In the last six months, we have witnessed Superstorm Sandy flooding New York City, New Jersey and surrounding areas, a massive Midwest drought impacting 40% of the US corn crop, and unprecedented air pollution from burning fossil fuels that forced Chinese authorities to tell Beijing residents to stay in their homes. When we think about climate change, we are no longer thinking about polar bears stranded on melting ice caps. Climate chaos has come home and its impacts are being felt all around the world.
What health scientists are telling us is that climate change will bring increased asthma, more virulent allergens, medical emergencies from heat stress, the spread of water- and vector-borne diseases and increased severe weather events. The Lancet, Britain’s premier health journal, calls climate change “the biggest global health threat of the 21st century.”
Given these dire warnings, one would expect that the healthcare sector would be prepared for the coming public health storm. Nothing could be further from the truth. When Hurricane Katrina hit New Orleans, the hospitals were completely flooded along with everyone else. But because they all had their electrical equipment as well as their back-up generators in the basement, , they lost all power. And because none of the windows in the hospital were operable, hospital staff had to break all the windows in the hospitals’ upper floors to get air into the facility.
Five years later during Hurricane Sandy, a similar story occurred. Both Bellevue Hospital and New York Langone Medical Center had to be evacuated because all their electrical systems were in the basement. At NYU Langone, millions of dollars of medical research specimens were destroyed because of lack of consistent refrigeration. It took Bellevue more than ten weeks to clean up the mess and reopen its doors to patients.
We are learning the hard way that the healthcare sector’s understanding and ability to respond to climate change is still in a primitive stage of development.
What, then, should the role of healthcare be in dealing with climate change?
First, hospitals need to focus on preparedness and resilience in their design and operations so they can be critical players in responding to extreme weather events, rather than being one of the victims. Spaulding Rehabilitation Hospital in Boston is one example of a hospital that has taken the reality of climate change to heart. The hospital, which is scheduled to open in April 2013, employs on-site power generation, operable windows to provide natural ventilation and has put all the mechanical/electrical equipment on the roof of the facility. These innovations are part of the overall business strategy of Partners Healthcare (Spaulding’s owner) which has added climate change to its top “business risks” category.
The second critical role for health care should be to model the transition to a post-fossil fuel economy. In the U.S., health care represents 18% of the entire GDP, and is likely to increase to more than 20% when health care reform is in full swing. In other industrialized countries, health care represents 10% of the economy. Given its enormous economic clout and its healing mission, health care is well positioned to “model” the transition away from our addiction to fossil fuels, which not only contributes to global climate change but also has local pollution and public health impacts. Reliance on coal, for example, contributes dramatically to increased asthma and respiratory diseases while fracking for natural gas contaminates local groundwater and vents toxic chemicals into the community air. Health care has a mission-related imperative to lower its own extensive carbon footprint and lead the effort to a secure and sustainable energy economy.
Reducing hospital dependence on fossil fuel energy through conservation efforts improves resilience – the less energy that hospitals require, the longer they can operate during and after extreme weather events. An alternative source of power independent from the electrical grid also helps in weather emergencies; while all hospitals have diesel generators, much of this infrastructure has proven to be vulnerable and inadequate for prolonged grid outages.
During Sandy, hospitals that had on-site power generation continued to provide critical care to their patients, and offered safe haven for those hospital patients that were evacuated from flooded areas. Known as co-generation (or Combined Heat and Power), this technology not only dramatically improves the hospital’s energy efficiency and saves money, but it also turns out to be a critical climate resiliency strategy. Kiowa County Hospital, destroyed by a massive category 5 tornado in 2007 that damaged 95 percent of the town of Greensburg, Kansas, has been reconstructed with a 100 percent renewable wind energy system. According to FEMA, renewable energy infrastructure has performed well in extreme weather events, demonstrating that sustainable design and increased resilience go hand in hand.
The third central role of the health care sector is in education and advocacy around climate change policy. Health care professionals, especially doctors and nurses, enjoy an unprecedented role as positive messengers for health in society. As we begin to calculate the enormous health care and social costs of climate change, health care professionals are in a position to educate their patients about the public health impacts of climate change and help prepare them for these impacts, and also become potent spokespersons for policies at all levels of government that would rein in climate change. As Margaret Chan, director general of the World Health Organization, has stated, “the health sector must add its voice – loud and clear – and fight to place health issues at the center of the climate agenda. We have compelling reasons for doing so. Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, and water.”
Climate change will bring us many more heat waves, hurricanes and droughts in the years to come. We need to engage the health care sector in climate change mitigation so they can help communities be prepared to weather these crises and help lead us to a healthier and more sustainable future. Who else is going to play this role?
Gary Cohen, Co-founder and President, Health Care Without Harm
[This article was published as part of a special series for World Health Day and in advance of the 2013 Skoll World Forum. Watch the live stream on April 10-12.]
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