With little fanfare and even less notice, the National Academy of Medicine (NAM) recently launched its Action Collaborative on Decarbonizing the U.S. Health Sector.
During a kick-off event, speakers made clear that the time for action is now. As one member stated, “the urgency is immense.”
Carbon emissions from the U.S. health care industry account for approximately 8.5% of the country’s total and 25% of global health care emissions, killing approximately 98,000 Americans annually and approximately three times that number worldwide. Unlike other large U.S. industries, the health care sector fails to publicly report its carbon emissions.
That the health care industry has ignored its bloated carbon footprint for decades is tragic particularly since the world has now reached, as the UN Secretary-General António Guterres recently stated, “a code red for humanity,” meaning the climate crisis is putting the health of billions of people, including more than one billion children, at risk. To make matters worse, Anthropocene warming is a major cause of the current and accelerating sixth mass extinction that currently threatens one-quarter of all species. Biological annihilation is an existential crisis of its own and one that is more immediate than the climate emergency because it is not reversible.
The new collaborative, co-chaired by the NAM, the Department of Health and Human Services’ recently formed Office of Climate Change and Health Equity, UnitedHealth Group, and Cardinal Health, is composed of 50 members representing the federal government, the health care industry, trade and professional associations, academia, and consultancies. Its charge is to reduce the health industry’s carbon footprint while “strengthening its sustainability and resilience.”
Collaborative members are gathered into four workgroups: supply chain and infrastructure; health care delivery; education and communication; and policy, financing, and metrics. This last group, led by Donald Berwick, the former administrator of the Centers for Medicare & Medicaid Services, and Elizabeth Fowler, director of the Center for Medicare and Medicaid Innovation, may be the most important since the collaborative’s work will presumably amount mainly to making regulatory reform recommendations.
A great deal is riding on the action collaborative. Not only is it the only effort of its kind, but HHS’s just-released 2021 Climate Action Plan fails to say anything about de-carbonizing health care. That’s why it is essential that the industry-dominated effort does not default to greenwashing or virtue signaling.
Because the health care industry and federal health care policy makers have done nothing to address what the United Nations Environment Programme terms the most pervasive threat to human societies the world has ever experienced, there are obvious recommendations and activities the collaborative can immediately pursue that would quickly help close the stunning gap between where the health care industry is and where it needs to be.
Correctly define the problem. The first step is correctly defining the problem. The NAM makes repeated mention that the health care industry is responsible for 8.5% of total U.S. carbon emissions, suggesting that this amount — more than 550 million metric tons of carbon equivalents a year — is what the industry needs to eliminate.
Keep in mind that the U.S. is the largest emitter of carbon emissions historically, at 25% of total emissions since 1750. (The U.S. currently ranks second to China in annual emissions and ninth in emissions per capita.) As for energy consumption by U.S. hospitals, it is more than two times that of an average European hospital. This means the U.S. bears a greater burden to reduce emissions.
Instead of merely reaching the Biden administration’s target of a 50% reduction from 2005 levels by 2030, the health care industry should reduce its carbon emissions by 195% — cutting emissions by 70% by 2030 and facilitating the remaining 125% by financing developing countries’ health care emission reductions particularly since, again, U.S. health care emissions disproportionately cause health harm worldwide.
Urge President Biden to declare a climate emergency. The action collaborative should immediately urge President Biden to declare a national climate crisis emergency, as more than 100 U.S. cities and counties have done, along with the entire European Union and other countries totaling a population of one billion people. Beyond helping establish the collaborative’s bona fides, presidential action would send a necessary international signal. Declaring a national emergency is not necessarily virtue signaling. Doing so grants the president additional powers under the National Emergencies Act. For example, President Biden could re-institute the ban on U.S. exports of crude oil that President Obama lifted.
Create a regulatory pathway to eliminate the health care industry’s carbon emissions. To begin, the industry needs to stop digging the hole and rapidly reduce its carbon footprint. The collaborative should convince HHS to publish by the end of 2021 an interim final rule that would amend hospitals’ Conditions of Participation to require them to publicly report their carbon emissions, which Walt Vernon and I proposed in a First Opinion essay in June, and then to submit detailed plans to rapidly eliminate emissions that they directly discharge as well as those they indirectly emit via purchased electricity. The collaborative should not waste time researching and recommending more formal sustainability reporting since these have largely proven to amount to greenwashing.
To help accomplish this, HHS should sign a cooperative agreement with the Environmental Protection Agency to achieve this goal via use of the EPA’s Energy Star Portfolio Manager that most hospitals already use, albeit for other purposes. The collaborative should also urge HHS to require hospitals and other sizable health care facilities to comply with the Department of Energy’s ASHRAE 90.1 standards that outline minimum requirements for energy-efficient design.
Supply chain emissions account for more than 70% of total health care industry emissions. As outlined in an April memo to HHS Secretary Xavier Becerra signed by nearly 70 organizations that that identified more than 60 climate crisis-related policy reforms, the FDA needs to immediately incorporate emissions reduction into pharmaceutical and medical device rule-making. Considering the size of the health care industry, addressing its supply chain emissions would have a substantial economy-wide knock-on effect.
Provide technical support to hospitals. The collaborative should design and launch by early next year a technical support program that instructs hospital chief operating officers how to reduce their facilities’ direct and energy-related emissions. Useful resources for doing so include the International Energy Agency’s comprehensive road map outlining government actions to rapidly boost clean energy use and the work of sustainability expert Mark Jacobson, who has argued for over a decade that the only obstacles to rapidly transitioning to a clean energy economy are political.
Reinvent the CDC’s Climate and Health Program. HHS’s only ongoing climate crisis effort is the Centers for Disease Control and Prevention’s Climate and Health Program, which currently funds eight states to improve their climate resiliency. This program is mainly playing defense, essentially an impossible task because even if the climate crisis was not a quotidian reality, effectively preparing for or minimizing climate disaster events is financially impossible.
The collaborative needs to reinvent the CDC program. In doing so the collaborative should take a lesson from the United Kingdom’s National Health Service, which has been working to address its carbon footprint since 2008. Over the past decade, the NHS has reduced its carbon emissions by an estimated 62% compared to a 1990 baseline.
HHS also clearly lacks requisite sufficient climate and health staff; the collaborative should also recommend HHS quickly acquire this expertise.
Create climate financing. The U.S. fossil fuel industry receives $650 billion in annual subsidies, which is increasingly irrational due to the dramatic decline in prices for renewable energy. The collaborative must make the case that fossil fuel subsidies are killing people in the U.S. and around the globe. Because the mass of health care providers cannot independently achieve zero emissions, the collaborative should work with health care foundations and others to create an entity like Breakthrough Energy to fund the formation of an energy services company to help the industry simultaneously curb its carbon emissions and drive commitments to buy clean energy. To date, the community of philanthropic foundations has been absent on this issue. For example, the W.K. Kellogg Foundation, dedicated to assuring all children have an equitable and promising future with its $7 billion endowment, does no climate crisis programming.
Enforce climate-related civil rights protections. Like the Covid-19 pandemic, the climate crisis worsens health inequality, making it a racial justice issue. It is inexplicable that over the past five years, the HHS Office of Civil Rights has never issued a single bulletin or news release related to the climate crisis, here understood or defined as environmental racism. With at least 1,550 climate litigation cases worldwide, including many in the U.S., increasingly compelling governments to implement climate commitments, the collaborative must compel the Office of Civil Rights to protect Medicare and Medicaid beneficiaries’ right to a healthy environment.
Should the NAM’s effort fail, it will give new meaning to the aphorism that the road to hell — here Hothouse Earth — is paved with good intentions.
David Introcaso, a vice president for regulatory policy at Strategic Health Care in Washington, D.C., has done environmental and health care policy research for the U.S. Congress, the Department of Health and Human Services, and a range of non-profit and for-profit clients. The views expressed here are his own.
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