The Pagitsas File


  • Strategic adviser, keynote speaker, author and head of Pagitsas Advisors.
  • Senior adviser, McKinsey & Company.
  • Vice president of ESG, Fannie Mae.
  • Director of green financing, Fannie Mae.
  • Director at Chemonics International.
  • Senior consultant, JDM Associates, Wipro and American Management Systems.


  • Author of the book Chief Sustainability Officers at Work: How CSOs Build Successful Sustainability and ESG Strategies.
  • Board member, Healthy Building Network.
  • Strategic adviser, Sustainable Living Innovations and Climate Club.
  • Recipient of the Green Bond Champion Award from the Climate Bonds Initiative and the Leadership Award from the U.S. Green Building Council.


  • Master of Business Administration, Darden School of Business, University of Virginia.
  • Bachelor of Arts, Johns Hopkins University

At the International Summit & Exhibition on Health Facility Planning, Design & Construction in March, Chrissa Pagitsas delivered a keynote on how health care physical environment leaders can innovate through sustainability. This month, the author, speaker and adviser shares takeaways on bridging the interests of sustainability and business.

How did you realize that sustainability was a critical career path for you?

My career began over 20 years ago building large-scale financial and billing systems for traditional utility companies in the U.S. and Europe. I gradually shifted from supporting utilities on their energy pricing and billing models to identifying renewable energy opportunities for methane biodigesters to creating sustainability and energy-efficiency solutions for real estate portfolios. 

By the time I arrived at Fannie Mae in 2010, I knew the sustainability field was where I belonged. As the head of the green financing business there, I built a team that used the power of financing to launch green mortgages for the multifamily market. As a result, Fannie Mae issued over $51 billion in green bonds through 2018, making it the largest issuer of green bonds in the world at the time. 

I next became head of environmental, social and governance (ESG), where I engaged with the board and senior executives to address how we could support better quality housing through green and social financing solutions. Today, I advise decision-makers on how to shift their portfolios to lead their companies with an ESG and sustainability strategy. 

What is ESG, and what does it look like in health care?

ESG is a relatively new term compared to concepts like “sustainability” and “impact investing.” I consider the terms overlapping but not identical. Traditionally, sustainability focuses on how a business sustains and impacts the environment and society as well as itself. It’s about assessing impact to the broader community. Conversely, ESG is a lens through which investors assess a company’s performance and its exposure to risk from environmental, societal and governance issues. The metrics of sustainability are broader, whereas the metrics tied to ESG are being actively defined by lawmakers, investors and ESG reporting organizations. They are seeking to develop a comparable language of environmental and social risk across industries and sectors.

For health care, sustainability and ESG mean that everyone, from investors and regulators to customers and suppliers, expects companies not only to deliver on relevant issues such as patient care, but also to reduce their impact to and risk from the environment by building to green building standards and developing sites and adding technologies that allow the facilities to be resilient to climate change.

What inspired you to pursue a career as an adviser, public speaker and author?

I was driven by a desire to teach and coach about how to create additional value for businesses through sustainability and ESG. As an adviser, I work closely with chief sustainability officers and senior executives, in fields ranging from health care to financial services to philanthropy, who are developing their companies’ sustainability and ESG strategy for the first time or revamping it to meet rapidly changing market and regulatory environments. In all areas, I seek to inspire others to take the leap of faith with sustainability and ESG while answering the hard questions of where to start. 

How has the scope of sustainability shifted over the years?

Today, more people are aware of a broader array of environmental issues, such as the importance of reducing food waste and removing toxic chemicals from products. This is more advanced than the generic missive to “be kind to the environment.” More powerfully, there is increased discussion about the intersection of environmental and social issues. 

For example, a new study identified that Black Americans are exposed to air pollution at higher rates than white Americans, an issue driven by refineries and other industrial operations being located more frequently near communities of people of color. This environmental issue creates additional social pressures, as these communities may have less access to health care, be located in food deserts and have fewer social services. 

Real estate professionals have the opportunity to think about this intersectionality and create innovative solutions to address it. How does living in a green building improve a person’s quality of life? How can buildings and interior design support stronger mental health? There are organizations that can help professionals in health care answer these questions. I serve as a board member for Healthy Building Network (HBN). Its product guidance helps property developers, architects and planners understand which materials in their buildings are in the “red zone” (most hazardous) and how they can move toward using safer, “green-zone” products. Processes like this are harder than calculating the energy intensity of a square foot of commercial real estate, but they address the issues that sustainability and the real estate industry must continue to contend with.

Chief Sustainability Offers at Work draws insight from chief sustainability officers across industries. Was there a common theme to their insights? 

For my book, I intentionally chose chief sustainability officers from a diverse set of industries, each of whom take on tough environmental and social issues for businesses operating across multiple countries and continents. Despite their different industries, they shared a focus on partnerships, products, process, priorities and patience. For example, Kara Hurst of Amazon addressed the importance of fostering internal partnerships and forging new external ones with peers and even competitors. Scott Tew of Trane focused on catalyzing the redesign of processes so that sustainability principles could be incorporated into new and even legacy products. Staying focused on the top environmental, social and business priorities allowed them to deliver on the ambitious commitments their CEOs had made, as Alexis Rosenblum of BlackRock raised. Ultimately, all of these individuals are patient because they constantly weigh the immediate, pressing needs of the business with long-term cultural and behavioral changes internally at a company. 

How can leaders in the health care built environment field — especially those not in the C-suite — champion sustainability in their own workplaces?

In conversations with business leaders, I regularly hear, “Sustainability will be taken care of by the sustainability team. There’s no role for my team in the conversation right now.” My response is that every seat in an organization is a sustainability role, and you can integrate sustainability principles into your work today. 

Leaders in health care face daily decisions related to sustainability. Designers can make choices about the materials that go into a building; and engineers and architects can raise awareness with the client or property owner that the bar can be raised above the minimum building code for energy efficiency and indoor air quality. These affect the financial costs to operate the building as well as the health of the people it serves. Even if it may not seem there is an opportunity to make a change in your current job’s scope or activities, reaching out to peers to learn about their interest in sustainability, joining industry associations and taking courses on sustainability are tangible first steps to being a sustainability leader. 

Landon Hegedus is assistant editor at Health Facilities Management magazine.