Diagnosing the link between health and climate change

Public Health Watch

Climate change is rarely top of mind for people racing off to the hospital for an emergency, or even a more routine doctor's appointment — nor is the environmental toll of massive hospital facilities likely top of mind for doctors and other providers coping with long patient rosters.

Yet the link between health and climate change has been documented, and it's increasingly earning a spot on the broader agendas of health care organizations, national health policymakers and other stakeholders looking to bolster the resilience of communities.

Kaiser Permanente, for one, has an environmental stewardship officer and an extensive environmental mitigation program that has involved everything from switching out Polyvinyl Chloride plastic IV tubing and vinyl exam gloves — leading the industry to do the same — to shifting its power procurement so that 50 percent of the electricity used in its California facilities will come from renewable sources by 2016.

Last week, President Barack Obama also addressed the link between health and climate change, announcing new initiatives to expand data collection. The goal: better public sector understanding of the link between health and climate change, hopefully leading to better health policy responses.

In particular, Obama spoke about the rising prevalence of asthma, which many tie to greenhouse gas emissions, that is likely be exacerbated by more frequent wildfires spewing pollution into the air. He spoke of longer and more severe allergy seasons because of warmer weather and rising cases of insect-borne diseases brought on by warmer seasons and rising coastal waters.

To confront those daunting scenarios, the president is enlisting technology firms to help better assess health risks, pinpoint locational risks such as wildfires through mapping and boost preparedness and prevention.

Google, Microsoft and others are part of the initiative, with Google saying it will donate 10 million hours of computing time on advanced new tools to pinpoint risks. About 30 medical schools, nursing schools and public health degree programs also have pledged to train their students in the health impacts of climate change.

The most obvious health risk to climate change has been the rising cases of asthma in the U.S., particularly in industrialized urban centers. The number of asthma cases in the U.S. has increased by 48 percent in the last decade and now afflicts 24.6 million people, according to statistics from the American Lung Association. Children miss an accumulated 13 million school days a year because of asthma.

Seeking solutions

Aside from their role as providers trying to formulate a response to health problems linked to climate change, hospitals and the health care industry have started to step forward as part of the solution.

Hospitals — with their around-the-clock use of myriad medical devices and life-saving machines — are big users of electricity and collectively contribute in a big way to greenhouse gas emissions. Hospitals account for 8 percent of electricity consumption, while the health care industry as a whole contributes 8 percent of U.S. greenhouse gases, according to one academic study.

Kaiser Permanente is among health care organizations trying to mitigate pollution and greenhouse gas emissions within its operations. Some of the others with noteworthy efforts include Partners’ HealthCare and Spaulding Rehabilitation Center, both in Massachusetts, Dell Children’s Medical Center in Texas (which built the first LEED Platinum hospital in the U.S.) and Group Health Cooperative in Washington state.  Gundersen Lutheran Health System in Wisconsin even won a White House award for innovation when it set off on a path to become carbon nuetrial by 2014. And Dignity Health in California devised a way to lower its GHG emissions, and costs, by a recycling process of turning waste into gas.

In an interview, Kaiser’s Environmental Stewardship Officer Kathy Gerwig, who is also vice president of employee safety, health and wellness, said Kaiser’s environmental activism began about 17 years ago when it became to look at the health impacts of dioxin, mercury and some other chemicals used in medical equipment.

Partnering with Health Care Without Harm, a nonprofit organization dedicated to getting toxic pollutants out of health care settings and medical supplies, Kaiser responded to early data about potential toxicity in various widely used hospital equipment. It ended up changing the procurement for nearly all of its neonatal intensive care equipment, its IV equipment, its exam gloves and numerous other products that were plastic based. The point was to avoid plastics that might leach a chemical clalled di-ethylhexyl phthalate. Because Kaiser is so big, its purchasing decisions ended up affecting the whole market, with suppliers eventaully changing their stock to be DEHP free, Gerwig said.  

From there, Kaiser — following Heath Care Without Harm — began to study whether any of its purchased supplies had negative environmental health impacts at the manufacturing stage or the disposal, end of use stage.

“There were a number of people concerned about the amount of waste being generated and about things like mercury being used in health care,” Gerwig said. “We decided that if we believed in preventive health care, that also meant preventing environmental contributors to disease.”

Exploring environmental impacts was tied, “to our social mission around improving the health of our communities.” 

In 2008, it took on climate change in a bigger way, establishing a formal commitment to climate change mitigation. After input from all levels and departments in the organization, Kaiser adopted a statement that drove its actions in environmental stewardship from then on:

“Climate change will cause health effects that will directly impact Kaiser Permanente’s ability to fulfill our promise of qualify affordable care.”  

A series of actions sprung from that statement's adoption, Gerwig said, including changing procurement to avoid products whose manufacture or disposal would harm the environment, to new decisions involving recycling and reuse and sterialization of diagnostic equipment rather than replacement. Even its sterialization process changed, with more emphasis on steam cleaning and less on harsh chemicals.

“This statement was endorsed by people at all levels of the organization, including our most senior leaders and board of directors," Gerwig said. "They appreciated that climate instability is going to increase the demand for health care and increase threats to clean water and clean air." 

Most recently, Kaiser announced plans to procure 153 megawatts of renewable energy — enough to power half of all its California facilities, or about 590 million kilowatt hours a year, mostly through power purchase agreements of wind and solar energy. 

In so doing, Kaiser became the first big health care company to make a substantial commitment to renewable energy, which is something the organization now hopes will propel the health care industry generally to follow.

“The reaction was extremely positive, both from the health sector and from the general public,” Gerwig said of Kaiser’s announcement of its renewable energy plan in February. "The reason, I think, is it makes it very clear that if Kaiser Permanente is doing this, then climate does have a connection to health — it’s a health issue."

By extension, climate change is a patient issue, and thus patients need to be congizant of risks that could evolve from climate change and from its causes.

That is ultimately, what the Obama administration wanted, was for people to realize that climate change is not some ephemeral futuristic problem but something that can affect their health here and now.  And if we do something to reduce climate change, we reduce health risks.

Scientists at Lawrence Berkeley National Laboratory undertook a study to quantify the potential health benefits of reducing greenhouse gas emissions.

They determined that "economic benefits of reduced health impacts" that could result in the U.S. by reducing greenhouse gas emissions by 150 million metric tons per year would be $6 billion to $14 billion. If it doubled that effort and reduced emissions by 300 million metric tons a year, it would be $10 billion to $24 billion.