Taking action on climate change today could lead to a more resilient Future of Health tomorrow

By Elizabeth Baca, M.D., M.P.A., specialist leader, Deloitte Consulting, LLP

I’m a physician who now focuses on health care strategy and innovation. Some people are puzzled when they hear that I also spend a lot of my time thinking about climate change. At first glance, climate change doesn’t seem remotely related to medicine or health care strategy. However, they are profoundly intertwined. Environment and climate have a direct impact on everyone’s health and well-being. The other side of the coin is that our health care system broadly affects the natural environment.

When I was a practicing pediatrician, I typically worked with children and families who lived in distressed communities. Some of my patients were overweight or obese and often didn’t have access to safe outside areas to play. Other kids struggled with asthma and lived in areas with poor air quality. When I began working for the California Governor’s Office, one of our goals was to build healthy communities. We developed policies to open new parks and other healthy places to play. We also worked to improve air quality and to make healthy food more accessible. For me, there was an ah-ha moment.

As I noted in a blog last fall, up to 80% of health outcomes are affected by social, economic, and environmental factors. These drivers of health (also known as social determinants of health) include the physical environment, food, infrastructure, economy, wealth, employment, education, social connections, and safety. Climate change can have an exacerbating effect on all of those factors. For example, climate change not only has the potential to reduce nutritional value in food, it also can have a negative impact on food production, which can impact food security. In addition, climate change can lead to economic instability for businesses. This can result in potential job losses, which affects employment and wealth. Across the board, social and economic factors are at risk from climate change. Absent aggressive and rapid steps to cut emissions, chronic illnesses tied to the environment will likely get worse.¹ Health costs related to climate change and pollution are estimated at $820 billion a year, according to a recent report.²

An opportunity in confronting this challenge

The public health community has dubbed climate change the greatest threat to public health of the 21^st Century.³ In the United States, daily record-high temperatures now outnumber record lows two-to-one, according to NASA. The global average temperature has increased by 1.2-degrees Celsius since the mid-1900s.⁴ In the Pacific Northwest, and in Northern California where I live, record-breaking heat led to an increase in emergency room visits and as many as 200 deaths. Millions of us are under heat warnings.⁵

As the planet gets warmer, climate change increases the risk for wildfires, rising sea levels, extreme heat, severe weather, air pollution, and droughts. These factors can have a direct impact on health. For example, smoke from fires and higher pollen counts (caused by warmer temperatures) can lead to respiratory disease or exacerbate asthma. Moreover, severe weather—including extreme heat and droughts—can increase the risk for heat-induced illnesses including cardiovascular disease and heat stroke. Climate change is now evident on every continent. More than one-third of global heat-related deaths can be attributed to climate change, according to a recent study.⁶ Climate change will likely force millions of people to migrate to new areas, which could lead to more mental health issues and further stress health care infrastructures.⁷

On the flip side, mitigating and adapting to climate change presents an opportunity to remake the foundations of our society, including health care and systems that support health. As we emerge from COVID-19 and look to the future, health care leaders should consider how a systems-thinking approach could lead to new models for resilience. For instance, how can health systems invest in their communities to improve planetary and human health at the same time? What about leveraging purchasing power and general operations budgets to create demand for products that have an environmental and health benefit? How might emerging technologies such as virtual health, increased computing power from cloud, artificial intelligence, and machine learning be combined with new business models to create more resilience in our health care systems?

Solutions and the Future of Health

As my colleague Sarah Thomas noted in a recent blog, the health care sector has historically been a significant contributor of greenhouse gasses, that impact climate change. Hospitals are still the second highest energy user of any sector and use double the amount of energy per square foot as commercial office buildings, according to the Department of Energy.⁸ A recent study by researchers at Yale University determined that the US health care industry is responsible for roughly 10% of the country’s greenhouse gas emissions.⁹

Hospitals and health systems, along with health insurers and life science companies, are uniquely positioned to lead change. Improving health is part of their mission. We are in the midst of major transformation in health care, driven by sophisticated tools, emerging technologies, and increasingly interoperable data.

Organizations are taking steps to become part of the solution. Consider these examples:

• National Health Service (NHS): The United Kingdom’s publicly-funded health system, which provides about 17 million inpatient admissions a year, has been working to reduce its carbon footprint for more than a decade. Between 2009 and 2019, the NHS says it reduced carbon-dioxide emissions by 26%. A decarbonized UK electricity grid significantly reduced energy-related emissions, and the phase-out of chlorofluorocarbon propellants in inhalers also helped to decrease greenhouse gas emissions. More recently, increased use of telehealth monitoring, remote diagnostics, and virtual appointments is helping cut air pollution related to car emissions. The next step is to convert gas boilers to electric heat pumps and switch to a low-carbon energy source, according to NHS.¹⁰
• Kaiser Permanente: Last fall, California-based Kaiser Permanente announced that it had become carbon-neutral. Onsite, Kaiser Permanente installed solar panels, made long-term purchases of renewable energy, and took other steps to make its buildings more energy efficient. The organization is also sourcing local and sustainable healthy food for its patients and employees. They have also taken steps to substantially reduce food waste in their supply chain. Off-site, the health system invested in ways to offset emissions generated by its hospitals.¹¹
• CommonSpirit Health: The health system operates 137 hospitals and more than 1,000 care centers in 21 states. The organization intends to cut its energy use by 25% by 2030, reduce greenhouse gas emissions by 40% and cut water consumption by 25%. The health system is also looking to sustain and expand the use of virtual health. Since the pandemic began, CommonSpirit says it has provided more than 1.5 million virtual visits. Between March 16, 2020 and April 2, 2021, it estimates that virtual visits reduced gas emissions my more than 15,000 metric tons and saved patients about $3.5 million in fuel costs.¹²

Conclusion

The pandemic placed a renewed focus on the importance of health, health equity, and the need for proactive action against future disruption. Health stakeholders are uniquely positioned to lead by example both through their mission and operations. We have a short window for action and now is the time to act. 

Endnotes:

^{1.        The Lancet Countdown on Health and Climate Change, The Lancet, December 8, 2018} 

^{2.        Report: Health Costs from Climate Change and Fossil Fuel Pollution Tops $820 Billion a Year, Natural Resources Defense Council, May 20, 2021}

^{3.        The Lancet Countdown on Health and Climate Change, The Lancet, December 8, 2018} 

^{4.        2020 tied for warmest year on record, NASA analysis shows, NASA press release, January 14, 2021}

^{5.        Historic Northwest heat wave linked to dozens of deaths and hundreds of ER visits, CNN, June 30, 2021}

^{6.        The burden of heat-related mortality attributable to recent human-induced climate change, Nature Climate Change, May 2021}

^{7.        Planetary Health: Protecting nature to protect ourselves, Island Press, August 2020}

^{8.        Department of Energy announces launch of the Hospital Energy Alliance, Department of Energy, April 29, 2009}

^{9.        Health care industry is a major source of harmful emissions, YaleNews, August 2, 2019}

^{10.     Health care’s response to climate change: a carbon footprint assessment of the NHS in England, The Lancet, February 1, 2021}

^{11.     The first carbon-neutral health system in the US, Kaiser Permanente press release, September 14, 2020}

^{12.     CommonSpirit Health Sustainability Report FY2019}

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