Health systems around the world are turning their attention to greenhouse gas mitigation and resilience. Globally, health care is responsible for nearly 5% of total global greenhouse gas emissions. Nationally, US health care is responsible for 8.5% of US greenhouse gas emissions and similar fractions of toxic air emissions. Disease burden stemming from US health care pollution is on the same order of magnitude as medical errors, but is presently unaddressed. As mandatory carbon reduction looms on the horizon for all sectors, this three-part symposium provides an overview of the current state of health care sustainability accounting, and seeks global lessons that can be adopted by the US health care delivery sector to guide mitigation and resilience strategies. Broadly, attendees can expect to be able to: Explain current needs for health care organization sustainability accounting Review different global framework tools for environmental and social performance accounting Describe international health care system sustainability exemplars and their applicability to the US system Discuss how health care organization sustainability accounting supports the development of data-driven interventions, mitigation targets and timelines