A major city vulnerable to climate change is modeling some of the nation's most innovative and ambitious climate and energy resilience plans.

By Kathy Fay Mahdoubi on October 25, 2016

feature2image1As a major center of biomedical research, advanced medicine and academia, some might be concerned to learn Boston is also the fourth-most vulnerable city in the United States in terms of its susceptibility to the adverse impact of climate change, according to the World Bank. Climate change-driven sea level rise, storm surges, extreme precipitation and heat put into sharp relief the region’s need to protect the community sustainably. In response, The Barr Foundation and former Mayor Tom Menino created the Boston Green Ribbon Commission, including 22 hospitals in a Health Care Working Group, to implement some of the nation’s most innovative energy and climate resilience plans.

Three Cases In Point

Boston Medical Center (BMC), the area’s acclaimed safety-net and research hospital, completely redesigned its existing campus and energy systems to improve patient care and resilience. Critical infrastructure elements were moved to higher floors in buildings. A new, islandable combined heat and power (CHP) plant also supports the city of Boston’s nearby emergency telecommunications infrastructure in the event of power outages. BMC’s greenhouse gas emissions will be reduced by more than 50 percent by 2018, saving $8 million to $11 million per year, averaged over 20 years. “Every dollar spent on energy is a dollar not spent on our mission,” said Bob Biggio, the hospital’s vice president of facilities and support services. “[These savings are] really helping us fulfill our mission.”

Another of the city’s most climate-resilient medical facilities is the brand-new Spaulding Rehabilitation Hospital—winner of a 2016 Greenhealth Emerald Award and named 2016 Energy Champion for the American Society of Healthcare Engineers. Spaulding can offer a strong aquatics-based patient rehabilitation program because it is just 91 feet from Boston Harbor, which gives the program open water access. But with 2015 full-moon high tides cresting above parts of Boston’s waterfront, a growing risk from storm surges and a predicted doubling of extreme heat days, the facility’s design had to adapt.

Spaulding’s ground floor was raised. Plantings, walkways and retaining walls in areas patients use for rehabilitation and respite act as a protective “reef.” The thermal envelope was upgraded to increase passive resilience and eliminate perimeter heating and cooling. There are demand-controlled and keyed operable windows. A raised entrance prevents seawater from entering underground parking. All critical systems—with robust redundancy—are located above flood levels, including a large penthouse for mechanicals.

Supporting such efforts, Boston’s innovative Green Ribbon Commission (GRC) is comprised of 34 big-name civic, institutional and business leaders, all of whom work to engage their sector peers and help execute the city’s Climate Action Plan. Its goals are to lower greenhouse gas emissions while preparing for climate change’s many infrastructure, health, economic and social impacts. GRC health care executives sponsor energy and climate work both in their institutions and sectorwide, and help other sectors appreciate the extent to which climate change impacts public health and health care costs. With coordination by Health Care Without Harm (HCWH), the GRC Health Care Working Group provides leadership, coordination and best practices, and tracks important climate and energy public policy.

For example, city officials and the GRC just completed Phase I of what is probably the most detailed urban climate-risk assessment in the United States,, and are discussing options such as flood gates, industrial pumps for subway stations, neighborhood-scale microgrids, expansive water portability in the case of a water main break, and other systems to ensure that patients and health care workers can reach and do well in health care facilities, even during extreme disruptions.

Leveraging Action for Health and Resilience

The Rockefeller Foundation defines energy resilience as “the capacity of an individual, community or institution to dynamically and effectively respond to shifting climate impact circumstances while continuing to function at an acceptable level.” Renowned health care sustainability architect Robin Guenther describes resiliency as a balance between hardening systems to withstand acute shocks and managing chronic stressors such as poverty in the community.

Boston first armed itself against climate change in 2007, following the Climate Protection Agreement and Cities for Climate Protection campaign, with an executive order outlining how the city would go about reducing greenhouse gas emissions by 80 percent by 2050. Since then, new benchmarks have been set every few years. The nearest goal is a 25 percent reduction in greenhouse gas emissions by 2020. At least five major hospitals in Boston will meet or exceed that goal, estimates Bill Ravanesi, senior director of the Health Care Green Building and Energy program for HCWH and co-coordinator of the Health Care Working Group for the GRC, inspiring a friendly competition between health care, higher education and commercial property owners.

Building Without Harm: By The Numbers

Representation from the health care sector is crucial; it’s the city’s largest employer. Nationwide, health care produces as much as 9 percent of all commercial and industrial greenhouse gas emissions. In metro Boston, health care spends more than $200 million per year on energy and is responsible for half-million metric tons of carbon dioxide equivalent emissions annually, from the consumption of more than 7 trillion Btus per year in 22 million square feet of owned buildings. This is according to a recent analysis by the GRC Health Care Working Group and HCWH, which in 2011 began a collective effort to track sector energy and greenhouse gas performance, three years before Boston began requiring energy reporting.

One of the big challenges for Boston health care—renowned for its cutting-edge research—is reducing energy use in laboratories. “Labs are challenging energy hogs, with their high ventilation rates, many fume hoods, extensive freezer farms, equipment density, long hours of use and the fact there is virtually no ENERGY STAR lab equipment available,” said Ravanesi. “However, we’ve done a lot of work with the GRC’s Higher Education Working Group, utilities and hospitals to spread best practices in lab energy efficiency.”

The good news is that sector energy efficiency efforts thus far have reduced greenhouse gas emissions equal to an average passenger vehicle driving 85 million miles. Absolute energy use decreased by 6 percent from 2011 to 2013, and source energy use intensity decreased by 4 percent. These are major accomplishments, considering that demand for energy has increased about 1.5 percent per year in health care historically.

“The challenge for health care facilities is that factors like the aging population and clinical progress are outside their control,” said Paul Lipke, senior advisor of Energy and Buildings for HCWH and co-coordinator of the GRC Health Care Working Group. “You can do great energy efficiency work, but at the same time, your hospital might treat more and sicker patients, add two MRIs, three operating theaters, and thousands of new computers and electronic medical devices that increase your load. If you’ve already done a lot of energy efficiency, it can be a huge accomplishment just to hold energy use flat.”

Climate resiliency is built into the design of Spaulding Rehabilitation Hospital.

Climate resiliency is built into the design of Spaulding Rehabilitation Hospital.

Big-Ticket Items for Cleaner Medicine

Virtually all of the major hospitals in Boston, including Beth Israel Deaconess Medical Center, Boston Children’s Hospital, Dana-Farber Cancer Institute, Tufts Medical Center and Massachusetts General Hospital, either already benefit from or are developing highly efficient CHP systems, many with the ability to keep the facility operating for long periods if/when the grid goes down. CHPs also reduce greenhouse gases and major pollutants, and largely eliminate the significant energy losses that occur between a facility and its energy suppliers.

In addition, climate change and 2008’s spike in energy costs prompted many hospitals to put serious money and time into strategic energy master plans, advancing both energy efficiency and renewable energy purchases. Because Partners Healthcare’s energy costs that year were $20 million above business as usual, “we invested in a Systems Engineering Management Plan (SEMP) with the specific goal of finding out how to meet [climate and greenhouse gas] targets, and also isolate ourselves from fluctuations in the cost of energy,” said John Messervy, corporate director of design and construction.

In implementing its SEMP, Brigham and Women’s Hospital has achieved a 36 percent reduction in greenhouse gas emissions since 2009. On the supply side, “over 60 percent of the power that Partners purchases is now green power—a combination of wind, solar, biogas and low-impact hydro power,” said Messervy. “We’re hoping to have about 20 percent of our total energy consumption being generated by off-site wind, and then our plan is to continue to increase the renewable energy fraction as opportunities present themselves.”

Similarly, the GRC is accelerating renewable energy generation and purchases, especially by big energy users. In June 2016, the GRC sent a large, diverse team to Europe to study leading practices in resilience, especially offshore wind power generation. With Barr Foundation support, the GRC also offered a $100,000 prize (plus technical support) for the institution or institutional collaboration that purchased at least 10 megawatts of renewable energy, with criteria such as physical proximity, replicability and retirement of renewable energy credits. The prize stimulated tremendous activity by many GRC members, and as a result, renewable energy deals totalling about 70 megawatts by health care, commercial and other nonprofit organizations will be signed by late 2016.

Also, in August 2016, Massachusetts Gov. Charlie Baker signed legislation that would make the state a leading source of wind power by requiring solicitation of 15- to 20-year contracts for 1,600 MW of deepwater wind power south of Martha’s Vineyard, and an additional 1,200 MW from other hydro, wind or solar sources. “If we continue to be aggressive, Massachusetts could become an energy exporter within a decade,” said Ravanesi.

One Step at a Time

These and other steps taken by Boston hospitals with the help of the GRC and HCWH are significant when viewed as an indicator of an industrywide shift toward sustainable practices. Still, very difficult work lies ahead. What will be needed in 35 years may be hard to discern, but several things must happen before Boston and Massachusetts can meet their shared 80 percent reduction by the 2050 target, suggested Ravanesi.

First, the state will need to pass recently introduced legislation that allows for a revenue-neutral carbon fee. Second, renewable energy purchasing and generation will have to be adopted by all major energy users. While the 1,600 MW of offshore wind and 1,200 MW of other renewables to be developed are encouraging, they are not enough. “Over the coming decades, the Commonwealth would need to scale deepwater wind, solar, etc. to achieve much higher output,” said Ravanesi.

Other opportunities include deeper energy efficiency in homes and businesses, grid modernization and more aggressive demand-response energy initiatives to shift customer energy usage to off-peak times. The state recently raised its solar net metering cap, which puts a ceiling on hookups and incentives for renewable energy generators, but Ravanesi wonders if outright removal of the cap may be needed to reach the state’s long-term goals. He also spoke plainly about the eventual need for society to largely give up fossil fuels. It may take several decades, but with the help of forward-thinking policies, organizations like the GRC, and the dedication to energy resilience seen from Boston health care and other large institutions, anything is possible.

What We Eat: Food’s Role in Resiliency

The broader definition of resilience is the community’s ability to respond to any threat. That includes the impacts of climate change, but also influences such as gentrification and downward harmonization, which push vulnerable populations and smaller businesses out of the community.

“We are activating hospitals’ role as anchors in the community to not only become energy-efficient, but also restorative in their practices,” said Stacia Clinton, director of HCWH’s Healthy Food in Health Care program. “It’s very important when we are talking about climate preparedness that it is not just focused on energy resilience, but also the many ways people are susceptible, including their housing and access to food and safe water.”

Restorative practices in institutional food procurement programs look at using purchasing dollars wisely by investing at least a percentage of funds into foods that are grown within the community or region. These also involve supporting not only local farms, but also local cooperatives, processing centers and agricultural programs to promote economic growth and development in the community.

A recent meta-analysis of 56 studies investigating the effects of industrial farms on the socioeconomic health and welfare of smaller communities found that, across the board, industrial farming led to several unfortunate outcomes, such as significant income inequality, reduced property values, higher levels of unemployment, and reduced community services and civic engagement. New food procurement campaigns such as Healthy Food in Health Care aim to bring a greater balance between large, midsize and small-scale farms and downstream processors and distributors in order to bolster the community and nourish patient populations at the same time.

“We are building a regional food system that is now less reliant on national suppliers that have to get in and out of the state because we are growing the food locally,” said Clinton.

These campaigns are gaining momentum, but the quantitative impact of local procurement has not yet been fully assessed. Metrics for improvement include job growth, local workman ownership and upticks in sales to suppliers. Such diversified food access is essential to any resiliency plan, not just for the ongoing well-being of a community, but also because a major storm or unforeseen drought could have a devastating effect on local and national food supplies. Smart purchasing by hospitals can also go a long way toward influencing food suppliers to limit food waste and contribute to climate health by reducing chemical inputs such as nitrogen fertilizers and being discerning about how food is transported. —K.F.M.