Starting in 2015 the Associação Paulista para o Desenvolvimento da Medicina (SPDM) conducted extensive greenhouse gas inventories and implemented sustainable strategies throughout its facilities. They achieved a significant reduction in emissions (nearly a 50% reduction in emissions in tCO₂e per FTE from 2018 to 2022), expenses (savings of USD 62,000 in 2020), and increased awareness and acceptance of health care sustainability and environmental impact among staff, health care leadership, the government, and the communities served.