Prescribing a climate remedy: Healthcare leaders aim to affect international climate change negotiations

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 Shore-LIJ 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 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 2-degree 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.”