Narrative Proceedings of the Inaugural Health Systems Implementing Climate Action Conference 2024

The climate crisis poses a critical threat to health systems and populations globally, with projections of 14.5 million preventable deaths and $1.1 trillion in healthcare costs by 2050.1 The pace at which the climate is destabilizing is accelerating.2 Global temperatures could rise more than 2°C above preindustrial levels by mid-century, a tipping point beyond which climate impacts may outpace capacity for adaptation.3 The relationship between climate change and health is well established. Further, climate-driven catastrophes threaten continuous care delivery by disrupting supply chains, straining or destroying critical healthcare physical and social infrastructure, increasing costs and care demand by adding and exacerbating disease burden, and negatively impacting overall quality and access to care. At the same time, the healthcare sector itself is a major emitter of environmental pollutants, contributing nearly 5% to total global greenhouse gas emissions and inflicting 4.5 million disability adjusted life-years in health harms each year from its air pollution alone.4 The healthcare sector must mitigate its own environmental impact while simultaneously strengthening its ability to meet escalating threats to health and care delivery posed by the climate crisis.5 To help address this crucial challenge, the Yale Center on Climate Change and Health and The New York Academy of Medicine instituted an annual conference focusing on sustainable healthcare system transformation. The inaugural event, “Health Systems Implementing Climate Action,” took place on September 27, 2024, during Climate Week NYC, in tandem with the United Nations General Assembly. The conference brought together leaders from the health and business sectors to discuss the latest experiences and research findings on several themes: low-carbon, resilient healthcare delivery; ensuring healthcare infrastructure resilience to climate impacts; preparing the healthcare workforce for climate impacts; the role of health insurers in meeting climate risks; engaging government and philanthropic funders to support healthcare resilience and pollution mitigation; and addressing the rise of greenwashing in the healthcare sector. See Table 1 for a complete list of topics and speakers. The insights and strategies presented during the panel discussions and keynote presentations, summarized below, provide guidance for implementing climate action in healthcare to build and scale up sustainable health systems. TABLE 1 - Health Systems Implementing Climate Action 2024, Conference Presentations Presenters Panel Marina Romanello, PhD, Executive Director, Lancet Countdown on Health and Climate Change Setting the Stage Eric Berzon, MBA, Former Vice President and Assistant Treasurer - Finance, Kaiser Permanente Anna Goldman, MD, MPH, MPA, Assistant Professor of Medicine, Boston University School of Medicine; Medical Director of Sustainability, Boston Medical Center Lauren Sorkin, MS, Executive Director, Resilient Cities Network Moderator: Megan L. Ranney, MD, MPH, FACEPMBA, Dean, Yale School of Public Health Cities, Facilities, and Utilities: Healthcare Infrastructure Mitigation, Adaptation, and Resilience Adrita Bhattacharya-Craven, MSc, Research Director, Health and Demography, The Geneva Association Maria McGowan, BA, Global Underwriting and Claims Risk Manager for Manulife Moderator: Joe Bialowitz, MS, MSc, Former National Environmental Program Leader, Kaiser Permanente Managing Healthcare Risks in the Era of Climate Change: The Pivotal Role of Health Insurers Pamela F. Cipriano, PhD, RN, Vice-President, International Council of Nurses; Dean & Sadie Heath Cabiniss Professor, University of Virginia School of Nursing Oliver Eitelwein, PhD, Partner, Oliver Wyman Health and Life Sciences Renee Salas, MD, MPH, Founding Director, The Cooperative; Massachusetts General Hospital and Harvard Medical School Moderator: Omnia El Omrani, MD, Imperial College London Clinical Care Workforce: Readiness and Resilience Melinda K. Abrams, MS, Executive Vice President for Programs, The Commonwealth Fund Brent Sandmeyer, MPH, Senior Program Officer, Agency for Healthcare Research and Quality Alexis Feeney Tallman, MBA, Managing Director, Health Initiative, The Rockefeller Foundation Alan Dangour, PhD, Director of Climate and Health, WellcomeModerator: Ann Kurth, PhD, CNM, MPH, President, The New York Academy of Medicine Climate and Health/Care: The Role of Philanthropy and Government Funding to Advance the Evidence and Affect Policy and Practice David Callaway, MD, MPA, Professor of Emergency Medicine, Carolinas Medical Center; Chief of Crisis Operations and Sustainability, Advocate Health Andrea MacNeill, MD, MSc, Director, Planetary Healthcare Lab, University of British Columbia; Co-Chair, Lancet Commission on Sustainable Healthcare Fiona Miller, PhD, Director, CASCADES - Creating a Sustainable Canadian Health System in a Climate Crisis, University of TorontoModerator: Caren G. Solomon, MD, MPH, Deputy Editor, New England Journal of Medicine; Associate Professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital Implementing Sustainable Solutions in Clinical Care Delivery Donna Drummond, BS, Senior Vice President, Chief Expense Officer, and Chief Sustainability Officer, Northwell Health Matthew Eckelman, PhD, Professor of Civil and Environmental Engineering, Northeastern University Kristina Wyatt, JD, MBA, Deputy General Counsel and Chief Sustainability Officer Moderator: Gabriella Mickel, JD, LLM, MEM, Center for Applied Environmental Law and Policy Accounting and Oversight of Sustainable Healthcare Transformation: How Do We Avoid Greenwashing? Githinji Gitahi, MBBS, Global CEO of Amref Health Africa Closing Remarks SETTING THE STAGE: FINDINGS FROM THE 2024 LANCET COUNTDOWN Key findings from the Lancet Countdown on Health and Climate Change underscore the pace and severity of climate-related health threats and healthcare’s contribution.6 Heat-related mortality among adults older than 65 years has increased 167% since the 1990s. Drought and heatwaves are driving food insecurity, with 127 million more people experiencing moderate to severe impacts in recent years. Climate-sensitive infectious diseases such as malaria and dengue are spreading into new geographic areas, including highland regions and parts of Europe and North America. These risks are converging, intensifying existing pressures on overstretched health systems and compounding vulnerabilities in settings with limited adaptive capacity. Healthcare systems are also major contributors to the crisis. Global healthcare emissions have risen 36% since 2016 and now account for nearly 5% of total greenhouse gas emissions. In many high-income countries, healthcare system emissions now greatly exceed the point at which additional spending generates any further health gains, revealing systemic overconsumption and missed opportunities for sustainable care. Healthcare systems must be reimagined to reduce emissions while improving care access and high-quality outcomes. These findings make clear that healthcare must play a central role in both responding to and helping to stabilize the climate crisis. Cities, Facilities, and Utilities: Healthcare Infrastructure Mitigation, Adaptation, and Resilience More than half the global population currently resides in cities, a figure projected to reach 70% by 2050.7 Developing sustainable, climate-ready cities therefore is key to supporting healthier populations and ecosystems. Ensuring healthcare and public health systems are integrated into adaptation planning is vital, yet cities have been slow to incorporate health into their climate strategies. A report by the Yale School of Public Health, Resilient Cities Network, and The Rockefeller Foundation found that, although 44% of cities have resilience plans, only 27% address health comprehensively.8 Through strategic partnerships, city administrators and public health and healthcare leaders will be better positioned to implement and fund data-driven solutions to strengthen infrastructure, protect vulnerable populations, increase health system resilience, and reduce its contribution to an unstable climate. Urban centers are responsible for 75% of global emissions, driving significant climate-related health and care risks.7–9 These risks include physical trauma, heat- and smoke-related illnesses, vector-borne and waterborne diseases, and mental health challenges.10–18 Extreme weather events such as floods, hurricanes, wildfires, and heatwaves can disrupt infrastructure and supply chains that healthcare systems depend on, jeopardizing ongoing patient care and emergency response capabilities.19 Poorly designed or outdated facilities are vulnerable to power outages, water contamination, and structural damage, resulting in service interruptions. Collaboration between city, public health, and healthcare system administrators is essential to plan for and develop resilient infrastructure capable of withstanding these climate-related challenges, to ensure continuous care delivery.20–22 The healthcare sector must take responsibility for reducing its carbon footprint.23–26 Healthcare systems can significantly reduce emissions by transitioning to renewable energy, optimizing energy and resource use, and environmentally preferable purchasing. Not only are these interventions often cost-effective, but they can also increase the resilience and energy independence of healthcare facilities. For example, Kaiser Permanente achieved carbon neutrality in 2020, eliminating Greenhouse Gas Protocol scope 2 (purchased electricity) emissions of 768,000 tons per year and saving $19.6 million annually through improved energy efficiency and $2.8 million by reducing unnecessary water use.27 Such efforts can also improve patient safety indirectly through reducing healthcare pollution disease In the United the has of in and for healthcare systems to in renewable energy and resilient for more energy by the several healthcare systems have healthcare and for are to recent in populations, often in or the of and health Boston Medical Center the to fund a energy that generates for implementing energy that increase their energy healthcare systems can help mitigate emissions, increase resilience, and address social and environmental of health in the they Program In Boston Medical Center the to for renewable energy that reduce a and this with an of in or significantly reducing energy by the 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to renewable energy and optimizing to mitigate and pollution and by in resilient infrastructure to climate impacts and increase energy The for renewable energy have been by healthcare systems to support their energy and to improving the social and environmental of in the United and globally, climate adaptation Managing Healthcare Risks in the Era of Climate Change: The Pivotal Role of Health Insurers climate risks and and insurers in the impact on health insurers climate events intensifying in both and health insurers may increased mortality and strategies. 2024 the year on and is climate change to and Climate change could in 14.5 million additional deaths and trillion in by is of the risks that climate change poses to health and including for mortality of health and care and insurers currently only a limited impact of climate change on their is health insurers are from the costs of increased by the annual of as well as and by and government to protect insurers and The is to as climate change and In to the and health risks posed by climate and environmental insurers may be by the or on health of climate-related For example, increased supply of energy may mitigate risks as air quality is but a from to gas may to health such as that have been in is a between risks from climate change at the population and the of these risks to the on and are for but can be to for example, can be to and may be with a climate Further, the climate is and events are of severity and by the Geneva Association of of global and as well as that to health risks from climate change are only by but also by with to or that could social of business and sectors may be to of For data-driven and are the to insurers help to build the of and research on climate-related health while or that can insurers can also including such as that a to an that in to of health insurers can or in existing to improve climate for example, air or air in the of are vulnerable to or insurers can play a more role in the to 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