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For Kathy Regan and Lovisa Gustafsson, leaders at the Commonwealth Fund, improving the sustainability of the health care system in the United States is also key to improving the quality of health care in the country.

The Commonwealth Fund (the Fund) focuses on efforts to make high-quality health care more accessible to everyone, including individuals most affected by the impacts of climate change and those who do not have health insurance. Regan serves as the Fund’s executive vice president and chief operating officer, and Gustafsson is vice president of the foundation’s Controlling Health Care Costs program.

Kathy Regan and Lovisa Gustafsson

“It’s a very inspiring mission that has been relevant through a long stretch of history,” Regan says.

Through their work at the Fund, both women have found immense value in their involvement with the National Academy of Medicine (�������) Action Collaborative on Decarbonizing the US Health Sector (Climate Collaborative). Regan is part of the Climate Collaborative’s health care delivery working group, while Gustafsson serves on the policy, financing, and metrics working group. Regan and Gustafsson each credit their involvement with the Climate Collaborative with having a positive impact on the Fund’s efforts to promote sustainability measures and provide funding opportunities to support decarbonization research.

The Commonwealth Fund’s Role

Regan and Gustafsson gravitated toward the health care field early in their careers and were drawn to the Fund’s mission to advance health for all communities. This emphasis informs the organization’s support for independent research concerning a variety of health care-related topics, including efforts to mitigate the levels of greenhouse gas emissions generated by the US health sector. They say the link between climate change and the US health care system is undeniable.

More people are only now beginning to understand the lagging role that health care has had in addressing carbon’s contributions to climate change.

“We see it more and more in terms of both impacts on people’s lives and health, along with the health system itself and its ability to serve community needs,” Gustafsson says. “We have thought about the different angles we could take within the climate change and health space, and we quickly saw that the decarbonization side was an area that was lacking compared to some other industries. And not only that, but there was also a lack of funders who were doing grant-making in the space. So, that created an opportunity for us.”

“I have actually known about the role of climate change within the health care system for a long time, but it’s really just now starting to take center stage,” Regan adds. “More people are only now beginning to understand the lagging role that health care has had in addressing carbon’s contributions to climate change. And at the Fund, we really see this as being integral to the idea of a high-performance health care system—a system that is equitable while simultaneously taking issues around climate into account.”

Regan adds that the recent COVID-19 pandemic allowed extra financial means for the Fund to look at the climate change problem.

“With all of the challenges we faced during COVID, one of the bright sides was that we actually had extra funding as a result of strong market returns,” she says. “We went through a process of looking at various different ways we could use those funds. The research and building evidence and momentum around addressing health care’s role in climate change—and the opportunity to decarbonize the health care system—were issues we decided to tackle through those means.”

Being Part of the Climate Collaborative Network

This knowledge about the importance of climate issues in health care ultimately drew Regan and Gustafsson to the �������’s Climate Collaborative, which is dedicated to addressing the health sector’s environmental impact while strengthening its sustainability and resilience.

In her role at the Fund, Gustafsson says she and her colleagues have been exploring the different ways Congress can play a role in tackling the ongoing sustainability challenges in the health care field.

“We are looking at independent funding in different spaces,” Gustafsson says. “We’re thinking about, for instance, Medicaid, along with various policy options, both at the federal and state levels, to develop work that is complementary to what we are doing.”

Regan adds that in the Fund, there are three major pillars—policy, practice, and leadership—working together to achieve the organization’s goals.

“We think it is extremely important to participate in both the policy sphere, where Lovisa is participating, and also the practice sphere,” Regan says. “I also happen to be sitting on the Board of Boston Children’s Hospital, which is one of the leading pediatric hospitals in the country, and one that has become heavily involved in the…challenges around decarbonization.”

Regan and Gustafsson agree that the Fund’s connection with the Climate Collaborative has been invaluable and has generated significant results. “It has been such a helpful and wonderful environment to be a part of,” Gustafsson says. “It really is bringing together the leaders from academia, from industry, from health systems across the board, who are working and wanting to solve some of these really important issues.”

As Gustafsson notes, some of the positive developments that have grown out of this relationship have included inviting grantees to present their research, along with identifying areas of research that are in need of additional funding. “It’s been a really, really helpful experience for us, and I think for the field as a whole, to have that kind of safe space to come together to talk about the biggest challenges we’re facing and where we want to go from there,” she says.

Inspired by this affiliation with the Climate Collaborative, the Fund has also moved to incorporate an emphasis on sustainability into some of its core products that routinely reach broad media and policy audiences. Regan notes that one major goal is to make this emphasis well known in the , which measures how states, local communities, and the nation are performing on key health system benchmarks and improvement targets.

“In our next State Scorecard, which is something that we publish on an annual basis, we’re going to be providing a set of planetary health metrics by state,” Regan says. “We think this will start a conversation and discussion around sustainability more broadly, hopefully within a broader group of states, and at least provide some of the basic tools to start to understand what some of the opportunities might be for improvement in that field.”

Through the Fund’s , the foundation is continuing to pursue a path that corresponds with the mission and goals of the Climate Collaborative. As Gustafsson explains, some of the core questions that informed the development of this initiative include: “How can we motivate the health system to take on the commitment to decarbonization? And then once they’ve made that commitment, what are the tools and resources that they need to actually do the work and to be successful?”

Describing this emphasis on motivation, Gustafsson notes the importance of considering questions such as: What are some of the policy levers? What are quality metrics? What is the business case and ROI of doing this work?

“We think that’s a key part of this,” Gustafsson affirms. “Especially as people consider all the various competing priorities that organizations face. Showing that there is a business case and that that really is or can be a key part of getting the internal buy-in from leadership that is necessary to be successful.”

In addition to the work associated with this initiative, the Fund has also funded several projects with a wide range of partners within the Climate Collaborative itself. These projects cover a variety of topics—including research, measurement, and education for clinicians—and also provide funding to organizations working to transform the health sector, some of which include Healthcare Without Harm and the Institute for Healthcare Improvement.

When ������� takes on an issue, as they have in this case, it really does help create a movement and shine a light on some important topics.

As Regan points out, many of the leaders that the Fund supports through its work in this area are active practitioners as well as researchers. “I think the role of folks like us can be to help fund some of their time so they can free themselves up to do the research as well as the actions and activities around what it takes to be successful in decarbonizing,” she explains. “It’s really a very exciting combination.”

Looking Toward the Future

Regan and Gustafsson say there is room for improvement when it comes to the availability of funding opportunities supporting decarbonization research. Still, they are positive about the momentum that has been building recently in this area. “We’ve seen some real progress in a number of different health systems over the past couple years,” Gustafsson notes. Furthermore, she attributes this development not only to an uptick in funding efforts but also to a growing sense of knowledge and awareness about these concerns. “When ������� takes on an issue, as they have in this case, it really does help create a movement and shine a light on some important topics,” she observes. “We’ve seen a lot more people coming to the table—everything from the number of chief sustainability officers that are within health systems to those who are trying out new strategies and efforts to do this work.”

“I think there’s definitely more that could be done if more funders came to the table,” Gustafsson concludes. “But it has been really rewarding to see all the progress that we’ve seen over the past couple years.”

Regan is also optimistic about what the future holds in this respect: “It’s been exciting to see so many involved with ������� and that there’s so much engagement within the health care workforce, and the up-and-coming health care workforce and medical students, residents, and trainees. Not just at the professional physician level, but also more broadly as well.”

“I think it’s really compelling in this time of our evolution in the health care workforce where we’re seeing so many challenges around burnout and retention that this initiative—which I think is a very forward-looking, very encouraging, and very engaging mission—is integrated into the health care system,” Regan adds. “It keeps the critical health care workforce engaged and excited about doing new things, doing them better, and doing them more sustainably.”