They affect cost. They affect continuity of operations. They affect health.

And when clinicians see that their daily choices can protect patients while lowering emissions, the work becomes personal. Because it is personal.

The moment leadership becomes responsibility

I have also seen how this plays out inside organizations once the board begins to ask the right questions.

In one company, after some early resistance even to discuss climate stress, we discovered that material aspects of the business were being seriously and expensively affected. Higher energy costs. Greater flood risk. Disrupted clinical care. More strain on vulnerable patients. New infrastructure expenses that nobody had anticipated.

When the board and senior management saw the full picture, they were surprised by the magnitude. Then came the realization.

This is part of our fiduciary responsibility.

That is the shift I have been describing. The intersection of climate and health is moving from being an important issue to being a strategic leadership responsibility. Not because it is fashionable. Because it is unavoidable.

What comes next

The politicization of climate over the past two decades has caused shifts and rollbacks in federal guidance. That is the reality.

But the private sector, supported by trusted and nonpartisan institutions like the NAM, has an opportunity to lead with the health of people and the planet at the center.

We need to keep going because climate related disruptions are already affecting patient care and community health. And because the health care sector has a responsibility to reduce avoidable pollution and waste. To do no harm.

The next two to five years are about making climate-smart health care the default. Cleaner operations. More resilient facilities and supply chains. Practical changes in clinical practice that protect patients while lowering emissions.

As the NAM Climate Grand Challenge and Climate Collaborative move into its next phase, we are poised to scale what works. Spread common tools. Normalize transparency. Help leaders align across health systems, suppliers, clinicians, and policymakers so barriers to action are lowered and progress is measurable and durable.

This is a moment for steady leadership. The kind that boards understand. The kind that clinicians respect. The kind that patients deserve.

We know what is coming. The question is whether we will meet it with preparation and responsibility.

We should.

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Author’s Note:

As a physician, I have spent much of my career studying human health. Increasingly, I have come to believe that understanding, and protecting, the health of the planet is inseparable from protecting our own.