March 28, 2022

by William Pang

On March 18, government officials, hospital administrators and members of the general public gathered for the second annual Yale Care without Carbon symposium to discuss the urgent need to address sustainability within health care. The virtual event was hosted by the Yale School of Public Health and the Yale Center for Business and the Environment.

Dr. Jodi Sherman, M.D., an associate professor of anesthesiology and of epidemiology (environmental health sciences), set the stage by emphasizing the links between climate change and the health care sector.

“Globally, health care emits nearly 5% of total greenhouse gas emissions,” said Sherman, founding director of the Yale Program on Health Care Environmental Sustainability. She noted that the United States emits the highest amount of greenhouse gas per capita.

Federal agencies are key stakeholders in ensuring that the health care industry moves towards a more sustainable future. This year’s conference featured two keynote speakers: Admiral Rachel Levine, M.D., current assistant secretary of health for the U.S. Department of Health and Human Services (HHS), and Dr. Lee Fleisher, M.D., chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS).

Levine began her remarks by emphasizing that addressing climate change, including addressing climate change impacts within U.S. health care systems, is a key priority for President Joseph Biden.

“Supporting environmental justice and climate resilience are priorities for [Department of Health and Human Services] Secretary [Xavier] Becerra and myself,” Levine noted. “We at HHS are working hard to address climate change and its impact on health, both through a number of new actions in the department and through collaborations [with outside groups]”.

Major directions taken toward this end include the establishment of the Office of Climate Change and Health Equity (OCCHE), which reports directly to Levine. The three main goals of this office include building resilience for communities to the health impacts of climate change; creating initiatives that promote long term recovery from the health effects of climate change; and working with hospitals to reduce their greenhouse gas emissions.

Levine envisions OCCHE to be the “glue” that ties together all of the climate change initiatives at HHS, with particular emphasis placed on initiatives that help those who are most burdened by the health impacts of climate change.

“Globally, health care emits nearly 5% of total greenhouse gas emissions.”

Dr. Jodi Sherman

“We know that many of those people are also most burdened by health disparities in general as well as those from long standing environmental injustice,” she added.

Fleisher discussed the broad policy levers CMS could use to tackle population health.

“Without equity, there is no quality of care, for both health care and to achieve the health of the population,” he said, emphasizing that advancing equity is one of the key strategic pillars within CMS.

Levers that CMS could utilize to produce better population health include payment incentives, quality and safety oversight programs, and different quality measurements and public reporting.

In particular, all health care organizations must fulfill minimum requirements in order to participate in Medicare and Medicaid programs. These requirements – known as Conditions of Participation, or CoPs – serve as important policy tools that CMS can deploy to ensure that health care facilities are prepared for the effects of climate change.

“How we think about what emergency preparedness means today and how our facilities prepare for climate change are really important questions,” Fleisher said.

He concluded by emphasizing the need for more qualitative and quantitative research in this area, as well as a systems approach to properly address climate change in health care.

“We are thinking a lot about ‘systemness,’ which I think climate change is a lot about,” he noted.