Climate Change And Health Insurance: Adapting To Environmental Challenges In Europe – The alarming new “Climate Change 2021” report from the UN Intergovernmental Panel on Climate Change states emphatically and unequivocally that “human influence has warmed the atmosphere, ocean and land”. The next few years will determine how much the Earth will warm and how much it will stress all life on it.
The health sector, with its mission to help and heal, should be at the forefront of the fight against climate change, one of the greatest threats to global health in the 21st century. Inexplicably, it isn’t.
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The evidence of climate change is everywhere. California drought affects US food supplies. A heat wave in the Pacific Northwest has killed nearly 200 people in Oregon and Washington states and scorched nearly 1 million acres of land in California and Oregon. Floods in Germany killed more than 175 people in July.
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Climate change is affecting almost every aspect of health: from burns and malnutrition to seasonal allergies, mental health and even snakebites. By optimizing climate policy, the world could prevent an estimated 74 million deaths over the next 80 years.
Globally, the healthcare sector produces 4.4% of global greenhouse gas emissions. In the US, this sector—hospitals, health systems, doctor’s offices, pharmaceutical companies, medical device companies, and others—is responsible for 8.5% of US greenhouse gas emissions.
The healthcare industry needs to do more than treat its victims to address climate change. As a doctor, I am committed to doing no harm, and I want the rest of the healthcare sector to do the same.
Health care utilization creates greenhouse gas emissions, these emissions exacerbate acute and chronic health conditions, and exacerbations of acute and chronic health conditions lead to health care utilization. This vicious cycle increases the harmful impact of health care utilization. National policies aimed at stopping it are needed.
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By thoughtfully applying policy to stimulate research, the health sector can achieve the triple aim of medicine—improve patient experience, improve patient value, and improve public health—while reducing the climate impact of health care without any major technological advances.
Regulatory institutions such as The Joint Commission, the national accrediting body for health care organizations, along with state and local health departments should enforce the minimization of emissions and pollution. In particular, they can set emission standards and pollution standards for healthcare systems. Through these standards, they can emphasize the link between environmental health and patient health and safety. Such policy changes would prompt the healthcare ecosystem to combat climate change by investigating and mitigating the sources of healthcare-related pollution.
There are always choices in medicine: Clinicians and patients choose between brands, reusable or disposable items, and medical intervention versus surgical procedures. A comprehensive life cycle assessment calculates the global warming potential for the creation, use, and disposal of items or behaviors. Using life cycle assessment, clinicians and administrators can consider the impact of their decisions on the environment and public health. This is particularly useful when clinical choices appear to be equally beneficial to patients.
My profession of anesthesiology offers an excellent example of the power of life cycle assessment using two anesthetic drugs: propofol and desflurane. Propofol is a liquid that induces anesthesia by infusing the patient. Desflurane is a hydrofluorocarbon gas that induces anesthesia by being inhaled by the patient – once exhaled, it is released directly into the atmosphere. The impact of desflurane on climate change is hundreds of times worse than the impact of propofol. Desflurane persists in the atmosphere for 10 years. Each hour of desflurane anesthesia can create a greenhouse effect greater than driving 220 miles. Each hour of propofol anesthesia creates the greenhouse effect of driving less than 1 mile.
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This information has prompted an international effort to limit the use of desflurane to situations where the benefit to patients is clear.
A well-thought-out national policy aimed at minimizing pollution from the healthcare sector will encourage healthcare companies to carry out and publish life cycle assessments of their goods and services before they are placed on the market. This would motivate the creation of a more sustainable healthcare supply chain. Fewer products will be designed as disposable with a return to reusable instruments designed specifically for easy sterilization, storage and durability. Inevitable disposables will include materials that can be composted or recycled on their way to a healthcare economy in which no item is landfilled or incinerated.
Kaiser Permanente, a health system leader in sustainable health care, operates in Pacific Northwest states plagued by heat waves, drought and wildfires. In 2020, it declared itself a carbon-neutral health system. While this is an important step, the ultimate and challenging goal in the fight against climate change is to achieve carbon neutrality without the use of accounting maneuvers such as carbon offsets and renewable energy certificates that allow institutions to claim carbon neutrality while still generating greenhouse emissions.
Sustainability is the future of healthcare. A changing climate and its impact on public health creates a moral imperative for the healthcare sector to take the lead in reducing emissions, waste and pollution. Healthcare companies that are the first to pivot will capture the 21st century healthcare market because efficiency and sustainability are attributes that are attractive to employees and appealing to consumers.
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As doctors trained in a post-Katrina and post-Maria world enter leadership positions in the health care sector, we will be making decisions based on climate impact. We plan to hold our organizations accountable to the same standard we have sworn ourselves to: do no harm.
Matthew J. Meyer is a health care intensivist and sustainability researcher at UVA Health, co-chair of the UVA Health Sustainability Committee, assistant professor of anesthesiology at the University of Virginia, member of the Virginia Clinicians for Climate Action Steering Committee, and co-founder of PeriOp. Green, an organization dedicated to reducing waste in operating theaters to the smallest possible amount.
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Elaine Chen’s Obesity Revolution STAT Plus: Worried by the popularity of Ozempic and Wego, insurers are waging a multi-front battleDr. Serving in multiple national and global advisory roles, Elizabeth Baca provides systems thinking that supports innovation in care delivery and promotes overall health and well-being, recognizing that health equity and sustainability are central to this work. Previously, she was on the faculty of General Pediatrics at Stanford School of Medicine and directed the Community Pediatrics and Child Advocacy Rotation and served in both the administrations of California Governors Brown and Newsom. Baca studied health policy at the Universidad Simon Bolivar in Venezuela and completed an MPA at the Harvard Kennedy School of Government and an MD at Harvard Medical School.
Neal Batra is a leader in Deloitte’s Life Sciences and Health Care business model innovation, redesign and transformation business model and commercial operations model. He leads Deloitte’s Life Sciences Strategy & Analytics and leads the way for next-generation business/functional evolution by connecting strategic choice with analytics and technology. Batra has over 15 years of experience advising healthcare organizations across the ecosystem on critical strategic challenges, including leading companies in biotech, medical, health insurance and retail healthcare. Batra co-authored Deloitte’s provocative look at The Future of Health, which speculates on the healthcare ecosystem in 2040 and the business models and capabilities that will matter most. Batra lives in the Tribeca neighborhood of New York. He holds an MBA from the London Business School and a BBA from the College of William and Mary.
Michael Joseph Johnson is a managing director at Deloitte Consulting LLP and has extensive experience in healthcare transformation. His engagements have focused on financial operating model transformation, payer-provider convergence, digital-focused patient pricing experiences, and innovative contracting and pricing strategies. He also serves as a leader in developing Deloitte’s climate change and health strategy and offerings.
Jay Sekhon is a manager at Deloitte Consulting, leading end-to-end operational transformations for healthcare providers and payers, helping them improve patient outcomes.
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