In a talk presented by The Hastings Center, Gary Cohen, president of Health Care Without Harm, explains how the health care industry can fight climate change, mitigate social determinants of health, and reduce costs through a series of targeted efforts.
Is it possible to have healthy people on a sick planet?
With the 52nd anniversary of Earth Day right around the corner (April 22) and dire climate change projections cropping up in headlines on a daily basis, the question proves apt for consideration, especially given the fact health systems are still reeling from the COVID-19 pandemic and might not have the bandwidth to accommodate rising demands.
Changes in the earth’s climate will lead to drastic increases in physical and mental ailments necessitating care down the line and putting further stress on health systems. And from increased frequency of natural disasters like wildfires and hurricanes to rising emissions and global temperatures, some of these ramifications are already evident today.
“The emissions from fossil fuels are killing twice as many people as AIDS, malaria, and tuberculosis combined,” said Cohen in his opening remarks, adding climate change “will also be a force multiplier for all the racial and social inequities, and health inequities that we see in our society and societies all around the world.”
Using redlining as an example, Cohen explained how communities that have suffered systemic disinvestment over the years—for example, urban settings with less tree cover and are predominately populated by racial minorities—could run up to 10 degrees hotter than majority-white, suburban areas.
Not only will increased heat lead to exacerbated health conditions, but changes in migration patterns will contribute to upticks in mosquito- or tick-borne illnesses. Twenty-five years ago, dengue fever was in Panama, but it has moved farther north to places like Texas and Florida, Cohen said.
“Anyone who's concerned with public health, malaria, dengue, other infectious diseases, tick-borne diseases, they've got to be concerned with climate change because the actual area in which those disease vectors are thriving is expanding.”
But all this begs the question, why should the health care industry shoulder the burden of addressing climate change when it is already responsible for so much?
According to Cohen, the answer comes down to the “do no harm” principle. Initially, Health Care Without Harm began with the mission of combatting medical waste incinerators, notorious for emitting large quantities of dioxin, a pollutant linked to birth defects, and mercury emissions.
“The health care sector is the one sector of our economy that has healing as its mission,” Cohen said. “What hope do we have to create the conditions for healthy communities—a healthy planet—if the very sector that is supposed to live by this ethical frame of ‘do no harm’ is itself a massive polluter? That cognitive dissonance, that irony has driven our work over the course of the last quarter century.”
Currently, the US health system is responsible for almost 9% of the country’s total greenhouse gas emissions, almost 5% of emissions globally, and a quarter of health care emissions globally. Meanwhile, it makes up 20% of the US economy, providing an opportunity to model a transition away from fossil fuels for other industries, Cohen explained.
The process of doing so will be instrumental in concurrently tackling some of the social determinants of health linked with poor outcomes of those most affected by climate change in the United States.
For example, hospital systems can use their buying power to invest in renewable energy when building climate resilient facilities and in sustainable food systems, and work to help improve housing, all with the bonus outcome of reducing costs down the line.
“We need to re-invent the incentives of health care to support prevention that will build resilience, that can build equity in communities,” Cohen said, stressing this transformation will focus more on relationships and partnerships as opposed to siloed advancements isolated to the health care industry.
By working with key players in communities, health systems will have a better chance at success because of that added local knowledge and expertise. “It’s about marrying those assets in a partnership model, it’s not the savior model.”
Throughout the discussion, Cohen referenced the case of Gunderson Health System in Wisconsin, which, in 2008, began investing in renewable energy projects, and in 2014, became the first energy independent health system in the United States.
Previously, the system was highly dependent on coal, and through their investments neighboring towns have transitioned to wind power as well.
According to analyses, over 70% of health systems’ carbon footprints result from supply chains. Focusing purchasing power on more sustainable options like plant-based diets served at facilities and energy efficient MRI machines will help encourage a more circular economy and build climate resilience along the supply chain, Cohen said.
On a larger scale, Britain’s National Health Service has committed to a net zero emission goal by 2045 primarily by only opting to work with suppliers who have matched their commitments to decarbonize. In the past, this demand-oriented approach has seen success in the health care industry, with Cohen pointing to the transition to mercury-free alternatives for medical equipment.
With regard to those who already pay the health price from the fossil fuel industry, Cohen feels these communities, which are often communities of color in the United States, will need to be compensated for their suffering.
“And we’ve got to educate the next generation of health professionals to understand these essential links between climate equity and health,” he said.
Health professionals have some of the highest trust ratings of any profession, and leveraging this trust to increase awareness of climate change’s repercussions on health is crucial.
To Cohen, the choice becomes that of diametrically opposed values: those of the fossil fuel industry or those seeking to ensure children are born into a toxic-free environment.