Outline

2. Outline Presentation goals: • Why Kaiser Permanente and other health care organizations have global warming concerns • Understand health care’s climate footprint • Review Kaiser Permanente’s climate action plan • What have we done? • What are we working on? • How does this tie in to your work?

3. Kaiser Permanente’s Evolving Role as a Total Health Organization Do Good Things Make an Impact Be Accountable for All Our Impacts Ensure access to high quality care and coverage Address the conditions of health in the physical, social, natural environment Understand our ecological and economic footprint, and their impact on community health; act accordingly; set a good example

4. Kaiser Permanente’s Environmental Stewardship Council Our Environmental Stewardship Council has identified the following four environmental focus areas to guide our work: Climate Action Safe Chemicals Sustainable Food Waste Reduction

5. Organizational Guideline on Climate Action Kaiser Permanente will: • Understand climate change • Assess climate-related impacts • Commit to continuous improvement • Take practical actions to limit emissions of carbon dioxide and other greenhouse gases • Help reduce the carbon footprint of the communities we serve by supporting: a) appropriate land-use and transportation decisions b) development of appropriate local food systems • Support industry standards • Inform public policy

6. Effects of Climate Change Climate change is causing health effects that potentially impact Kaiser Permanente’s ability to fulfill our promise of quality, affordable health care • Global climate instability increases the demand for health care • Cost of energy and water likely to continue increasing while supplies diminish • Threats to forests and biodiversity threaten availability of potential cures for diseases

7. Health Effects of Climate Change A few examples: • ↑ Temperature + ↑ UV radiation + primary emissions = ↑secondary air pollutants (ground-level ozone, particulates) • ↑ extreme heat episodes = ↑ electric power use = ↑ emissions & pollutant formation • ↑ Temperatures + ↑ CO2 = ↑ Ragweed in urban locations = ↑ risk of asthma & allergy • ↑ Biomass + more arid conditions = ↑ risk of wildfires = ↑ risk of injury & ↑ air pollution Source: CA Department of Public Health

8. Kaiser Permanente’s Greenhouse Gas Inventory

9. Kaiser Permanente’s Greenhouse Gas Emissions Trend New construction and increased energy use associated with electronic medical records are two key reasons why our combined CO2 emissions from use of electricity and natural gas grew by more than 10% between 2005 and 2007:

10. Kaiser Permanente’s Greenhouse Gas Emissions Trend Energy efficiency initiatives for building systems and electronic equipment have helped to decrease our emissions intensity per square foot since 2006: National average for all hospitals = >30 lbs/sqft Source: DOE (2003 CBECS) “Above The Line” sqft = Medical Services, Hospital Services, Outpatient Pharmacy, Optical, Other Benefits, & Health Plan Admin “Below the Line” sqft = Regional Admin, Property Management, Program Offices, Parking, & Vacant/Under Construction

11. Energy-based Climate Action Strategy Harvard University’s campus GHG reduction plan Source: Harvard University

12. Broad-based Climate Action Strategy Breakdown of NHS England 2004 Emissions Source: NHS England Carbon Emissions: http://www.sdu.nhs.uk/page.php?page_id=93

13. Broad-based Climate Action Strategy

14. Organization-wide Risk Assessment To Determine the Most Significant Contributors to Global Warming Excerpt from risk assessment

15. Goals Based on Risk Assessment and Overall Priorities of the Organization Kaiser Permanente is linking its Sustainable Energy Strategy with its Climate Action Plan to pursue GHG emissions reductions through organization-wide activities in the areas of: • Benchmarking • Building systems • Efficient delivery of care and service • Plug loads • Food • Transportation • Waste reduction • Employee engagement

16. Benchmarking and Building Systems: ENERGY STAR Performance Ratings Building-specific, campus-specific, region-level, and system-wide benchmarking, goal-setting, dashboarding and best-practice sharing 100 Apply for ENERGY STAR label, and share best practices Rating Scale 75 Operational change Retrofit Candidate 50 SiteCharacteristics 25 Confirm data and set immediate goal of improving rating by 10 points within 1 year 0

17. Benchmarking: Conserving Energy by Conserving Water Water efficiency comparison for hospitals, 2008

18. Benchmarking Major accomplishments as of August 2009: • Greenhouse gas inventory (Climate Registry) • Energy audits • Water use (40% below average U.S. hospital) Goals Measure and report: • Eco-Health Footprint (Global Health and Safety Initiative’s new calculator tool to help measure and manage carbon emissions, resource intensity, and toxic pollutants) • Energy performance ratings for existing and new buildings • Waste volumes

19. Building Systems: Energy-conserving Building Standards

20. Building Systems: Energy-conserving Building Standards – Major Accomplishments Between 1994 and 2009: • Installed 100 acres of cool roofs • Lighting occupancy sensors (10% decrease in lighting energy use) • Light fixtures (30% more energy efficient than average) • Building automation controls systems maximized energy efficiency • Adopted an energy efficient HVAC (heating, ventilation, air conditioning) design standard • Installed co-generation plants in 7 hospitals (~45% decrease in energy to heat water and ROI of ~20%) • Windowpanes with low emissivity glass (50% to 70% reduction in solar heat) Goals: • Adjust design templates to achieve ENERGY STAR rating of 75 or greater for each hospital and medical office building planned for construction. • Establish targets for improving the energy performance (in BTUs/sqft) of existing building portfolio • By 2011 reduce the combined annual water use of the hospitals, medical office buildings and commercial office buildings by 5%

21. Building Systems: Sustainable Energy Scorecard for Kaiser Permanente’s Regions Key Energy Program Elements are already in place or underway in several regions

22. Building Systems: Onsite Renewable Energy Generation Major accomplishments as of August 2009: • Solar photovoltaic array at Modesto Medical Center Goals: • Install 5 megawatts of new onsite solar energy generation this year

23. Building Systems: Onsite Renewable Energy Generation Major drivers: • Reduce Kaiser Permanente’s impact on global warming • Element of National Energy Strategy • Hedge against future regulation • Lower long-term energy costs • Eliminate risk of electrical cost fluctuations • Diversify supply • Brand benefits • Retain Renewable Energy Credits

24. Onsite Renewable Energy Generation

25. Building Systems: Roof-mounted Solar Array

26. Building Systems: Solar Field

27. Building Systems: Solar Carports

28. Efficient Care and Service Delivery Major accomplishments as of August 2009: • Electronic medical records • In-house distribution networks for specimen, supplies and equipment • In-house and mail-order pharmacies • Email-your-doctor Goals: • Evaluate technologies for recycling anesthetic gases and establish targets for reducing emissions of waste anesthetic gases • Engage members to take advantage of efficient delivery models such as mail-order prescriptions, email-your-doctor and mobile clinics

29. Plug Loads Major accomplishments as of August 2009: • Electronic Product Environmental Assessment Tool (EPEAT) Silver-rating for all newly deployed laptop and desktop computers in 2008 • Timers and occupancy sensors for vending machines in California Goals: • EPEAT Gold-rating for all newly deployed laptops and desktops in 2009 • Determine percentage of ENERGY STAR labeled printers and set target for increasing this percentage • Determine the most energy-intensive medical equipment and set target for improving energy efficiency • In 2010 all equipment and appliances provided by builders of new California Kaiser Permanente hospitals have to be ENERGY STAR labeled if ENERGY STAR is applicable to that equipment or appliance

30. Reducing Carbon Footprint by Reducing Waste

31. Waste Reduction Major accomplishments as of August 2009: • Patient meal preference software reduces waste • Single-use device reprocessing reduced waste by ~208,198 pounds, avoided ~$90,000 of waste disposal costs and saved ~$5.7 million in medical device costs • Resold or rendered into raw materials and recycled 74,000 pieces of Kaiser Permanente’s electronic equipment • Recycled 100% of building materials generated from demolition of warehouses at construction site of new hospital • Standardized service process for document destruction improved diversion of paper waste to recycling stream Goals: • Sustain and, where possible, expand existing programs

32. Food

33. Food: The Impact of Agriculture Policy on the Environment • The Gulf Dead Zone • Corn and soybean monocrops • Extensive use of fertilizers and pesticides • Soil erosion • Concentrated Animal Feeding Operations • Groundwater contamination • Air quality • Antibiotics for livestock Source: Lustig, 2008

34. Food Major accomplishments as of August 2009: • Hosting 30 farmers markets and farm stands in 4 states • Locally grown produce is part of inpatient meals at 23 of our hospitals • Ad campaign and partnerships with community groups to promote healthy eating Goals: • Increase percentage of our overall food spend allocated to foods that are more sustainable than conventional alternatives • Support development of local food systems featuring locally grown, sustainably farmed food

35. Transportation

36. Impact of Car Culture on the Environment California’s Greenhouse Gas Emissions by Sector 2004 (Gross emissions: 433.3 MMT CO2e) Air Resources Board. Greenhouse Gas Inventory. http://www.arb.ca.gov/cc/inventory/data/graph/graph.htm

37. Transportation Major accomplishments as of August 2009: • Ad campaign and partnerships with community groups to promote active living and building parks and bike paths • Successfully encouraged our largest materials distributor to join the EPA Smartway program • Rightsizing initiative for our courier vehicles (conserved 20,786 gallons of gasoline and saved $79,610) • Videoconferencing (avoided ~5,000 metric tons of C02 emissions in 2008 and saved ~$2.5 million) Goals: • Sustain and expand accomplishments above • Reduce business travel by 25% in 2009

38. Employee Engagement http://insidekp.kp.org/insidekp/reduceyouruse/index.htm

39. Employee Engagement Major accomplishments as of August 2009: • Reduce Your Use campaign encourages Kaiser Permanente physicians and employees to reduce consumption of resources • In 2008, staff eliminated the use of 240,000 sheets of paper and 20,000 disposable bags Goals: • First half of 2009 campaign: “Get Tapped In” to reduce bottled water use • Second half of 2009 campaign: “Lights Out on Global Warming” to conserve energy

40. Lessons Learned: Benchmarking An annual GHG inventory is a crucial first step toward measuring and managing emissions. An automated utility bill payment system facilitates tracking of energy use and GHG emissions.

41. Lesson Learned: Work With Others to Build a Social Movement GHSI is a coalition of health care systems and organizations working to sector wide movement working together to transform the way hospitals build, buy and operate their facilities • Open source sharing of information and best practices • Group purchasing to transform the market • Research to document benefits, improvements, outcomes http://www.globalhealthsafety.org/

42. Moving Forward: Key partners for success • Direct Energy: KP-IT, NFS, P&S, Green Teams • Supply chain: P&S, Green Teams • Food: P&S, Nutrition Services, Green Teams • Transportation: Commuter programs, HR, KP-IT, Green Teams • Pharmaceutical manufacturing: Pharmacy • Adaptation of care and service delivery to mitigate global warming and adapt to its health effects: Medical groups, DOR, UCDA, Green Teams • Industry standards: GHSI, Climate Registry • Public policy: Industry associations and health advocacy groups

43. Resources For additional information about environmental stewardship at Kaiser Permanente, please visit our Green Resource Center: www.kp.org/green Or visit our Green Teams web site: http://kpnet.kp.org/ehs/green_team/index.htm Or contact: Joe Bialowitz, Environmental Stewardship Project Manager joe.bialowitz@kp.org