FYI: The health care industry is not decarbonizing

Recently, four expert participants in the Department of Health and Human Services (HHS) and the National Academy of Medicine’s (NAM’s) co-sponsored action collaborative to decarbonize the health care industry signaled the industry is not interested in decarbonizing nor HHS in mandating. In a Dec. 14 article, these highly credentialed collaborative participants argued independently, their disclaimer explicitly noted their views are their own, that “GHG-related measurement and reporting should be a requirement for all health care delivery organizations.” Interestingly, the four admittedly failed to take the next logical and necessary step and recommend mandating GHG emissions be eliminated. It’s striking that four of the collaborative’s participants are apparently unwilling to support mandatory decarbonization and suggests the industry and HHS are likely not interested eliminating health care’s substantial greenhouse gas (GHG) emissions. Of all industries, the health sector can’t ignore the deadly impact of such emissions.

The four collaborative members do, however, discuss decarbonization at length. They admit the “urgency of the climate crisis and its implications for public health” and admit “measurement alone is insufficient.”  

“Mandatory reporting of emissions,” they recognize, “is only an enabling first step in implementing decarbonization.” Nevertheless, they chose not to recommend mandating decarbonizing and they do not explain why. One might think they would have been encouraged to do so by the Inflation Reduction Act that for the first time makes renewable energy development tax credits available to tax exempt health care providers. Instead, they make eight carefully parsed decarbonizing recommendations. These include recommending HHS “establish, communicate and promote shared decarbonization goals and time lines for the U.S. health care system;” Centers for Medicare & Medicaid Services (CMS) “develop policies that support decarbonization action and interventions;” and, the industry draft “climate action plans” with “science-based decarbonization goals.”

This is, in my view, disturbing since all 50 collaborative participants should be expected to know: health care accounts for nearly 9 percent of total GHG pollution that helps explain why the U.S. is the world’s largest per capita GHG polluter; even if met current climate goals will lead to 2.8 degrees Celsius of warming significantly higher than the Paris Climate Accord’s 1.5 degrees Celsius goal; warming that currently has reached 1.2 degrees Celsius on average globally, 1.4 degrees Celsius in the U.S., means we have likely passed five climate tipping points. This means some level of warming is now self-perpetuating. Today, no one on the planet can avoid fossil fuel-polluted air that presently accounts for one in five deaths globally. As for anthropogenic warming the UN concluded earlier this year, “everywhere is affected, with no inhabited region escaping the dire impacts from rising temperatures;” concerning the planet’s ongoing sixth mass species extinction, a problem even more immediate than climate breakdown, despite the fact one-quarter of all species currently face annihilation many within decades, the U.S. remains the only country not to sign the 1992 Convention on Biological Diversity. All this means in sum, “we are on a highway to climate hell” leaving us “staring down the abyss heading into uncharted territory of destruction,” meaning, UN Secretary General António Guterres has stated further, “we are digging our own graves.”

Despite being on the brink of climate carnage what possibly explains the failure by not just four but the entire HHS collaborative to pursue decarbonizing health care — particularly when the industry has to date demonstrated little interest in doing so. As the four collaborative members recognized, unlike all other major U.S. industries, health care, Emily Senay, associate professor at the Icahn School of Medicine at Mount Sinai, and her colleagues concluded last March, “lags far behind in terms of sustainability management and disclosure.” This is because, they explained further, “there is no sector-wide push from academic or industry leaders, government ... regulators ... or payors,” or exactly those that make up the HHS collaborative.

The collaborative is largely compromised of the American Hospital Association (AHA), the Biotechnology Innovation Organization, Pharmaceutical Research and Manufacturers Association (PhRMA) and UnitedHealth Group. Yet, mitigating the climate crisis does not appear to be a policy priority for either the AHA or PhRMA or the two health care sectors that emit the most GHG pollution.

National Academy of Medicine President Dr. Victor Dzau did not help matters when he seemed to argue during the collaborative’s launch event 15 months ago that there was no clear business case for the industry to decarbonize. This is true only if HHS and the industry want to ignore any or all of the innumerable and unrelenting health problems resulting from GHG emissions that potentially damage every cell and every organ in the body.

As for HHS, under a unified Democratic government over the past two years the department failed to forward any Medicare or Medicaid regulations that would either mitigate the industry’s 500 million ton annual carbon footprint or improve climate crisis-related care delivery. For example, the Health Resources Services Administration (HRSA) has yet to recognize the climate crisis despite the fact HRSA-regulated Federally Qualified Health Centers (FQHCs) provide care to moreover minority patients who are disproportionately exposed to climate-related harm.

Finally, it is worth putting a few items into context — if not dispelling a few tropes. The four experts note that just 61 health care entities have signed onto an HHS pledged to reduce their GHG emissions. This point is counterproductive as HHS does not require them to use standardized reporting metrics. Stating that reporting carbon emissions will be “onerous” ignores the fact there exist programs, for example Carbon Trace, that use satellite data to track human-caused GHG emissions. Noting that providers face other competing priorities misunderstands the climate crisis — as a meta problem it makes all other competing delivery problems unsolvable until when carbon emissions are no longer emitted into the atmosphere and oceans. That there is a “dearth” of climate-related HHS funding is the department’s choice. Regarding necessary funding to transition to renewable energy, beyond the health care industry’s ethical duty not to poison its patients air and environment, it is within the industry’s near and long-term financial interests to go green. Numerous studies show it has become cheaper to save the climate than destroy it.

Two weeks before the HHS collaborative launched last year, 200 health journals simultaneously published an editorial titled, “Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health.” It argued, “as health professionals, we must do all we can to aid the transition to a sustainable, fairer, resilient and healthier world.” We are definitively not. Shame on us.

David Introcaso, Ph.D., is an independent health care policy consultant specializing in climate crisis-related health care policy reform. He has conducted environmental and health care policy research for the U.S. Congress and the Department of Health and Human Services. He also is the creator and host of “The Healthcare Policy Podcast.”