Healthcare confronts climate change: Schools, providers focus on health effects to dampen political opposition

A number of medical, nursing and public health schools around the country are launching programs to train students about the effects of climate change on health and how to reduce its impact.

In addition, some health systems have established ambitious green initiatives to reduce their own carbon footprint and inspire broader climate change initiatives.

Some leaders of the efforts say they are stressing the health-promoting features of the initiatives to minimize political opposition to mentions of climate change.

In April, about 30 leaders of U.S. medical, nursing and public health schools met at the White House and pledged to train the next generation of healthcare professionals in how to address the health effects of climate change. “Climate change is absolutely a critical public health issue,” said Dr. Ali Khan, dean of the University of Nebraska Medical Center's College of Public Health, who attended the meeting along with Dr. Bradley Britigan, dean of the university's College of Medicine.

Johns Hopkins University's Bloomberg School of Public Health also signed the White House pledge. Dr. Cindy Parker, director of Johns Hopkins' global environmental change and sustainability program, said the school plans to host a climate change and health symposium this fall in advance of the U.N. Climate Change Conference in Paris this December.

Parker, author of a 2008 book on climate change and health that is used as a textbook, called climate change “a risk amplifier. There isn't a disease that directly results from climate change. It just makes some more likely.”

Tulane University's School of Public Health and Tropical Medicine is another school committed to training future healthcare professionals about climate change. LuAnn White, director of the Tulane Center for Applied Environmental Public Health, said the school will integrate climate change into existing courses rather than create a new program.

Sue Ann Bell, a clinical associate professor at the University of Michigan School of Nursing, is pleased the school plans to provide climate change-related education “because it's very important for nurses to take leadership on this important issue,” she said.

“Climate change is a hot-button topic. So as a nurse educator, I focus on the empirical facts,” she added. “We're seeing longer allergy seasons, and because of that, we're seeing increased respiratory disorders.”

Kathleen Potempa, dean at the University of Michigan School of Nursing, said her school will take a big-picture perspective on the issue.

“Climate change is presumed to affect health in many ways directly as thermal stress, extreme weather disasters and infectious disease,” she said. “We are preparing our students to be leaders in a global context.”

During last week's G7 summit meeting in Germany, the world's leading economic powers, in a nonbinding agreement, pledged to work to keep the Earth's temperature from rising more than another 2 degrees Celsius by reducing their use of fossil fuels and promoting renewable energy in developing countries. But conservative Republicans in the U.S. continue to dispute climate change and how much of any change is due to human activity, despite overwhelming scientific consensus on both issues. That is holding up strong policy action to mitigate climate change.

Angela Wan, a graduate student at U-M's School of Public Health who is currently an intern in California, said public health and healthcare leaders need to talk a lot more about the effects of climate change. “It's affecting the health of their patients—it isn't just about polar bears,” she said.

Wan, a U-M nursing school graduate, last summer launched the Nurses for Cool and Healthy Homes program, which piggybacked on a home-visit program by the Fresno County (Calif.) Department of Public Health. She and her colleague Valerie Tran described their program as a “climate change intervention by public health nurses.” It got started with the help of a grant from the international not-for-profit Health Care Without Harm.

Wan and Tran hired a nursing student who helped 30 public health nurses incorporate a home environmental assessment into their visits to about 425 clients in the program. During the visits, mostly for women and children, the nurses determine the clients' vulnerability to extreme heat in their home.

They also recommend passive cooling strategies and refer clients to resources with the local utility, Pacific Gas & Electric, a partner in the program, where they can get utility-bill assistance or help boosting the energy performance of their home. The goal is to avoid negative health impacts of extreme heat while reducing the homes' carbon footprint.

Tran added that for many clients, it's not safe to leave windows open at night. But Pacific Gas & Electric staff showed participants how to use weatherstripping and other low-cost methods to keep their homes cool. “We were concerned with this program just being a promoter of air conditioning,” Tran said. Adding shades and sealing cracks lets people keep their homes cooler without air conditioning.

Tran said leaders of the county Public Health Department recognized that heat-related illness needed to be addressed. But they were nervous about political reactions from the Fresno County Board of Supervisors, given that the area leans conservative Republican. To avoid stirring up a political hornet's nest, the program focused on a healthcare message.

“It's a project about extreme heat and you can't deny extreme heat is a problem,” she said. “With the nurses, whether or not they believe climate change exists, they see the babies sweating and being in bad condition.”

The University of Nebraska's Khan said Nebraska clinicians' ability to take up climate change is strengthened because the issue is taken seriously in a heavily agricultural state where temperature and water conditions are key to the economy. In addition, more frequent heavy rainfalls have led to flooding, which contributes to waterborne diseases. And vector-borne diseases spread by ticks, mosquitoes and other bugs now can survive farther north later in the year. “The patterns of existing diseases are changing from what we were taught,” he said.

Meanwhile, some health systems around the country are addressing climate change through promotion of energy conservation and renewable energy production, though they, too, face political sensitivities in conservative areas.

Mark Platt, senior vice president of business operations at the La Crosse, Wis.-based Gundersen Health System, said that CEO Dr. Jeffrey Thompson's decision in 2008 to pursue renewable energy production was not universally popular at the time and that the climate change message continues to get some pushback. “Our CEO didn't say he was taking on climate change,” Platt said. “He said our mission is the health and well-being of our community, and how we produce power causes pollution and pollution causes health problems.”

Platt said Gundersen focused on the “brutal facts,” including that the health system was the largest energy consumer in the region and filled the air with carbon dioxide, particulate matter and mercury. “We know what that does to people,” Platt said.

Last October, however, Gundersen “broke the sound barrier” by producing more energy from its renewable energy sources than it consumed, Platt said. The energy comes from wind and solar; methane from the manure of 2,000 cows from a nearby dairy; geothermal heating and cooling sources drawn from the ground underneath a parking lot; and a biomass boiler that creates energy from wood chips. Where the system used to get natural gas from companies in Pennsylvania and Texas, it now gets wood from local sources.

The system spent $40 million on its renewable energy projects, with $11 million of that supplied by local, state and federal grants. In 2008, it spent $2 million on energy conservation projects, which now help produce $1.3 million in annual savings on its electricity bill.

Gundersen assembled energy engineers to design and implement its energy program, and it's now exporting their expertise as the Gundersen Envision consulting service. “We've shown some big systems in a two- or three-day energy checkup how to save 20% on their energy costs,” Platt said.

In April, Gundersen joined Health Care Without Harm's 2020 Healthcare Climate Challenge, an international effort to reduce healthcare's carbon footprint and protect the public health from climate change. Oakland, Calif.-based Kaiser Permanente and Seattle's Virginia Mason Medical Center also are participating.

Under Virginia Mason's EnviroMason program, the organization reduced electricity consumption by 3.4 million kilowatt hours from 2012 through 2014, which saved more than $607,000. It also conserved 7.3 million gallons of water during the same period and saved almost $440,000. “You can't separate the health of the planet from the health of its people,” said Brenna Davis, Virginia Mason's director of sustainability.

Virginia Mason also helped launch a local initiative, the Washington Business Climate Declaration, which includes Seattle Children's Hospital, the Seattle Mariners baseball team, Microsoft Corp. and REI, the outdoor recreational equipment retailer. Its members support using energy efficiently, investing in cleaner fuels, advancing renewable energy and reducing greenhouse gas emissions.

The healthcare industry generates about 8% of the nation's greenhouse gases, said Ramé Hemstreet, chief energy officer at Kaiser Permanente, and he said his organization is doing its part to lower that number. In 2008, Kaiser pledged to reduce its greenhouse gas emissions by 30% by 2020. Kaiser has started building carports in its parking lots and installing solar-photovoltaic panels on top of them.

The program started at 11 sites in California in 2010. Plans now call for expanding the concept to about 170 sites including hospitals, medical office buildings, data centers and other facilities. Combined, they will produce about 6% to 8% of Kaiser's California energy needs. A Princeton, N.J.-based company, NRG Energy, will build, operate and own the solar arrays that will produce about 70 megawatts of power that it will distribute back to Kaiser at a fixed cost. Kaiser also has solar installations in Colorado, Hawaii and Oregon and is looking for opportunities in Maryland and Washington, D.C.

Hemstreet thinks the most significant move Kaiser has made has been to sign 20-year agreements with NextEra Energy Resources to purchase 110 megawatts of electricity from its solar energy plant in Riverside County, Calif., and 43 megawatts from its wind farm in Alameda County, Calif. With these purchases, Kaiser will reach its goal of a 30% reduction in greenhouse gases by 2020 three years early, and half of its California energy needs will come from renewable sources. The 590 million kilowatt hours in renewable energy that Kaiser and its partners will produce is enough to power 82,000 homes.

Kathy Gerwig, Kaiser's environmental stewardship officer, said her organization's efforts to mitigate climate change are part of its mission to improve health. “Preventing disease is always better than treating it after it's diagnosed,” she said.