The U.S. Department of Health and Human Services has stated it will do all that it can to mitigate the health care industry’s greenhouse gas emissions. The evidence suggests it is climate washing.
Climate washing is defined as a government or business providing inadequate, inaccurate, misleading, or false public information about its climate policy ambitions or implementation efforts to reduce greenhouse gas emissions, especially when the claims are made without independent third-party assurance. More simply, climate washing means simultaneously engaging in positive communications about climate performance and negative climate practices.
According to Columbia Law School’s Climate Change Litigation Databases, the first climate washing cases were filed in 2016, both of them against Exxon Mobile Corporation. Since then, the number of these lawsuits has substantially increased. More than half of the 120 climate washing cases to date were filed over the past two years; 44 of them in the U.S. Of the 60 cases decided through 2023, 42 were in favor of the plaintiffs; 25 of them in the past two years.
Three years ago this month, HHS established the Office of Climate Change and Health Equity (OCCHE). The White House directed HHS via an executive order to create the office because the Biden administration pledged in April 2021 to a 50% to 52% reduction in 2005 levels of greenhouse gas pollution by 2030 to protect public health and advance environmental justice.
In establishing the Office of Climate Change and Health Equity, HHS Secretary Xavier Becerra stated, “the investments we make today to protect health from climate change will pay benefits for generations to come in terms of reducing illness and health care costs. This includes . . . reducing air pollution as we reduce greenhouse gases. The climate crisis is here. The DHHS is rising to meet the challenge.” In response to a reporter’s question, Becerra said, “we’re going to use everything — every tool at our disposal” to reduce or mitigate health care’s greenhouse gas emissions.
Three years later, these comments increasingly look like climate washing.
A stated “priority” of the Office of Climate Change and Health Equity is to support HHS’s regulatory efforts to mitigate health care’s considerable greenhouse gas emissions. At more than 550 million metric tons, U.S. health care annually emits well over four times the cumulative greenhouse gas emissions of Exxon, Marathon Petroleum, Phillips 66, Chevron, and BP.
Yet the Office of Climate Change and Health Equity has done nothing regulatorily, either independently or cooperatively with any other HHS operational division (OCCHE is within the Office of the Assistant Secretary for Health), to mitigate health care emissions, even though it co-chairs, with the National Academy of Medicine, an action collaborative to decarbonize health care that was launched in September 2021. This failure is likely due in large part to the fact Becerra has never argued for funding for the office in congressional budget testimony over the past three years.
The Office of Climate Change and Health Equity has instead been largely focused on attempting to build climate resilience, a strategy HHS outlines in its 2021 “Climate Action Plan” and its 2023 follow-up “Climate Change and Health Strategy Supplement” report.
As opposed to solving the problem or mitigating carbon emissions, climate resilience or adaptation assumes climate breakdown is unavoidable, a fait accompli. Resilience preaches accommodating or adjusting to endless climate disasters and is “almost always about how the poor must adapt,” Joel Wainwright and Geoff Mann argued in their book “Climate Leviathan.” HHS’s resilience policy is made evident in the Office of Climate Change and Health Equity’s effort over the past two years publishing a monthly climate and health outlook report that simply warns the public of upcoming climate-charged disasters.
Housed within the unfunded OCCHE is the Office of Environmental Justice. It was created in May 2022 and dedicated to protecting the health of disadvantaged and vulnerable populations disproportionately harmed by environmental hazards. A priority of the office is to support the Biden administration’s Justice40 program, which was designed to allocate 40% of climate-related federal funds to communities overburdened by environmental pollution. The Office of Environmental Justice, however, has done nothing about mitigating health care’s greenhouse emissions. This is particularly disappointing since none of HHS’s 13 Justice40 programs to date work to reduce industry emissions.
HHS has stated repeatedly that it strives for health equity that is “inextricably linked to environmental justice,” yet its just-published environmental justice scorecard has nothing to say about mitigating health care’s greenhouse gas emissions.
Under the OCCHE, Becerra announced in 2022 a voluntary climate pledge in which health care organizations promise to meet the Biden administration’s commitment to reduce greenhouse gas emissions by 50%. The pledge defines greenwashing. Pledgees are not required to use sustainability accounting practices such as the Greenhouse Gas Protocol. They are not required to use the Environmental Protection Agency’s Energy Star Portfolio Manager program that in part measures greenhouse emissions, nor are they required to publicly report any progress. There is no enforcement whatsoever.
HHS’s 2022-2026 strategic plan includes Strategic Objective 2.4. It states that HHS “invests in strategies to mitigate the impacts of environmental factors including climate change on health outcomes.” Among other strategies identified to accomplish this objective is the use of HHS “tools” to “mitigate . . . climate change impacts” and implement “efforts between public and private health care system stakeholders to make health care more environmentally sustainable.” My review of HHS’s FY 2023, FY 2024, and FY 2025 annual performance reports shows the department has made no measurable progress in meeting this objective.
The Centers for Medicare and Medicaid Services, which are responsible for regulating Medicare and Medicaid, is among the operational divisions in HHS assigned to meet Objective 2.4. CMS has never promulgated Medicare or Medicaid regulations that would require and/or financially incentivize health care providers, largely hospitals, to mitigate their greenhouse gas emissions. That’s a missed opportunity, because of the approximately 3,500 hospitals that participate in the Environmental Protection Agency’s Energy Star program, which allows participants to measure their energy consumption, only 37 (1%) were Energy Star certified last year for energy efficiency.
CMS has also never offered any discussion about mitigating Medicare and Medicaid’s greenhouse gas emissions in its strategic framework, national quality strategy, health equity framework, and the CMS Innovation Center’s strategic vision and priorities.
In the just-published in-patient hospital rule, CMS finalized a policy that allows a small number of hospitals selected to participate in a five-year Medicare demonstration to voluntarily report to HHS their greenhouse gas emissions. But since any hospital can do this at any time, the proposed policy constitutes a regulatory illusion intended to accomplish nothing.
CMS, or HHS more broadly, have yet to publicly recognize a White House September 2023 fact sheet that directed the federal Office of Management and Budget to create a baseline social cost of federal programs’ greenhouse gas emissions, for example, Medicare and Medicaid. Roughly calculated, the social costs of health care’s greenhouse gas emissions are as high as $3.6 trillion annually. HHS has also failed to publicly comment about the federal Security and Exchange Commission’s climate disclosure rule finalized this past March — the EPA and others have commented — even though the highly leveraged health care industry faces significant climate-related financial risk exposure.
HHS’s failure to protect Americans’ health from climate breakdown over the past three years amounts to climate washing. The department has not used any tool in its toolbox, certainly not any regulatory tools, to meet the climate crisis. Its failure is particularly odious because HHS effectively regulates a $4.9 trillion market that accounts for over half of annual global health care spending.
Because global warming is proportional to cumulative greenhouse gas emissions, and emissions from the U.S. substantially exceed those of any other nation, the U.S. government, particularly HHS, has an outsized responsibility to end its dependence on fossil fuels. This is true particularly if HHS cares about intergenerational justice. As Thomas Jefferson wrote to James Madison in 1789, “the earth belongs in usufruct to the living.”
David Introcaso, Ph.D., is a Washington, D.C.-based health care research and policy consultant whose work largely focuses on the climate crisis.
