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    1 Comment for this article
    Health care should do more
    Frederick Rivara, MD, MPH | University of Washington
    We have all realized that the health care organizations for which we work are large businesses. Should they be treated like other large corporations and follow policies that will protect our environment? If not, why not?
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Public Health
    August 3, 2018

    Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organizations

    Author Affiliations
    • 1World Trade Center Health Program Clinical Center of Excellence, Selikoff Centers for Occupational Health, Division of Preventive Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
    • 2Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
    JAMA Netw Open. 2018;1(4):e180975. doi:10.1001/jamanetworkopen.2018.0975
    Key Points español 中文 (chinese)

    Question  Do large health care organizations participate in the business trend to report on sustainability activities?

    Findings  In this cohort study of 49 large US health care organizations appearing on 2015 or 2016 lists of the largest US corporations (Fortune 500, S&P 500, Forbes 100 Largest Charities, Largest State Employers, and largest health care systems by facilities owned), 50% of Fortune 500, 33% of S&P 500, and 12% of all health care corporations published a sustainability report compared with 78% of Fortune 500 and 82% of S&P 500 corporations.

    Meaning  Sustainability reporting would provide health care organizations with an incentive to quantify and reduce their environmental impact, reduce operating costs, and enhance protection of human health.


    Importance  Sustainability practices by large corporations are increasingly important to reduce the environmental and social impacts of the business enterprise. The health care industry represents 18% of the US economy, employs more people than any other economic sector, and is responsible for 10% of US carbon emissions. The engagement of large health care delivery organizations in reporting sustainability efforts has not been previously assessed.

    Objective  To evaluate sustainability reporting by large US health care delivery organizations compared with reporting trends in all other economic sectors.

    Design, Setting, and Participants  Cohort study of 49 large health care organizations (HCOs) by inclusion on one of the following lists in 2015 or 2016: Fortune 500, S&P (Standard & Poor) 500, Forbes 100 Largest Charities, Becker’s Hospital Review of largest HCOs, and 24/7 Wall St’s largest state employers. Each HCO was analyzed for sustainability reporting by reviewing the main corporate website, Google search, and search of publicly available databases. The percentage of sustainability reporting by HCOs on each list was compared with the percentage of sustainability reporting by all corporations on each list as obtained from public reports and publicly available databases. Data analysis was conducted in January 2018.

    Main Outcomes and Measures  The percentages of large health care corporations and other corporations publicly reporting sustainability information.

    Results  Forty-nine large for-profit and nonprofit US HCOs were analyzed (10 appeared on >1 list but were analyzed only once) appearing on the Fortune 500 (8 [16%]), S&P 500 (3 [6%]), Forbes 100 Largest Charities (8 [16%]), largest state employers (14 [29%]), largest for-profit HCOs (11 [22%]), and largest nonprofit HCOs (17 [35%]) by facilities owned for sustainability reporting. Among them, 4 of 8 (50%) on the Fortune 500, 1 of 3 (33%) on the S&P 500, and 6 of all 49 health care corporations (12%) published a sustainability report compared with 389 of 500 (78%) on the Fortune 500 and 410 of 500 (82%) on the S&P 500 reporting by all economic sectors.

    Conclusions and Relevance  The health care delivery sector lags behind other US economic sectors in sustainability reporting. Publicly reporting sustainability activities would provide HCOs with an incentive to quantify and reduce their environmental impacts, lower costs, and protect human health.