We know that climate change is a public health problem—and now, health care leaders are getting a better understanding of how their own organizations are contributing to the problem.
Radio Advisory's Rachel Woods sat down with Advisory Board's Miles Cottier to discuss the state of climate change and why health care leaders shouldn't wait for government action to start making progress.
Read a lightly edited excerpt from the interview below, and download the episode for the full conversation.
Rachel Woods: Your take on climate change is that this is absolutely a problem for health care leaders to help solve specifically. Why is that? Why is that your take?
Miles Cotter: So health care is not a passive actor anymore. It's a major contributor to climate change. The U.S. Health Sector contributes 9% of its nationwide emissions, so if the global health sector were a country, it's the fifth highest emitter on the planet.
Now that 9% of the U.S. is much higher than aviation, which we think is one of the worst committers, and only slightly less than the entire manufacturing sector. The problem is the industry doesn't know that it's doing it. I can't tell you how many executives I've spoken to that don't know their energy usage, their water usage, their footprint, or how much waste they produce. And save for a few countries, most execs have no idea how much their organization contributes to climate change.
Woods: Which is why I don't want to necessarily blame leaders. There is clearly some personal responsibility for the health care industry, but it makes sense that individual actors probably don't know the depth of the problem because we don't actually have good data or standardized data to actually track things like an organization's carbon footprint.
Cottier: No, exactly. I think that's part of the problem. I think leaders aren't aware of their footprint because they don't know how to track data, their systems aren't in place, there's no standardized method, no governmental top-down mandate forcing organizations to track and report.
Some organizations, especially in the U.S., have started to do quite well here: Kaiser Permanente, Boston Medical Center, to name a couple. But I think even they will tell you that they haven't perfected their data collection or reporting yet.
Woods: Would that actually even be enough? Let's say that we had a better understanding of health care's influence, we had better, more standardized data. Would that be enough to actually push leaders to take action?
Cottier: It would be the start of the journey, I think. The problem is with the status quo that we have with health care being so stable, it's reinforced these cognitive biases in health care leaders' minds, right?
So cognitive biases, we mean that the oversimplification of the complex world we live in, that kind of reinforces certain behaviors. We spoke about what we call the bystander effect, so it's the government's problem, not our problem. We won't make any changes. That's one example.
Once health care leaders actually start making moves to move those behaviors into the kind of forefront into their consciousness, they can actually start to make changes to overcome them.
Woods: And it will influence more people to take action.
Woods: Miles, so far, we've been talking about the depth of the problem and the specific actions of the health care industry. We've also started to unpack why we haven't seen a ton of movement, at least not yet, but I have to believe that there has been some movement.
You referenced a couple of health care systems in the U.S. that are at least getting part of the data story right. What has the health care industry done so far to actually combat climate change?
Cottier: Sadly, not a lot in the U.S. I think there are probably 10 to 20 organizations that have done something meaningful, maybe 20 to 30 have gravitated toward action, but it's been relatively low at this point; hiring a chief sustainability officer or creating a roadmap to sustainability. It's a good start, but it's not enough. In the rest of the countries, organizations have done nothing at all.
Another thing is that HHS has issued a voluntary initiative for U.S. hospitals, health systems, pharmaceutical companies, to submit pledges, to reduce greenhouse gas emissions. That's voluntary for now, but it's not enough.
Woods: Is your kind of estimate on the amount of action here just for providers or does that span all kind of corners of the health care industry?
Cottier: It spans all corners of the health care industry. The one thing I will say is that about 70% to 80% of the ecosystems emissions that come from the supply chain.
Woods: You're joining us from a team that actually focuses on international research, and thus far we've been talking about the U.S., but how does what we see at America compare to what you are tracking in other countries?
Cottier: Well, I'd say most of the early movers, most of the best performance here, have come generally from Europe and the U.K., most of which of course are public health systems. Generally we've seen two types of approach. We've seen top down from the NHS—they set a target of the entire health system being net zero by 2040, and the wider supply chain by 2045, and they've mandated reporting and they've mandated every organization to submit a path to net zero by the end of this year.
We've also seen a more kind of market-based approach, so from places like Germany, they set up a project to install what they call climate managers in local hospitals there, which kind of enact local change from the ground up, have a direct line of sight to the CEO as well. So there's two different approaches you can take there.
Woods: We started off by saying that we, in U.S., can't necessarily wait for government action. What do you want U.S. leaders to learn from these kinds of approaches?
Cottier: It's difficult for the U.S. to directly copy the U.K. because of the kind of publicly funded nature of the NHS. I see the best course of action is a bit of both, right? So we wait for legislation that squeezes orgs to report data and commit to targets with incentives and kind of penalties as we go, but because we don't want to wait for it, we have to instill some market based approaches that can be used now that will make a difference whilst we wait for the top down changes to come through.
Woods: I want to take a moment to emphasize here the influence of leadership. There is certainly a huge influence that government institutions can have, that organizational leaders can have.
I also think that there is a role for provider leaders and physicians specifically, right? Doctors actually have a ton of influence over their larger organizations and their communities and their patients, and that can help us drive real change. In fact, I think you have a really interesting take here. Can you tell us about what your opinion is on the role of physicians?
Cottier: A lack of climate change action is very much going against the Hippocratic Oath, right? First, do no harm. Clinicians are, for better or worse, in health care to help people, but they're in action or indeed they're action driving to work in a diesel car, for example, they're having an outsize effect on the patients that they're trying to treat equally.
Doing nothing means that you are doing nothing to counteract the effects of climate change. Effectively doing nothing is no longer enough. It's affecting the patients that we are literally here to care for.