We Must Connect the Climate Crisis with Human Health

by David M. Introcaso

Tragically, President Biden’s 21-page “Tackling the Climate Crisis” Executive Order signed January 27th failed to make any effort to address the increasingly dire health effects caused by the climate crisis.  This may seem surprising since, for example, just one-month earlier Lancet published its fifth, well publicized and highly regarded annual report, “Countdown on Health and Climate Change.”  The report’s introduction opens by asserting planetary warming is “resulting in profound, immediate and rapidly worsening health effects.”  Nevertheless, the executive order makes no mention of the Medicare and Medicaid programs and ignores the fact the US health care industry’s greenhouse gas emissions significantly contribute to climate crisis-related health effects.  This is disturbing since the federal government, responsible for safeguarding the health of America’s most vulnerable citizens, should not allow the healthcare industry to systematically harm their health.

We have known for decades that greenhouse gas emissions significantly contribute to the prevalence and exacerbation of numerous disease conditions.  The Countdown report documents at length morbidity and mortality due to heat stress and heatstroke, wildfires, flood and drought and the transmission of numerous infectious vector-born, food-born and water-borne diseases including dengue, the incidence of which has grown thirtyfold over the past 50 years threatening half of the world’s population.  The Biden administration is aware that during the past 20 years there has been a 54% increase in heat-related deaths among those over age 65 and that nearly half of Americans breathe unhealthy air that explains why fossil fuel use accounts for 58% of excess US deaths annually.  The administration knows this because the Obama administration published in 2016 the nearly encyclopedic report, “The Impacts of Climate Change on Human Health in the United States.”

We also know the US healthcare industry is an immense $4 trillion market.  Its size, along with the fact it is energy intensive, hospitals are second only to food service facilities in power consumption, means the industry is responsible for a significant percent of total US greenhouse gas emissions at 10%.  (The industry is responsible for 25% of global healthcare emissions.)  In sum, this means the US healthcare industry’s carbon emissions account for, researchers concluded in 2016, an estimated 98,000 American deaths annually.  For deaths worldwide via US healthcare industry emissions multiply by three.

Those most harmed by the industry’s greenhouse gas emissions are ironically its core patient populations: children; childbearing age women; the frail elderly; and, those with pre-existing conditions, or moreover Medicare and Medicaid beneficiaries.  While the Medicare and Medicaid populations account for 35% of all those insured, a study published in 2019 found that approximately two-thirds of healthcare costs resulting from ten, 2012 climate disasters were billed to the Medicare (50%) and Medicaid (15%) programs.

To the extent the executive order’s failure to address healthcare can be explained, federal policymakers somehow fail to connect the climate crisis with human health despite the obvious fact there is only one health, planetary health.  As Countdown report editors felt forced to remind us, “human and environmental systems are inextricably linked.”

After extending and expanding renewable energy tax credits in the December 27th COVID relief bill, this past Congress’s most substantive effort to address the climate crisis was the release last June of the House Select Committee on the Climate Crisis’ 547-page report titled, “Solving the Climate Crisis.”  Despite its title and length, the report makes no recommendations to address the climate crisis in Medicare and Medicaid policy nor any to address the healthcare industry’s carbon emissions.  One might think the Medicare Payment Advisory Commission (MedPAC) and/or the Medicaid and CHIP Payment and Access Commission (MACPAC), independent Congressional agencies created in 1997 and 2009 respectively and given broad authority to recommend improvements to these programs, would have by now addressed the topic.  Neither has ever discussed.

 As the Countdown report notes, “climate change continues to be framed in ways that pay little attention to its health dimensions.”  “In the mind of the public,” the report stated further, “health and climate change represent different and separate realms of knowledge and concern.”  Evidence abounds.  Health Affairs, advertised as “the leading journal of health policy thought and research,” did not address the climate crisis until this past December, or 40 years after the publication was launched.  Inside Health Policy, Kaiser Health News, Morning Consult, Politico Pulse, all daily online health policy publications, ignore the subject.  The New York Times, for example, found no value in reporting the UN Secretary General’s recent “State of the Planet” address in which Antonio Guterres bluntly stated, “the state of the planet is broken” because “humanity is waging war on nature.”  As a result, “human activities are at the root of our descent towards chaos.”  Though the world is currently experiencing its sixth mass extinction, largely due to Anthropocene warming, biological annihilation evidently is not the concern of US healthcare policymakers.

The healthcare industry’s assessment of and contribution to the climate crisis can be termed nihilistic.  Research published in 2018 found the healthcare industry largely ignores publicly reporting its greenhouse gas emissions.  As few of 12% of large healthcare organizations publicly reported their emissions compared to 77% of S&P 500 corporations, none of which were healthcare organizations.  The industry has also largely ignored divesting in fossil fuels.  Between 2008 and 2019, the Countdown report found that out of the 1,157 organizations divested in fossil fuel funds only 23 were health institutions.  Of the $4 trillion divested in fossil fuels in 2019, health institutions divestment equaled $19 million.  A survey published in 2019 found that two-thirds to three-fourths of essential hospitals, those disproportionately serving Medicaid patients, had made no commitments to address climate crisis mitigation or resilience.  As for industry trade associations, in 2009 they were silent regarding the Waxman-Markey Congressional bill that would have created a carbon emissions trading plan, silent in 2017 when the US withdrew from the Paris climate accord and silent last year when the US Ninth Circuit ruled in the Juliana v. US case that Americans do not have a constitutional right to a survivable climate.

The Biden administration has both an opportunity and a responsibility to address the healthcare industry’s emissions and appropriately do so via Medicare and Medicaid regulatory reform.  Among other regulatory policies the administration should require the industry under Medicare and Medicaid program conditions of participation to report its greenhouse gas emissions and provide plans to, over an appropriate length of time, reduce its carbon footprint.  These policies have precedent and are achievable.  For example, the NHS has tracked and substantially reduced its greenhouse gas emissions since 2008 and last year Kaiser Permanente became the first US healthcare organization to be certified carbon neutral.  The cost of renewable energy has so declined, this past decade solar energy prices fell ninefold and wind power by 40% and utility scale batteries by 70% over the past five years, that the barriers to the US healthcare industry going green are neither technological nor economic, but political.  Among other policy reforms the administration should pursue is to tie emission reductions to Medicare’s increasing use of pay for performance reimbursement models, to federal funding of state Medicaid programs and to link climate crisis-related clinical care measures to quality benchmarking and performance rewards.