— The legislative package has great potential for climate, health, and economic benefits
Elizabeth Cerceo, MD
February 3, 2024
Cerceo is an academic hospitalist and environmental health advocate.
The news is replete with stories of how the health system has been battered over the past few years. There are workforce shortages and healthcare professionals leaving in droves. Clinicians face record levels of burnout. Across the country, 631 rural hospitals face impending closure. Moreover, extreme weather could shut down one in 12 hospitals worldwide. Among U.S. counties, 90% have experienced a weather disaster in the last decade, and 40% of Americans live in counties that faced a climate disaster in 2021 alone. In 2023, there were 28 weather and climate disasters exceeding $1 billion in direct and indirect damages, compared with an average of about eight “billion-dollar” annual events from 1980 to 2022. The potential for hospital closure — for any type of hospital — is not a far distant concern but a reality, one that clinicians must contend with.
With these devastating impacts stacking up, surely there must be legislative solutions decision-makers are considering to mitigate harm. So why have we heard so little about the Green New Deal for Health?
The legislative package from Sen. Edward Markey (D-Mass.), who chairs the Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Retirement Security, would lay the groundwork for health systems’ resilience from numerous threats by improving healthcare sustainability and supporting patients, clinicians, and communities. It would simultaneously work to address the health crises that disproportionately impact low-income, immigrant, and rural populations, and communities of color.
An immediate focus on climate action within the U.S. health sector is critical, as it is responsible for 8.5% of our nation’s greenhouse gas emissions. Pollution attributable to U.S. healthcare is responsible for public health harms commensurate with those caused by preventable medical errors, causing 388,000 disability-adjusted life years lost. This air pollution is associated with stillbirth, low birth weight, cardiovascular disease, cancer, pneumonia, asthma, dementia, and increased hospitalizations, among numerous other health conditions, with vulnerable populations (children, elderly, pregnant, low income, communities of color) experiencing disproportionate burdens.
There have certainly been efforts to advance climate-smart healthcare. The Joint Commission has created a U.S.-focused voluntary sustainable healthcare certification and sustainability standards internationally. In 2022, HHS launched a voluntary health sector climate pledge and asked health organizations to commit to reducing greenhouse gas emissions and to plan for climate resilience. There are innumerable piecemeal efforts at the state and local levels. These efforts, while critically important, are incomplete and unenforceable, which is how the industry would like to keep it.
Despite this clear need to expand efforts, the Green New Deal for Health — which would support all hospitals — has not hit the news with a splash, but a drop in a puddle. Why might this be? The name may not engender bipartisan warmth and, after the original Green New Deal (introduced in 2019), there may be less of an appetite to launch a campaign with an imprecise impact. The timing may also not be ideal as we approach another contentious presidential election. Conservative voices questioning large funding initiatives like the Inflation Reduction Act often find a home in health system administration where large spending initiatives are often met with distrust.
But there may be a way to reframe the deal in a way that will be more palatable to opponents. Just look at President Obama’s effective 2009 stimulus, which also had climate legislation built-in but was promoted as an economic package. A green bow symbolizing the economy, rather than backing nature, may make health systems want to open this legislative package.
An emphasis on economic benefits from the package is paramount because the argument many health systems have used to push back against efficiency upgrades and sustainability initiatives is the upfront cost. While the future return on investment is often sizable, major upgrades require capital investment, which health systems may balk at given that margins have been depressed and expenses elevated relative to pre-pandemic levels. No one questions that hospitals have faced a profound financial toll. But that’s precisely why legislation to support health systems, build resilience and sustainability, and support communities could not come at a better time. Weatherizing hospitals and optimizing energy efficiency is not tantamount to a welfare handout.
The legislation would provide upfront funds, critical to cash-strapped health systems. An allocated $100 billion would revive a New-Deal-era program to modernize, weatherize, and reduce the environmental footprint of health facilities. Funds would support hazard pay for healthcare professionals who continue to care for our patients during and after disasters. This would protect public health and ensure people can access and receive care during climate disasters. An additional $10 billion would support community planning grants and research on healthcare sustainability and resilience.
It carves out $9 billion to meet the educational needs of healthcare professionals so we as a community are trained to care for patients in a changing environment. Calls for climate health education have come from medical students all the way up to the Association of American Medical Colleges and the American Medical Association. This funding would support medicine’s academic mission to meet the evolving needs of our patients and our trainees.
While U.S. emissions declined slightly in 2023, it is not enough to avoid global warming or to impact pollution. We need legislation that marries what happens in the four-walls of the healthcare system and beyond it, recognizing that climate change impacts health. We need support to bring resilience and sustainability to our systems with federal guidance that proactively protects health.
One reason the original Green New Deal — which was broader than the new legislation’s focus on healthcare — did not advance was the lack of labor support. As with all climate legislation, there are vocal opponents from within healthcare and outside of it. Physicians, nurses, and all healthcare professionals need to be vocal advocating for legislation like this because it is just words on a page until supporters make a case for it. It is incumbent on healthcare and hospitals dedicated to patient care to promote healthy, sustainable, and climate-resilient systems. We should all ensure the Green New Deal for Health is a secret no longer because patients will continue to need care. It’s just a question of whether we will be ready.
Elizabeth Cerceo, MD, is an academic hospitalist and a founding member of Clinicians for Climate Action New Jersey. Her views do not necessarily reflect the views of her employer.