The Health Care Industry’s Climate Nihilism

Late last year, Alex Azar, secretary of the Department of Health and Human Services, stated in a speech that physicians “can’t simply write a prescription for . . . clean air.” 

Azar’s comment is tragically true in part because the health care industry is responsible for substantial greenhouse gas emissions that result in significant health harm.  The health care industry has also taken little interest in publicly reporting its GHG pollution and more substantively the resulting threat global warming poses to our survival.

In 2016, Matthew Eckelman and Jodi Sherman calculated the health care’s carbon footprint.  For the first time, they also estimated the resultant health consequences. The authors found the industry is exceptionally energy intensive.

In 2013, the industry was responsible for emitting 655 million metric tons of carbon dioxide equivalents, a 30 percent increase over 10 years. This represented nearly 10 percent of the total U.S. GHG emissions. If the industry were a country, it would rank 13th worldwide in GHG pollution.

The authors’ estimated health harm or burden in 2013 was at 470,000 disability-adjusted life years lost. “These indirect health burdens,” the authors concluded, “are commensurate with” the 44,000 to 98,000 annual hospital deaths the Institute of Medicine estimated from preventable medical errors.  

Other researchers estimated 58 percent of all excess U.S. deaths are attributable to the burning of fossil fuels. The overall effect the health care industry’s GHG pollution has on the national burden of disease is, they concluded, “significant.”

Though they did not attempt to calculate it, health care’s GHG pollution unavoidably contributes to global health harm.  Worldwide, upward of 9 million individuals die prematurely from ambient air pollution — a principal source is the burning of fossil fuels.  It is also worth considering how many lives are needlessly lost due to the fact that approximately one-third of U.S. health care is estimated as wasteful.

The extent that the industry recognizes or reports its emissions was recently examined by two Mount Sinai researchers. In research published last August, Emily Senay and Philip Landrigan found the health care sector “lags far behind” in disclosing GHG emission information.

“The business world,” they wrote, “has substantially surpassed the health care delivery industry in responding to the demand created for greater accountability for the environmental and social impacts of the enterprise.” For example, only 12 percent of health care organizations on the Fortune 500 List, as well as 12 percent of HCOs on the Forbes 100 Largest Charities List, reported their emissions to the Carbon Disclosure Project. This compares to 77 percent of all S&P 500 corporations reported emissions, none of which were health care organizations.

That the health care industry ignores its contribution to global warming is unsurprising.  Among related evidence, The Lancet’s 2018 “Countdown On Health and Climate Change” report found that of $428 billion committed in 2017 to fossil fuel divestment, the health care sector was responsible for $3 billion.

When Congress debated a carbon trading bill in 2009, Open Secrets showed no medical association lobbied in support.  When the White House announced it would withdraw the United States from the Paris climate accord, no prominent health industry associations protested. These organizations were also quiet when the U.N.’s Intergovernmental Panel on Climate Change released last October its shocking report “Global Warming of 1.5° C.”     

There are exceptions. Last September, Kaiser announced its purchase of 180 megawatts of clean energy that would power about two-thirds of its hospitals.  Kaiser also joined with other providers to form the California Health Care Climate Alliance.  The alliance is one of over 3,500 subnational actors working under the banner We Are Still In to meet the U.S. pledge under the Paris climate accord to reduce emissions by 28 percent below 2005 levels by 2025.  Absent federal engagement, however, WASI efforts in sum will fall substantially short of reaching the U.S. commitment.

Our planet has warmed by an average of 1° Celsius.  The latest analysis shows global warming will increase by over 3°C before this century’s end based on current policies. This would be considerably warmer than the 1.5°C limit the IPCC identified last year to avoid the catastrophic effects of warming to 2°C.  

The difference between 1.5° and 2°C is equal to 150 million more premature deaths from warming.  Far worse, 2°C of warming would likely constitute a tipping point whereby temperatures, absent use of currently nonexistent negative emissions technology, will rise uncontrollably.

For example, methane, a far more powerful greenhouse gas than carbon dioxide, would be released from melting Arctic permafrost.  This reality may already be unavoidable since the U.N. reported Arctic temperatures rising by 3° to 5°C are now inevitable. This explains why the IPCC concluded GHG pollution must be reduced by 45 percent from 2010 levels by 2030 and by 100 percent by 2050.

It should go without saying health care should have been playing the leading role in addressing global warming. Today, it should be demanded particularly because of reciprocal business and health outcome benefits.  

Per the International Renewable Energy Agency, renewables are now in line with fossil fuel costs, and by next year, electricity generated by renewables will be “consistently cheaper” than fossil fuels.  This is why over a hundred major banks have restricted their fossil fuel lending or left the business.  

As the World Resources Institute recently concluded in “The New Climate Economy,” transitioning to low carbon presents a $26 trillion economic gain by 2030 due, in part, to improved population health.  Research recently published in The Lancet Planetary Health concluded “the health co-benefits substantially outweighed the policy cost of achieving the target for all the scenarios [limiting warming] that we analyzed.”  

Kaiser’s goal to be carbon-neutral by next year is not strictly altruistic.  It is a sound business decision that further enables its patients to thrive. Azar should know providers can write prescriptions for cleaner air, and as the nation’s leading health official, he should lead the way in enabling them.   


David Introcaso, Ph.D., is a health care research and policy consultant working moreover with large, integrated health care systems. His comments are his own.

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