"The Extraordinary Steps Health Care Providers Are Taking To Prepare For Climate Change"
On October 29, as Superstorm Sandy downed power lines and flooded New York streets, 300 patients were evacuated from New York University’s Langone Medical Center after one of its backup generators, located in the basement, was knocked out. Twenty babies in neonatal intensive care went first, followed by the sickest adults. The evacuation took about 15 hours to complete.
Langone wasn’t the only hospital to need an emergency evacuation during or in the aftermath of Sandy. Coney Island hospital’s electrical switch room was inundated with floodwater, forcing the hospital to evacuate 260 patients, and Manhattan’s Bellevue Hospital evacuated after hurricane damage caused “Katrina-esque” conditions in the facility. Long Beach Medical Center is still closed as a result of severe damage, and officials have stopped predicting when it might reopen.
These evacuations show just how vulnerable the health care industry is to the effects of climate change — a reality that’s problematic, given how extreme weather events like Sandy are predicted to become more and more frequent as the Earth warms.
“When you look at what happened in Hurricane Sandy, some of the hospitals in downtown Manhattan were the first to go down,” said Gary Cohen, president of Health Care Without Harm. “They need to be the last ones. They should be the last buildings standing. But they weren’t designed in any way to address climate change effects.”
The industry hasn’t historically been outspoken on climate change, but the hospital evacuations forced by Katrina, Irene and Sandy — along with warnings of intense heat waves, increased incidences of asthma and allergies, and expanding ranges of disease vectors — have made health care professionals take notice of climate change and how it effects the industry and those who depend on it.
“Government and hospitals are really waking up to this,” Cohen said. “Hurricane Sandy was a huge wake-up call, especially to hospitals on the East Coast.”
Preparing for the worst
It’s these emergency evacuations that Hubert Murray, Sustainable Initiatives Manager for Partners Healthcare in Boston, wants to avoid at all costs. Murray was instrumental in “future-proofing” Boston’s Spaulding Rehabilitation Hospital, a 132-bed teaching hospital that opened in April. Spaulding was built near the bay — a location that may seem counter-intuitive to climate preparedness, but that Murray said made the most sense in terms of cost and ease of access for city patients — so its ground floor is raised 30 inches above the current 500-year flood level and 42 inches above the 100-year flood level. It has operable windows that, in the case of an air conditioning failure, can be opened so that patients don’t overheat — a feature Cohen said is an essential part of climate change preparation. The landscaping acts as a sort of reef, created to provide a certain level of protection from storm surge. And, perhaps most importantly, its electrical equipment is on the roof, instead of the basement, so it’s not susceptible to flooding.
Murray said these climate-proofing measures weren’t costly: they added about half a percent to the total cost of the building. Preparing new buildings for climate change, he said, isn’t a necessarily expensive or difficult venture, and its cost-effectiveness is something the city of Boston has noticed. Murray said the city asked Spaulding to share the criteria it used to climate-proof its building, and now, developers in Boston are required to develop a set of protocols similar to Spaulding’s when making plans for a new building.
“Now that we’ve done it, everybody else, not just in the health care industry but certainly in Boston and the commercial and real estate industry are looking at similar solutions,” Murray said. “Our research paid off not only for ourselves, but it seems to have paid off for the city.”
New York City, too, has recognized how vulnerable its hospitals are to the effects of climate change. In June, Mayor Michael Bloomberg announced that he wanted new and existing hospitals in the city to meet certain criteria for backup power and information technology in order to prepare for extreme weather. The announcement came as part of the mayor’s climate adaptation plan, which will cost the city $19.5 billion for more than 250 initiatives aimed at weather-proofing the city’s infrastructure.
Bloomberg’s plans are positive steps, but updating old hospitals to be better suited for extreme weather will be more of a challenge than building new, climate-proof hospitals, Murray said. Partners Healthcare, which owns Spaulding and several other medical centers in Boston, is doing a review of all its facilities to see what needs to be done to update them. It’s a lot more than just moving generators from the basement and insulating windows; equipping valuable lab space for power outages, for example, is essential.
“That’s the lesson learned from Sandy — New York lost a lot of research just from flooding. Experiments which were multi-year experiments just rendered useless overnight,” Murray said. “And since Boston is the highest recipient of NIH research funding in the country…we’re looking very carefully at our lab buildings as well as our acute care facilities.”
Insuring the future
Adaptation isn’t the only challenge. Because of their sheer bulk of high-tech equipment — much of which must be kept on 24-hours a day — temperature-sensitive lab materials and heavy transportation needs, hospitals use twice as much energy per square foot as regular office buildings. There are simple and often cost-saving steps hospitals can take to reduce their emissions, Cohen said, including cogeneration, which captures heat from the energy process and turns it into more energy, and can save a building up to 35 percent off its energy costs. He said about 200 hospitals across the country employ this technology, and that during Sandy, the hospitals that did were able to stay open.
“They were places that were critical respondents, anchors in the response to Hurricane Sandy,” Cohen Said. “It seems like this should be fundamental as a climate strategy.”
The health care industry accounts for 8 percent of U.S. emissions, according to one report, making it as big a contributor to climate change in the U.S. as agriculture. Some health care companies have taken note: Spaulding’s windows are triple-glazed, a feature Murray said eliminates the need for perimeter heating in hospital rooms, dramatically cutting the hospital’s energy use. The Gundersen Health System, a health care network in Wisconsin, is on track to be energy independent by 2014 and has saved $1.3 million annually through energy conservation. Maine’s York Hospital gets 90 percent of its energy from renewable sources, a switch that has saved the hospital more than $100,000 each year for the past decade.
In 2012, Kaiser Permanente, the third-largest health insurance company in the U.S., publicly acknowledged climate change’s role in human health and announced a plan of 30 percent reductions from its 2008 emissions by 2020. Kaiser’s recognition of the link between climate and health was noteworthy: when a Ceres report published in May ranked insurance companies in order of their climate risk disclosure and management, Kaiser was the only health insurance company to make it into the list’s top 10.
Kathy Gerwig, Kaiser’s environmental stewardship officer, said so far Kaiser has made a 5 percent reduction in greenhouse gas emissions compared to 2008 levels. It’s installed solar panels at 11 of its 648 hospitals and medical centers and has purchased about 43,000 megawatts of wind energy to power its Mid-Atlantic facilities. The company is also doing an inventory of all its health care facilities to see how it can better prepare them for the effects of climate change.
“We think that as health care providers it’s extremely important for us to acknowledge that climate change is already having health effects on populations, and that it will continue to do so,” Gerwig said. “We need to be in a position to both react in a way that will reduce greenhouse gas emissions to stop the problem, and also be responsive as a health care organization to the effects that are already taking place.”
Gerwig said that the company realized in 2008 that it wouldn’t be able to fulfill its mission — to provide affordable healthcare and improve the health of its members and communities — unless climate change was addressed. She said health care companies and organizations who haven’t yet acknowledged climate change likely don’t see it as an issue that requires urgency. When contacted by ThinkProgress, for example, the American Hospitals Association, which represents nearly 5,000 hospitals, health care systems and networks, said it didn’t have a position on climate change.
“I think people have a hard time realizing that there are impacts that are happening today,” Gerwig said. “Climate change feels to many people like something that’s a little abstract, a little long-term, and when you’re faced as health care facilities with many priorities, some people I think are finding it a little hard to think about this with the kind of urgency that we think about it.”
It’s hard to quantify how many health care companies and individual hospitals have taken steps to mitigate or adapt to climate change. A spokesperson from Health Care Without Harm said that, when asked, most hospitals say they are planning on addressing climate change, but don’t yet know how they will do so. There are 675 hospitals enrolled in the Healthier Hospitals Initiative, which employs seven “challenges” aimed at making hospitals more environmentally-friendly, and 50 more are in the process of signing up. Cohen, president of Health Care Without Harm and co-founder of the Healthier Hospitals Initiative, said hospitals are in the perfect position to lead the economy away from fossil fuels. The health care industry comprises 18 percent of the U.S. GDP and, with the implementation of the Affordable Care Act, could soon reach 20 percent.
“They’re in the best position to do so within their larger mission to not only heal patients but to heal communities and heal the environment,” Cohen said. “Health care is the fastest growing part of the economy and the only part of the economy that’s actually underpinned by a mission to first do no harm.”
A Holistic Approach
If the health care industry has the potential to be a leader in climate change adaptation and mitigation, health care practitioners can be just as key in educating patients on how climate change can affect their health, Cohen said. Health Care Without Harm has worked to educate nurses in about 700 hospitals in the hopes that they’ll in turn educate their patients and other nursing organizations on the climate-health link.
“Nurses and doctors are some of the most trusted messengers in our society,” Cohen said. “Having nurses, doctors, other health professionals be the spokespeople for climate change policy, to re-frame climate change not as an environmental issue but as a health issue that affects everyone — red state, blue state, poor, rich — it’s an incredible opportunity to mobilize an army of health professionals to win changes in energy and climate policy that can trump the arguments that the coal and fossil fuel industry make.”
The American Medical Association, which publicly acknowledged the link between climate change and patient health in 2011, encourages physicians to educate patients about their roles in environmental health, and to work with their local health departments to strengthen their hospitals’ climate change preparedness.
“Doctors may find themselves on the front lines in dealing with its serious and immediate problems,” the AMA said in a 2011 editorial. “Patients are sicker or developing new conditions as a result of changes in the weather. Greater awareness and understanding of the situation, from a medical perspective, is a proper priority.”
The government, too, can play a role in making the link between climate and health. The Obama administration has slowly begun to acknowledge the association — this month, the White House gave the Champions of Change award to 11 people — including Cohen — who are “working on the front lines to protect public health in a changing climate.” But it’s the Affordable Care Act that has one of the best opportunities for educating health care practitioners on the link between climate and health, Cohen said, which is why he’s working with the Healthier Hospitals Initiative to link the implementation of the Affordable Care Act with hospital sustainability. Obamacare, for the first time, addresses population health instead of just focusing on the health of individuals, making it an ideal vessel to carry the message of climate change’s effect on health.
“We’re spending 96 cents on the dollar to address people when they’re sick. We spend four cents on the dollar for prevention. So there’s something fundamentally wrong there — we’re not addressing the social and environmental factors that are making people sick in the first place and landing them in the emergency room,” Cohen said. “Under the new Affordable Care Act, for the first time, hospitals are mandated to do community health needs assessments, and start to align their care to those community needs.”
Cohen said he thinks climate and health have historically been seen as separate issues in America, but the more they’re linked — in the eyes of government officials, hospital planners, health insurance companies, doctors, nurses and patients — the more opportunity the country has to effectively prepare for and mitigate the harmful effects of climate change.
“The more that we link health care and climate change, I think the more powerful the argument becomes,” he said.
Andrew Breiner contributed the graphics for this post.