How Health Care Can Break the "Harm-Treat-Harm" Climate Emissions Cycle

Kenny Lin, MD, MPH
Posted on November 14, 2022

As the 27th United Nations Conference of the Parties (COP27) conference continues in Egypt this week, participants have actively discussed providing up to $100 billion of financial aid annually to developing countries to reduce carbon dioxide emissions and mitigate climate impacts. Climate injustice, "a term used to describe the situation in which countries that contribute the least to the climate crisis nevertheless pay the highest price," is ever-present in the African continent, which has contributed only 3% to 4% of all emissions but suffers disproportionately from the resulting heat waves, droughts, scarcity of food and drinking water, and coastal flooding.

In an October 19 editorial that was simultaneously published in more than 200 health journals, following last year's editorial on the climate emergency, the editors-in-chief of African journals highlighted the ongoing health impacts of climate change in their countries:

Droughts in sub-Saharan Africa have tripled between 1970–1979 and 2010–2019. In 2018, devastating cyclones impacted 2.2 million people in Malawi, Mozambique, and Zimbabwe. In West and Central Africa, severe flooding resulted in mortality and forced migration from loss of shelter, cultivated land, and livestock. Changes in vector ecology brought about by floods and damage to environmental hygiene have led to increases in diseases across sub-Saharan Africa, with rises in malaria, dengue fever, Lassa fever, Rift Valley fever, Lyme disease, Ebola virus, West Nile virus, and other infections. Rising sea levels reduce water quality, leading to waterborne diseases, including diarrheal diseases, a leading cause of mortality in Africa. Extreme weather damages water and food supply, increasing food insecurity and malnutrition, which causes 1.7 million deaths annually in Africa.

The authors emphasized that the international community should not only be concerned for Africa for moral reasons, but also because "knock-on" effects of "poverty, infectious disease, forced migration, and conflict" are global in nature. "In an interconnected world," they argued, "leaving countries to the mercy of environmental shocks creates instability that has severe consequences for all nations."

As a clinically focused journal, American Family Physician has devoted much environmental health content to what individual physicians can do in their offices to mitigate the health effects of climate change on patients and counsel them about actions that can help address the problem. In a recent position paper, the American College of Physicians went further by recommending "that the health sector must adopt environmentally sustainable and energy-efficient practices to aggressively reduce its greenhouse gas emissions." As noted in an accompanying editorial, the U.S. health care system accounts for an estimated 8.5% of national greenhouse gas emissions. Left unaddressed, these emissions cause harm that requires health care interventions, which generate more emissions that lead to more harm: the "harm-treat-harm" cycle.

What actions can clinics, hospitals, and health systems take to break this cycle? The Agency for Healthcare Research and Quality has released an evidence-informed primer for health care organizations from the Institute for Healthcare Improvement on measures and actions to reduce carbon emissions. An article in STAT News discussed energy efficiency initiatives at Boston Medical Center, the Cleveland Clinic, and Kaiser Permanente that have reduced carbon emissions associated with excess power consumption and saved millions of dollars. Notably, nonprofit hospitals are now eligible to receive renewable energy credit payments from the Inflation Reduction Act for investing in energy-saving projects.