September 26, 2022
If you’re still of the opinion that climate change is not real, this post is not for you. Best of luck. Try not to fall off the edge of the world on your next vacation.
For everyone else, take a moment to tally the industries you think would be most impacted by any large-scale efforts to address global climate change. Transportation, clearly, is near the top of the list. Fossil fuel production, obviously, would experience wholesale change, as would public utilities. Farming and ranching might have to make some significant changes as well.
And what about healthcare? Would real change be necessary in healthcare despite the fact that the industry doesn’t produce energy? Yes, it would. As an industry, healthcare is a major consumer of energy across the United States, making hospitals, health systems, and clinics a significant source of greenhouse gas generation.
“Health care as an enterprise faces a unique paradoxical climate crisis conundrum,” write Medsphere Board Chairman Kenneth Kizer, MD, and Stanford’s Kari Nadeau, MD, PhD, in a JAMA article. “It is health care’s essential mission to prevent and heal harms to health, but in accomplishing its healing mission, health care significantly contributes to climate change … For symbolic, ethical, and operational reasons, this conundrum must be resolved.”
Healthcare as an energy consumer and greenhouse gas creator
According to the Environmental Protection Agency, the healthcare sector is the second largest user of commercial energy in the United States. Of all the energy used in commercial buildings each year, healthcare is responsible for 10 percent at a cost of $8 billion annually; healthcare’s share of greenhouse gasses produced in the United States each year is 8.5 percent.
If there is any in these data points, the good news is that healthcare has the power to make a significant dent in global warming and directly alleviate a significant cause of worsening public health.
“Health care–related [particulate matter] (PM2.5) and ozone pollution are estimated to have caused the loss of 133,000–188,000 [disability-adjusted life years] (DALYs) in 2018,” says a study published in Health Affairs. “Between 2016 and 2017, national primary PM2.5 emissions jumped more than 12 percent, which caused a concomitant jump in health damages from health care of approximately 20,000 DALYs in that year.”
Overall, this means healthcare’s share of greenhouse gas emissions take roughly the same number of lives each year as preventable medical errors. Deaths from medical error, initially estimated to be as high as 98,000 by a 1999 Institute of Medicine report and since revised upward, made waves throughout healthcare and inspired numerous dramatic headlines in national media. Deaths from healthcare-generated climate change have had no such impact.
We should, before going much further, differentiate between greenhouse gases and particulate, both of which are created by burning fossil fuels and both of which threaten human health.
“The World Health Organization (WHO) considers air pollution as the single largest environmental risk responsible for almost 7 million deaths per year of which almost 75 percent are due to respiratory diseases, such as lung cancer, chronic pulmonary obstructive disease, or cardiovascular diseases like ischemic heart disease and stroke,” says a Wiley review article also co-authored by Medsphere Board Chairman Kenneth Kizer, MD.
While most industries would probably be thrilled to create additional customers through the simple process of providing a service absent any marketing or sales effort, the Hippocratic oath turns “if you build it, they will come” on its head. Even in America, where healthcare is run as a business, the idea of making health worse for some by providing care broadly has to give some providers pause.
Healthcare on the front lines of worsening climate change
This is not to say that healthcare providers are all alone on the front lines of climate change fallout. Much as it may pain the smaller government crowd, the impact of wildfires, rising tides, and heat waves on general populations can’t help but make local, state, and federal government agencies more necessary. There simply aren’t alternatives when dealing with disasters in a way that doesn’t morph into profiteering.
But the treatment of individuals with deteriorating health caused by climate change will fall to healthcare providers. What does that look like now and what are the short and long-term prognoses?
Right now, climate change is making life more challenging for many people in ways that are both predictable and genuinely surprising, e.g., it will shock no one to learn that levels of carbon dioxide in the atmosphere are increasing, but it may widen an eye or two to learn that increased CO2 decreases antioxidant production in many plants and increases the creation of pollen and mold spores. Time to stock up on Claritin?
Sure, increasing temperatures make life more challenging and create a strain on electric grids, but economists can also estimate how much such events cost the economy in lost productivity, increased medical treatments, and hospitalizations. A study conducted in France found that higher temperatures between 2015 and 2019 came with a cost to the economy of more than 25 billion Euros.
And then there are the fires and floods that come with ‘global weirding’ as some have called a climate phenomenon that can’t be accurately captured in the simplistic idea that the planet is warming. It is, to be sure, but how that impacts the environment manifests in multiple ways.
It’s not just that fires destroy things. It’s that the things they destroy—cars, homes, other buildings—turn into toxic clouds of smoke and particulate that impact people far from the actual blaze.
“Extreme wildfires around the world have created a new form of public health emergency in so far as they typically last weeks to months, follow an unpredictable course, and their smoke and ash may be carried by winds and air currents for hundreds or thousands of miles …” says Kizer et al in their report on how global climate change is specifically detrimental to human health.
With the drought in the West continuing now for many years, fire season is an annual event costing billions of dollars that the Bureau of Land Management largely calculates in terms of fire suppression, ecological rehabilitation, property and utility losses, decreases in tax revenue, and loss of human life (firefighters). The healthcare costs associated with breathing polluted air and smoke increases the BLM’s calculations exponentially.
The inescapable realities of a hotter climate
Among all the impacts of global warming, heat waves and hotter average temperatures overall deserve special consideration. It is possible to avoid floods and wildfires with enough notice, and it is also possible to mitigate the impacts of air pollution, though one could argue that approaches and cultural norms make this very challenging.
Heat, on the other hand, is nearly inescapable, particularly in parts of Europe and places like the Pacific Northwest in the United States that traditionally have had no need for air conditioning. The costs of implementing air conditioning systems after the fact are staggering, and the impact that surge will have on the electrical grid is disconcerting.
The 2021 heat event in the Pacific Northwest serves as an example of how this can play out.
“This [extreme heat event] was linked with a 69-fold increase in ED visits in Washington State for heat stroke, heat exhaustion, exacerbation of chronic medical conditions (e.g., cardiovascular conditions, respiratory disease, or diabetes), and one case of third-degree burns from walking on hot asphalt,” reads a NEJM Catalyst article, again co-authored by Medsphere Board Chairman Kenneth Kizer, MD. “If the mean planetary temperature increases beyond [two degrees Celsius], which is expected at the current pace of carbon emissions, then the Pacific Northwest can expect this type of 1-in-1,000-year event to occur every 5–10 years.”
The deleterious impact of these types of events will continually fall on the elderly, the infirm, and the poor.
And it isn’t just the direct impact of the heat on people. Higher temperatures for longer than normal have a cascading effect on the provision of care because of their impact on the power grid. In blackout or brownout situations, home air conditioning systems shut down and patients lose the support of mechanical or electronic devices at home. Without separate generators, hospitals, nursing homes, and other care facilities lose power and the ability to provide necessary care.
So, how does healthcare address both sides of the climate change challenge simultaneously?
Kizer and Nadeau have outlined a series of steps healthcare could take with the federal government as the primary catalyst. And while many roll their eyes when they hear of any plan in which Washington, DC, is the primary player, ask yourself who else can act in this situation in a significant enough way. Kaiser Permanente? Partners? HCA? Mayo? In all situations, a non-centralized player acting alone is not sufficient, and it puts them at a financial disadvantage in terms of competitiveness and stock value, which they cannot entertain.
“Colloquially speaking, humanity has reached a perilous precipice and must now find the will to change if it is to avoid devastating consequences,” say Kizer and Nadeau.
But too few people feel the direct impact of climate change now to find the will. By the time heat and fire and flooding and respiratory ailments impact enough people, we will probably be beyond doing anything substantive about the problem.
As a unique player on both sides—cause and effect—of global warming, healthcare and particularly the federal government, the largest payer in the country, have a perspective and the influence to make a significant difference. The individuals that run the relevant organizations must find the will to act even if many voters don’t support the actions they take.