This past Thursday the House Ways and Means Committee, with jurisdiction over the Medicare program, held a hearing titled, “Preparing America’s Health Care Infrastructure for the Climate Crisis.” The hearing, the first and only climate crisis-related hearing Ways and Means will hold this Congressional session, was motivated in part by Democratic majority staff’s release of findings resulting from three requests for information (RFIs) majority staff forwarded to industry providers, trade associations and group purchasing organizations earlier this year to help majority staff “better understand how climate events have impacted the health sector, as well as steps the health care industry is taking to address its role in mitigating the climate crisis.”
The hearing and accompanying RFI findings are notable for at least five reasons.
In introducing the hearing Chairman Richard Neal (D-MA), repeatedly defined the climate crisis as a “extreme weather,” “climate-related weather events,” “changing weather patterns,” and weather-related risks.” As I’ve noted numerous times it is beyond understanding why federal policy makers, including HHS’ Centers for Medicare and Medicaid Services, continue to propagate the fiction that climate crisis-health harms are limited to those associated with periodic weather events, catastrophes or disasters. Once again, the climate crisis health harms are both innumerable and unrelenting. For example, 93% of Americans breathe substandard air largely due to fossil fuel combustion and per a recent study published in Nature Climate Change 58% of infectious diseases are aggravated by more than 1,000 climate hazards or pathways.
As for the views of Ways and Means Republicans, in his opening remarks Ranking Minority Member, Kevin Brady (TX), refused to recognize the climate crisis arguing instead that the Democrats were engaged in forwarding what he termed “catastrophic green new deal policies” and what hospitals needed instead was affordable, reliable and resilient energy regardless of the source.
The hearing’s substantive benefit was found in the testimony provided moreover by Yale’s Dr. Jodi Sherman and Providence’s Dr. Elizabeth Schenk. (Readers are encouraged to read both.) On balance, regarding the healthcare industry’s efforts to date to decarbonize, Dr. Sherman concluded, “the vast majority of US health care organizations remain uncommitted to timely action” despite noting healthcare “is a major polluting industry” being one of “the most carbon intensive service sectors in the industrialized world.” Therefore, she stated, “voluntary measures are insufficient to transform the health care sector.” “Legislative action is urgently required to compel decarbonization.” Specifically, she argued, as have I, standardized public reporting and decarbonization targets and timelines need to be required. Reducing greenhouse gas (GHG) pollution should also become a mandated part of Medicare and Medicaid quality performance benchmarking and performance-based payments for all healthcare organizations.
Dr. Schenk’s comments served as an example of what’s possible. In order to meet their goal of becoming carbon negative (defined as offsetting more carbon than emitted) by 2030, Providence systematically tracks resource usage and cost on a monthly basis for all its 52 hospitals. Concerning energy consumption, 26 healthcare facilities in Washington and Oregon are presently operating on 100% renewable electricity. Providence anesthesia clinicians have reduced carbon emissions from anesthetic agents by 70 percent saving $3.5 million annually. Concerning transportation, Providence tracks emissions from business flights, rental cars, hotel stays, from employee commuting and from reimbursed miles when traveling for home visits, hospice care and other local business travel needs. The organization has estimated a 90% reduction in business travel during 2020 and 2021 and intends to sustain reductions by at least 50% compared to 2019. Concerning water use, hospitals in California have among other things upgraded their scrub sinks to antimicrobial laminar flow devices. Providence partners with food service vendors to reduce the carbon intensity of meals served and ensure sustainable and socially responsible food purchasing practices. Providence is presently working to divert more than 50% of its total organization’s waste away from landfills, some hospitals have already achieved this goal. Regarding work processes, Providence uses hybrid workspaces to allow more remote work and employs telehealth services when and where possible.
Concerning the majority staff’s coincident release of its RFI findings, first, majority staff’s inquiry amounted to a convenience survey. Since participants were not randomly selected, it is difficult if not possible to draw generalizations. Nevertheless, majority staff recognized (part 1), that the climate crisis is also responsible for increasing rates of disease, for example asthma, and that the crisis is also responsible for increases in infectious and vector-borne diseases and compromised food supplies.
Consistent with related studies, majority staff learned that only a third of respondents noted they had implemented climate preparedness plans. Majority staff also confirmed efforts to respond to the climate crisis were preliminary. For example, some respondents noted they had established working groups, had prepared guidance documents regarding preparation and response versus resilience and mitigation.
The majority staff’s conclusion (part 4) noted that they had corresponded with a number of entities that chose not to participate because, in part, they did not see “the relevance of the questions being asked” or noted “skepticism of the need for such de-carbonization and climate resiliency work.” These comments help explain why the majority staff’s conclusion opens with, “Findings from this RFI paint a picture of a US healthcare system only beginning to feel the damaging effects of climate-related weather events.”
Their conclusion is likely accurate in that this does appear to be the perception. For example, John Kotcher’s 2021 Lancet-published survey of clinicians’ understanding of climate crisis health effects found the same. Less than half of his survey respondents thought the climate crisis caused heat related illnesses, vector borne infections and disruptions in healthcare service delivery. It would have been more accurate and productive for majority staff to conclude US healthcare providers are “only beginning to recognize the damaging effects” and what this means considering the dire state of the climate crisis. Two days before the committee’s hearing seven organizations led by the UN Environment Programme, released a report under the name, United in Science, that found that the planet continues to warm rapidly. Among other conclusions, the group found there’s a 50% chance that during at least one in the next five years the earth will warm to 1.5C. UN Secretary General António Guterres concluded the “report shows climate impacts heading into uncharted territory of destruction.”
Thanks for this analysis, David, and thanks for beating the drum to get this important issue onto agendas for discussion and action.