By Sarah Fiorello

By: Andreas Psahos

There’s no sugarcoating it: Healthcare across the globe is lethal, and no, it isn’t because of COVID.

In 2016, the Yale School of Medicine reported that if the U.S. healthcare system were an independent country, it would rank 13th in the world in greenhouse gas emissions. That’s about 1% of all gases emitted into the atmosphere globally, and a higher climate impact than the entirety of Brazil, Australia, or the United Kingdom. The same report estimated that U.S. healthcare emissions have led to 12% of the country’s acid rain, 10% of the smog formation, and 9% of the respiratory diseases caused by particulate matter.

Talk about creating a vicious cycle of demand. If the thought of a killer healthcare system does not horrify you, here’s a hint: it should. Far from your childhood fear of getting a needle in the arm at the doctor’s office, it is disturbingly paradoxical reality that, for 9% οf people with respiratory disease in this country, the institution that is treating their life-changing illness is the one that gave it to them in the first place.

This phenomenon is not unique to the U.S., though we might be the most egregious example. The combined emissions from the hospitals, health services and medical supply chains of the OECD countries, China, and India amount to 4% of the global total, a greater percentage than aviation or shipping. Of these developed countries, only four so far have conducted any sort of governmental research on the footprint of their healthcare systems.

Across the globe, a simple analysis of our global capability to provide care reveals an anxiety-inducing, irreconcilable paradox between keeping humans and the environment healthy. We are at an impasse unique to the realities of decades of climate change inaction. But does healthcare have to be a tradeoff? Or can a reconception of climate change as a public health crisis and a reorientation of global healthcare systems allow us to pursue both climate action and universal healthcare simultaneously?

The negative health outcomes associated with climate change are well-documented, and they pose an incredible challenge to universal healthcare in the coming decades. Regardless of geographic location, a 2016 Harvard study estimated that a temperature rise of 1° Celsius would be predicted to increase cardiovascular mortality by 3.4%, respiratory mortality by 3.6%, and cerebrovascular mortality by 1.4%. Not only will infectious diseases like salmonella and malaria proliferate in ever-so-warm environments, but they have already begun to spread to elevations that were once too cold to allow for efficient transmission.

Examples of Climate Impacts on Health Outcomes. Source: U.S. Global Change Research Program, 2016 Climate and Health Assessment, Figure ES1

For incurable, non-communicable diseases, properly treating the increasing volumes of cases will only continuously pressure healthcare systems already at capacity. Rapidly shifting disease burdens will overwhelm healthcare in developing countries, with the most apparent vector of transmission being the hundreds of millions of climate refugees who will bring novel diseases and increased need to neighboring countries en masse. Climate disasters have the capacity to damage local healthcare infrastructure and global supply chains, as Bangladesh’s floods and Hurricane Maria in 2017 can attest to, respectively. In countries where healthcare is rudimentary and constantly upended by poverty, war, and famine, the impact of climate change on health is quickly transforming into “the major threat of the 21st century,” according to a 2017 report from the Lancet Countdown on Health and Climate Change.

Globally, healthcare has failed to meet the challenge of climate change, instead continuing to contribute to it in record amounts — over the last decade, U.S. healthcare emissions have increased by 30%.

However, there are both ethical and pragmatic considerations as to why climate change should be a chief focus of medical professionals moving forward. According to a 2008 paper published in the American Journal for Public Health, there are four distinct public health ethics that medical decision making should seek to preserve — autonomy (individual liberty), beneficence (helping the sick), nonmaleficence (not causing unnecessary harm), and justice (equitable care). Climate action and healthcare align perfectly in the last three goals and turning a blind eye to climate health would directly counteract them. In order to provide equitable services that help those in need and while preventing unnecessary negative outcomes, it is healthcare providers’ ethical obligation to build a global network that puts climate health and sustainability in the forefront.

The best method of finding solutions to the death spiral of healthcare-induced climate change is to examine why healthcare systems in developed countries are emitting such massive quantities of greenhouse gas in the first place. For the U.S., the problem is two-fold. Countries like the U.S. (of which there are many) have established a fee-for-service model of healthcare, where doctors are economically incentivized to overprescribe drugs and expensive diagnostic tests for their patients. On top of the fee-for-service model, inefficient hospital heating, electricity use, and emissions-heavy medical goods all add to an increased footprint.

Professor Helga Weisz, one of the scientists behind a 2019 report conducted by the Potsdam Institute for Climate Impact Research on methods of reducing healthcare emissions, advocates for a massive revolution in how care is delivered globally; a shift from curative to preventative healthcare — or to proactively stop crises from forming, a direct example of the nonmaleficence ethic. Current ongoing crises in the U.S. like the opioid and obesity epidemics have developed sizable emissions footprints all their own due to the strain they put on healthcare systems. Focusing on preventative messaging would be the most carbon-neutral solution that would not reduce the level or quality of service, but rather keep patients healthier longer.

A glimpse at the regional health crises across the United States spurred by climate change. Source: U.S. Global Change Research Program, 2016 Climate and Health Assessment, Figure 1.1.

Ideally, healthcare systems and global supply chains need to be reshaped to factor in the dangers of climate change and reduce their own contribution to the climate crisis. To reduce emissions, healthcare providers should be obliged to factor sustainability into their models, reduce electricity use, and adopt medical goods with less unnecessary packaging. To mitigate the already negative outcomes associated with climate change, the only way improvements can effectively be made is on the regional and community levels. In this way, the U.S. is no different than isolated islands in Bangladesh ravaged by floods. Disaster preparedness is particular to each region of the U.S., from wildfires and droughts to cold waves and sea level rise. Encouraging those in healthcare to investigate and report on the health impacts of regional disasters while partnering with community groups in case of sudden weather events would work to unravel the fee-for-service model of healthcare and provide an avenue for long-lasting, preventative climate health action.

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