Pre­scrib­ing a cli­mate rem­edy

Health­care lead­ers aim to in­flu­ence in­ter­na­tional cli­mate change ne­go­ti­a­tions

Modern Healthcare - - NEWS - By Bob Her­man

FOR AN IN­DUS­TRY that loves to pro­mote the “triple aim” buzz phrase, the U.S. health­care sys­tem of­ten leaves out one im­por­tant el­e­ment.

Im­prov­ing the health of pop­u­la­tions, en­hanc­ing the pa­tient ex­pe­ri­ence and low­er­ing the cost of care are the un­der­pin­nings of the so-called triple aim that prac­ti­cally ev­ery provider has adopted over the past few years. While some of the largest and most pro­gres­sive-lean­ing sys­tems like Kaiser Per­ma­nente and Part­ners Health­Care have pur­sued ways to ad­dress cli­mate change, it’s rare to find that ex­plicit mis­sion or busi­ness plan at the thou­sands of other hos­pi­tals, doc­tor groups, health in­sur­ers, de­vice com­pa­nies or drug­mak­ers.

“We ac­tu­ally have a re­spon­si­bil­ity to not only cure things we can cure, but if you can pre­vent some­one from ever get­ting a sick­ness and you don’t do it, you know what? That’s pretty much in­ex­cus­able,” said Sis­ter Carol Kee­han, CEO of the Catholic Health As­so­ci­a­tion, shortly af­ter Pope Fran­cis ear­lier this year is­sued a 184-page en­cycli­cal urg­ing cit­i­zens around the globe to tackle cli­mate change.

Per­haps mo­ti­vated by a grow­ing ur­gency, doc­tors, nurses and other hos­pi­tal pro­fes­sion­als will take a more ac­tive role at the much-an­tic­i­pated United Na­tions cli­mate con­fer­ence in Paris, which will run from Nov. 30 to Dec. 11. The con­fer­ence, which Pres­i­dent Barack Obama will at­tend, will come just weeks af­ter the Amer­i­can Pub­lic Health As­so­ci­a­tion’s an­nual meet­ing in Chicago. At that con­fer­ence, many urged their med­i­cal col­leagues to view cli­mate change through the lens of pub­lic health.

There’s an over­whelm­ing con­sen­sus among cli­mate re­searchers and sci­en­tists that the world is warm­ing at an un­sus­tain­able rate, and hu­man ac­tiv­ity is a pri­mary cause. The U.N.’s In­ter­gov­ern­men­tal Panel on Cli­mate Change, the U.S. Na­tional Acad­emy of Sci­ences and dozens of other global re­search bod­ies have dis­sem­i­nated re­ports con­firm­ing that con­clu­sion. Fur­ther, last year was the hottest year ever recorded, and the Na­tional Oceanic and At­mo­spheric Ad­min­is­tra­tion said 2015 is on pace to break that mark. The hope and ex­pec­ta­tion in Paris is for coun­tries to reach a legally

bind­ing agree­ment to re­duce green­house gas emis­sions and move to­ward a low-car­bon econ­omy.

“Health has a very im­por­tant voice in that de­ci­sion,” said Dr. John Bal­bus, se­nior ad­viser for pub­lic health at the Na­tional In­sti­tute of En­vi­ron­men­tal Health Sci­ences, part of the Na­tional In­sti­tutes of Health. Bal­bus is one of the lead­ing U.S. govern­men­tal health­care par­tic­i­pants in the Paris talks.

Other health­care groups will also stage events at the U.N. meet­ing to ad­vo­cate for so­lu­tions, which they say are needed to keep chron­i­cally ill, and of­ten poor, pa­tients healthy. Sev­eral health sys­tems are ex­pected to an­nounce their own com­mit­ments to re­duce their car­bon foot­print in con­junc­tion with the global pact.

Health­care lead­ers are get­ting more in­volved with the po­lit­i­cally con­tentious topic be­cause the sec­tor has an “in­cred­i­ble moral author­ity and voice to ed­u­cate the pub­lic about th­ese is­sues and help be a driver for poli­cies that are go­ing to change the equa­tion,” said Gary Cohen, a 2015 MacArthur “ge­nius” fel­low and pres­i­dent of ad­vo­cacy group Health Care With­out Harm. He noted that medicine and nurs­ing are among the most-trusted pro­fes­sions, and that the health­care in­dus­try ac­counts for about 18% of the econ­omy, 8% of emis­sions and a sig­nif­i­cant amount of garbage sent to land­fills.

“There really is no other sec­tor that has that power,” Cohen said. “It’s not even close.”

But health­care, like so many other in­dus­tries, has pro­cras­ti­nated on suggest­ing so­lu­tions be­cause it ei­ther hasn’t made busi­ness sense, or it has been viewed as a dif­fi­cult, far-off prob­lem. “We are just be­gin­ning as a so­ci­ety to view it as a re­al­ity and not just a con­cept for tree-hug­gers,” said Al Gini, a busi­ness ethics pro­fes­sor at Loy­ola Univer­sity in Chicago.

More than two-thirds of the pub­lic be­lieves there is solid ev­i­dence of global warm­ing, and a grow­ing per­cent­age be­lieves it is a very se­ri­ous prob­lem. Still, con­ser­va­tives re­main more likely to be skep­ti­cal of cli­mate change than lib­er­als and in­de­pen­dents, and Congress has been bit­terly di­vided along party lines over the is­sue, stalling any type of leg­isla­tive ac­tion.

Be­yond the im­me­di­ate eco­log­i­cal ef­fects, re­search shows that cli­mate change sig­nif­i­cantly am­pli­fies pub­lic health risks. For ex­am­ple, warmer global tem­per­a­tures cause more fre­quent ex­treme weather events, such as heat waves, droughts, floods and hur­ri­canes. Aside from desta­bi­liz­ing com­mu­nity health net­works and food sources, those weather con­di­tions will make peo­ple more sus­cep­ti­ble to heart prob­lems, stroke and in­fec­tious diseases. Burn­ing fos­sil fu­els also leads to more air pol­lu­tion, one of the most com­mon causes of res­pi­ra­tory con­di­tions and pre­ma­ture death.

“Most of us have looked at the is­sues and be­lieve cli­mate change is a se­ri­ous threat to health,” said Dr. Andy Haines, pro­fes­sor of pub­lic health and pri­mary care at the Lon­don School of Hy­giene & Trop­i­cal Medicine. “It could be cat­a­strophic.” Rare trop­i­cal diseases, such as dengue fever and chikun­gunya, have al­ready ap­peared in some of the poor­est ar­eas of the U.S.

“We have to ex­plain to peo­ple that this is no longer just global health,” said Dr. Tochi Iroku-Mal­ize, chair of the fam­ily medicine depart­ment at the Hof­s­tra North ShoreLIJ School of Medicine in Hemp­stead, N.Y. “You have to think of th­ese ill­nesses here.”

If cli­mate change’s pub­lic-health per­ils aren’t stim­u­lat­ing ac­tion, the fi­nan­cial ones could. A Health Af­fairs study found that the health costs from six cli­mate-re­lated trends in spe­cific re­gions to­taled more than $14 bil­lion be­tween 2000 and 2009, and the costs from sim­i­lar events will only worsen with fur­ther global warm­ing. And that to­tal didn’t in­clude the costs of dam­ages to build­ings and in­fra­struc­ture, which health­care lead­ers agree could be a ma­jor prob­lem.

HHS, the Cen­ters for Dis­ease Con­trol and Preven­tion and the U.S. Sur­geon Gen­eral have made some ef­forts to

“We see it in the same way as tobacco. You don’t in­vest in com­pa­nies that are ac­tu­ally against your mis­sion.” Gary Cohen Pres­i­dent Health Care With­out Harm

in­form and pre­pare providers for such prob­lems, but much more needs to be done, ac­cord­ing to a re­cent Gov­ern­ment Ac­count­abil­ity Of­fice re­port. The feds have a horse in this race, too. The GAO re­port said be­cause the gov­ern­ment is the largest pur­chaser of health­care ser­vices through Medi­care and Med­i­caid, its ex­penses “could in­crease in fu­ture years due to cli­mate-re­lated im­pacts.”

Now, groups like Health Care With­out Harm, the World Health Or­ga­ni­za­tion and the World Med­i­cal As­so­ci­a­tion will use Paris as a stage for ad­vo­cat­ing broader change.

The rhetoric lead­ing up to the Paris cli­mate talks has in­ten­si­fied from health­care groups. Doc­tors for Cli­mate Ac­tion, started by the Royal Aus­tralasian Col­lege of Physi­cians, said the con­fer­ence must re­sult in “mean­ing­ful and ur­gent ac­tion to com­bat the ad­verse health im­pacts of cli­mate change.” The United King­dom’s Lancet Com­mis­sion on Health and Cli­mate Change said this sum­mer, “Tack­ling cli­mate change could be the great­est global health op­por­tu­nity of the 21st cen­tury.”

Be­cause world lead­ers will be present, the pres­sure to get some­thing done is al­most pal­pa­ble. Most be­lieve a deal will be reached, and Obama de­liv­ered a sym­bolic mes­sage this month by re­ject­ing the con­tro­ver­sial Key­stone XL oil pipe­line, based on con­cerns over its en­vi­ron­men­tal im­pact. Much prepa­ra­tion has been done ahead of the con­fer­ence, and health­care of­fi­cials have taken no­tice.

Some coun­tries have al­ready sub­mit­ted “in­tended na­tion­ally de­ter­mined con­tri­bu­tions,” doc­u­ments that of­fer a rough out­line of their cli­mate com­mit­ments. The U.S., one of the largest global pol­luters per capita, has said it will re­duce green­house gas emis­sions by up to 28% of 2005 lev­els by 2025, al­though sev­eral other coun­tries have set much more ag­gres­sive tar­gets, ac­cord­ing to Dr. Jonathan Patz, di­rec­tor of the Global Health In­sti­tute at the Univer­sity of Wis­con­sin at Madi­son.

But cli­ma­tol­o­gists say those tar­gets are not enough. Cli­mate In­ter­ac­tive, a not-for-profit re­search group, found that the planet’s tem­per­a­ture would rise by more than 3 de­grees Cel­sius, be­yond the con­sen­sus 2de­gree tar­get, even if coun­tries fol­lowed through on their pledges.

“That’s where many of us are con­cerned at the present—not be­ing am­bi­tious enough,” said the Lon­don School’s Haines, who has worked on the U.N.’s In­ter­gov­ern­men­tal Panel on Cli­mate Change.

That’s why many health­care groups want to take the mat­ter into their own hands, and why the fos­sil-fuel divestment move­ment is gain­ing steam in the health­care sec­tor. Or­ga­ni­za­tions typ­i­cally in­vest a small por­tion of their as­sets in the en­ergy in­dus­try. But health­care groups hope that pulling money out of fos­sil-fuel com­pa­nies will keep en­ergy sources in the ground and spur more in­vest­ment in re­new­able en­ergy. That, of course, comes with fi­nan­cial and po­lit­i­cal risks.

So far, the Bri­tish Med­i­cal As­so­ci­a­tion, the Cana­dian Med­i­cal As­so­ci­a­tion and the Royal Aus­tralasian Col­lege of Physi­cians have com­mit­ted to fully dis­in­vest­ing their own fos­sil-fuel hold­ings. Last fall, Gun­der­sen Health Sys­tem in La Crosse, Wis., be­came the first U.S. health sys­tem to al­ter its fos­sil-fuel in­vest­ments when it froze all funds tied to com­pa­nies that ex­tract coal, oil and gas.

“We see it in the same way as tobacco,” said Cohen of Health Care With­out Harm. “You don’t in­vest in com­pa­nies that are ac­tu­ally against your mis­sion.”

A hand­ful of health sys­tems are discussing divestment “at the high­est level,” ac­cord­ing to Eric Lerner, cli­mate change di­rec­tor at Health Care With­out Harm. The con­cept be­came more widely dis­cussed in health­care cir­cles last year. It’s pos­si­ble that sys­tems could an­nounce divestment plans in Paris or soon there­after. Peo­ple in­ter­viewed for this ar­ti­cle could not dis­close which or­ga­ni­za­tions were con­sid­er­ing the de­ci­sion, be­cause noth­ing has been fi­nal­ized—and be­cause divestment is a par­ti­san hot potato. “It’s so po­lit­i­cal,” Lerner said. Those not im­me­di­ately eval­u­at­ing divestment or screen­ing of their fos­sil-fuel stocks are es­tab­lish­ing other poli­cies. Hu­mana and Bupa, health in­sur­ers based in the U.S. and the U.K., re­spec­tively, are com­mit­ted to cut­ting their car­bon foot­prints. Thirty-seven health sys­tems around the world have signed on to the 2020 Chal­lenge, a health­care-based ini­tia­tive in which par­tic­i­pants try to hit cli­mate and re­new­able en­ergy goals by 2020. Cal­i­for­nia-based sys­tems Dig­nity Health and Kaiser Per­ma­nente, Gun­der­sen, Part­ners Health­Care in Bos­ton and Vir­ginia Ma­son Med­i­cal Cen­ter in Seat­tle are among the U.S. play­ers, and each sys­tem will send rep­re­sen­ta­tives to Paris as well.

Health Care With­out Harm will lead U.S. or­ga­niz­ing ef­forts in Paris. The group has sched­uled three events with other global health groups for early De­cem­ber. Cohen said the events dove­tail with the group’s pri­mary ob­jec­tives: help­ing health­care to re­duce its own car­bon foot­print; build­ing a “re­siliency” to cli­mate change; and pro­vid­ing lead­er­ship to oth­ers.

“You can meet both your moral obli­ga­tion to de­crease your en­vi­ron­men­tal im­pact, and meet your fis­cal and so­cial re­spon­si­bil­i­ties,” said Dr. Jeff Thomp­son, a for­mer Gun­der­sen CEO. Thomp­son will be in Paris to dis­cuss how Gun­der­sen be­came an en­ergy-in­de­pen­dent sys­tem, and to ex­plain how other lead­ers can fol­low suit.

Many or­ga­ni­za­tions ar­gue it’s dif­fi­cult to de­velop a cli­mate plan while con­cur­rently deal­ing with new pay­ment mod­els, tech­nol­ogy in­vest­ments, in­dus­try merg­ers and qual­ity im­prove­ment. But some view that as a weak ex­cuse, since the Earth’s cli­mate doesn’t care about other busi­ness pres­sures, and be­cause some or­ga­ni­za­tions have proved it can be done.

Gun­der­sen al­ready has low­ered its car­bon emis­sions by 83% since 2008. If a sys­tem in a Mid­west­ern city of about 50,000 peo­ple can do it, Thomp­son said, oth­ers can as well.

“Health lead­ers have to de­cide if they’re go­ing to aim for medi­ocrity or aim to be bet­ter than that,” Thomp­son said. “A very good or great or­ga­ni­za­tion can do more than one thing at a time.”

“Health lead­ers have to de­cide if they’re go­ing to aim for medi­ocrity or aim to be bet­ter than that. A very good or great or­ga­ni­za­tion can do more than one thing at a time.”

Dr. Jeff Thomp­son, for­mer Gun­der­sen Health Sys­tem CEO

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