Launch of the 2019 Report of The Lancet Countdown on Health and Climate Change

Transcript

• 00:03- Alrighty.
• 00:04So, welcome to the launch
• 00:09of the 2019 Report of The Lancet Countdown
• 00:12on Climate Change and Health.
• 00:14I'm Robert Dubrow,
• 00:17I'm a professor of epidemiology in the department
• 00:19of environmental health sciences
• 00:21and I'm also the Faculty Director of the
• 00:23Yale Climate Change and Health Initiative.
• 00:26And so, let me introduce the two other participants.
• 00:30First I'll introduce Jodi Sherman,
• 00:34who is an associate professor
• 00:39of anesthesiology
• 00:41and she has a joint appointment with our department
• 00:44of environmental health sciences.
• 00:46She's an affiliated faculty member of the
• 00:48Climate Change and Health Initiative.
• 00:50And she's actually one of our most active
• 00:52affiliated faculty.
• 00:55Yale is really fortunate to have Jodi,
• 00:58because she's the world leader in the field of
• 01:00environmental sustainability in the health care sector
• 01:04which as you'll hear a little bit later
• 01:07is very important.
• 01:09So, that's Jodi.
• 01:11And then, we're also fortunate, very fortunate
• 01:15to have Dr. Nick Watts,
• 01:17who I'm gonna, make this screen larger now,
• 01:22(laughter)
• 01:23This is Dr. Watts.
• 01:25So, he's the Executive Director,
• 01:27oh, I should mention of course,
• 01:28Jodi is a co-author on the report.
• 01:31And Nick is the Executive Director and lead author
• 01:35of The Lancet Countdown.
• 01:37And, one of the pleasures of being part
• 01:40of the Lancet Countdown network for me has been
• 01:44working with like minded people from all over the world
• 01:48who are dedicated to this issue
• 01:49of climate change and public health.
• 01:51So, Nick really epitomizes that
• 01:54and it's been such a pleasure to get to know Nick
• 01:57and work with Nick over the last year and a half or so.
• 02:01He's really the heart and soul of the Lancet Countdown.
• 02:05And it's amazing to me, how he's able to work
• 02:08with sixty-eight other co-authors on this project
• 02:12who also have strong opinions
• 02:14and he's able to pull together a coherent document
• 02:19that's really written in a single voice.
• 02:22And if you've ever tried to do something like that,
• 02:25it's extremely difficult.
• 02:26And he does it with calmness and with grace.
• 02:29And so, I'd like to thank Nick for working tirelessly
• 02:34for the Countdown and for the cause
• 02:37of climate change and health.
• 02:40And so, Nick is gonna give a few words.
• 02:46Okay, so, we're actually,
• 02:49there are plenty of seats if people want to come in,
• 02:52you know, seats over there, over here,
• 02:57you don't want to stand.
• 03:03(shuffling of seats)
• 03:05Okay, so, yeah, we're really honored to be one of three
• 03:09U.S. regional launch sites
• 03:11for the Lancet Countdown.
• 03:14And so, let me first give you a little more background
• 03:19about The Countdown.
• 03:20The Lancet has had a long history of involvement
• 03:23with climate change.
• 03:25Dating back to its first report,
• 03:27it was commissioned in 2009,
• 03:30that was a published report
• 03:32which identified climate change as the leading threat
• 03:36to public health in the 21st century.
• 03:39Then they formed a second commission
• 03:42that produced a report in 2015
• 03:44that kind of shifted gears and identified climate change
• 03:48as being the greatest public health opportunity
• 03:52in the 21st century
• 03:54if we address it properly.
• 03:57There are enormous health benefits that can occur
• 03:59by addressing climate change over and above
• 04:02the health benefits of stopping climate change
• 04:05which we'll get into a little bit later.
• 04:08And so, since that report in 2015,
• 04:10which Nick was actually the lead author on that report,
• 04:13and as he remains being the executive director,
• 04:16there's been an annual report
• 04:18and it was named in 2016
• 04:22The Lancet Countdown.
• 04:23The reason it was called the Lancet Countdown is that
• 04:25the intent is to do a countdown every year
• 04:28until 2030.
• 04:30And maybe by that time, things will be great
• 04:33or we may need the countdown to go past 2030.
• 04:38So, just briefly, about the organization,
• 04:42I'll gloss over some of this,
• 04:44cause Nick covered some of it, but
• 04:45there are thirty-five academic institutions
• 04:48and UN agencies that are part of the collaboration.
• 04:52It's a fluid collaboration.
• 04:53Central office is based in University College, London.
• 04:57That's where Nick was speaking from.
• 04:59The Lancet, of course, was convened
• 05:02funded by the Welcome Trust
• 05:06and that was actually a big...
• 05:10This was being operated out of a basement
• 05:14in Nick's apartment
• 05:17until last year when major funding was obtained
• 05:21from the Weldon Trust.
• 05:23So that was really big.
• 05:26The Countdown is organized into five working groups
• 05:30which I'll name in a minute.
• 05:33And the report is organized according to indicators.
• 05:38And in the 2019 report there were forty-one indicators
• 05:42and in a few minutes, I'll give you a flavor
• 05:43about the indicators.
• 05:46And it's important to know that the indicators
• 05:48are based on observational data,
• 05:50not on projections.
• 05:52And both of those things are important.
• 05:53With climate change we do a lot of projections.
• 05:56But everything that I'm gonna show you today
• 05:58isn't guess work or what's gonna happen in the future,
• 06:01it's what has happened so far
• 06:03with regards to climate change.
• 06:06And each year, the indicators are updated and approved
• 06:08and some new indicators are added
• 06:10and some that weren't so good are taken away.
• 06:18Okay, next I'll show this,
• 06:20these are the partners.
• 06:21There are a good number of partners in the UK
• 06:24as you can see
• 06:25but, there's at least one partner from every continent
• 06:29except Antarctica.
• 06:32That's reasonable.
• 06:34(laughter)
• 06:35So, I'm not gonna go through these slides in detail
• 06:38but I just wanted to show you
• 06:39what the five working groups are.
• 06:42So, the first is
• 06:42Climate Change Impacts, Exposures and Vulnerability.
• 06:46Second is Adaptation Planning and Resilience for Health.
• 06:51Third is Mitigation Actions and Health Co-Benefits.
• 06:58Fourth is Economics and Finance.
• 07:02And the final one is Public and Political Engagement.
• 07:05So it tries to cover the whole gamut.
• 07:10So, Yale's role.
• 07:11We tried in the summer of 2018,
• 07:14we were not involved in the 2018 report
• 07:17but we are involved in the 2019 report.
• 07:21And we participated in two of the working groups.
• 07:25And as Nick alluded to, we've been responsible for
• 07:28two of the forty-one indicators.
• 07:31So one is Air Conditioning - Benefits and Harms
• 07:34and that's me, also Dr. Dung Phung
• 07:38who is at Griffith University in Australia
• 07:41but he was a visiting scientist here last year.
• 07:45And then the Mitigation in the Healthcare Sector
• 07:47is Jodi, along with Matt Eckelman
• 07:50who's at Northeastern University in Boston.
• 07:55So, these are the key messages of the 2019 report.
• 07:59And I'll be coming back to these.
• 08:01I'll just read through this
• 08:03because these are the key messages.
• 08:05The life of every child born today will be profoundly
• 08:08affected by climate change.
• 08:11Without accelerated intervention, this new era will come to
• 08:14define the health of people at every stage of their lives.
• 08:17That's the first message.
• 08:20Second one,
• 08:21and that's with the path that we're on now,
• 08:24which we could call a business as usual path
• 08:27this is what we expect to happen.
• 08:29However, there's an alternative.
• 08:31A second path- which limits the global
• 08:34average temperature rise to 'well below 2 degrees Celsius'-
• 08:37which is the Paris agreement goal,
• 08:39is possible, still possible, and would transform
• 08:43the health of a child born today for the better,
• 08:46right the way through their life.
• 08:49And then finally, it's possible, but it's not easy
• 08:52an unprecedented challenge
• 08:53demands an unprecedented response.
• 08:56It will take the work of the 7.5 billion people
• 08:59currently alive to ensure that the health of a child
• 09:02born today
• 09:03is not defined by a changing climate.
• 09:06So those are the three essential messages
• 09:08that the report is trying to convey.
• 09:13So, now the central office produced this
• 09:17three-minute video, that hopefully is gonna work.
• 09:23That I thought was worth showing.
• 09:25That summarizes things in a non-technical way
• 09:29in a much better way than I could possibly do.
• 09:34So let's see.
• 09:38- [Female Narrator] Our response to climate change today
• 09:39will determine the world we live in tomorrow.
• 09:42And will shape the health of children across the globe
• 09:46at every stage of their lives.
• 09:49The Lancet Countdown: Tracking Progress on
• 09:52Health and Climate Change
• 09:53monitors our choices, demonstrating what action
• 09:56or the failure to act, means for human health.
• 10:01There are many paths we can take
• 10:04from a world of extremes and uncertainty
• 10:07where a child has to fight simply to survive.
• 10:10To an environment that creates the conditions
• 10:13that allows them to thrive.
• 10:16If we continue down our current path
• 10:19a child born today will live through a world
• 10:22that is over four degrees warmer
• 10:25with a changing environment threatening
• 10:27the food they eat, the air they breathe
• 10:30and the communities they grow up in.
• 10:34Air pollution, already dangerously high in more than
• 10:3890% of cities, will worsen
• 10:42and further damage their hearts and lungs
• 10:45from the moment they take their first breath.
• 10:49As they grow, food insecurity will rise
• 10:53with children among the worst affected
• 10:56by the malnutrition and stunting
• 10:58that comes from crop failure in a more volatile climate.
• 11:02Throughout their adult lives, they will experience
• 11:06more heat waves, stronger storms,
• 11:09the spread of infectious disease
• 11:12and see climate change intensify mass migration
• 11:16extreme poverty, and mental illness.
• 11:20But the future doesn't have to look this way.
• 11:24A global response that limits temperature rise
• 11:27to well below two degrees will transform the life
• 11:31of a child born today for the better.
• 11:35Children in the UK will see an end to coal
• 11:39by their sixth birthday
• 11:41and the growth of solar and wind energy
• 11:44resulting in cleaner air across the country.
• 11:48In France, the last petrol car will be sold
• 11:52by the time they turn twenty-one.
• 11:54With cycleways and green spaces supporting safer
• 11:58and more livable cities
• 12:01and they will celebrate their thirty-first birthday
• 12:04as the world finally reaches net-zero emissions
• 12:08securing a healthier future for coming generations.
• 12:12Which of these two pathways the world travels down
• 12:15will depend on the decisions of individuals,
• 12:18businesses, and governments.
• 12:23And only an ambitious response can ensure that the health
• 12:27of a child born today isn't defined by a changing climate.
• 12:34Visit The Lancet Countdown online to find
• 12:37the latest assessment of health and climate change
• 12:40in your country.
• 12:49(keys clicking)
• 12:51Okay, so, what I'd like to do next
• 12:53is focusing on the key messages.
• 12:57So select some indicators
• 13:00that support a key message.
• 13:04So first, the first mentions that
• 13:06this a pessimistic message.
• 13:09The life of every child born today
• 13:10will be profoundly affected by climate change
• 13:13without accelerated intervention, this new era
• 13:15will come to define the health of people at every stage
• 13:18of their lives.
• 13:19So one of the trends in the indicators,
• 13:22why are we saying this.
• 13:23What are the trends of the indicators?
• 13:25And so I'll give a few illustrations.
• 13:27And so the first one, of course, the first thing
• 13:30a lot of people think about in regard to climate change
• 13:34is heat.
• 13:34That makes a lot of sense,
• 13:36the world is warming, we're seeing more heat waves.
• 13:37Heat waves kill people, and make people sick.
• 13:41And so, this indicator,
• 13:42Exposure of Vulnerable Populations to Heatwaves,
• 13:46first it defines a heatwave as four or more days with
• 13:50minimum daily temperature greater than
• 13:52the ninety-ninth percentile for summer months of 1986-2005.
• 13:56That's what it, different ways to define a heatwave.
• 14:00This is one of them.
• 14:01And then it defines a heatwave exposure event,
• 14:05which is one heatwave experienced by one person greater than
• 14:08age sixty-five years.
• 14:10So, why greater than age sixty-five years?
• 14:13Turns out that older people are more vulnerable
• 14:15to the adverse health effects of heat.
• 14:18And that's for a number of reasons, both physiological
• 14:21and social.
• 14:23And so, what this indicator takes into account
• 14:27is both the exposure, because if there were no heatwaves
• 14:30there's no exposure,
• 14:32and so the number of heatwave exposure events would be zero
• 14:36as well as vulnerability.
• 14:39So the more people over age sixty-five,
• 14:42the more heatwave exposure events there are.
• 14:46So it takes both exposure and vulnerability into account.
• 14:49And you can see the trend
• 14:51in comparison with the 1986 and 2005 average
• 14:56and the bottom line is that
• 15:00in 2018
• 15:01220 million additional vulnerable people
• 15:05were exposed to heatwaves
• 15:06over that baseline
• 15:08which is eleven million more than the precious record
• 15:10set in 2005.
• 15:12You can see that, as you know from experience
• 15:15with the weather, there's a lot of noise
• 15:17in all of these.
• 15:19But you can also see the upward trends
• 15:21and again, this is observational data
• 15:25it's not like, making projections into the future.
• 15:28Okay, second thing,
• 15:30wildfires.
• 15:31I need to have a good graphic for this
• 15:32but, we all know that wildfire is increasing
• 15:36in the western part of our country.
• 15:39I mean, you just know that from watching the news
• 15:41year after year.
• 15:42But, this was a more formal analysis
• 15:45that looked at the number of people exposed to wildfires
• 15:49expressing it in person-days.
• 15:52So one person exposed to a wildfire for one day
• 15:56is one person-day.
• 15:58And so, they found that 152 out of 196 countries
• 16:03saw increases in populations exposed to wildfires
• 16:08between a baseline year, or period
• 16:11of 2001-2004
• 16:13compared to 2015-2018.
• 16:19And so the mean increase per year of this exposure
• 16:23was almost a half a million person-days per year
• 16:27of exposure to wildfires.
• 16:29So, why are wildfires a health issue?
• 16:31So, for a number of reasons.
• 16:32One is it produces a tremendous amount of air pollution
• 16:36that doesn't just stay where the fire is, but it kind of,
• 16:39like, in Australia right now, there are record wildfires
• 16:42that were in Sydney, Australia, which is
• 16:45a city of five million people.
• 16:49I just heard this on the news yesterday,
• 16:53that the pollution levels for particulate matters,
• 16:55PM2.5, for those of you who know about this, is ten times
• 16:58the limit right now, in Sydney, Australia.
• 17:02So that's a huge public health issue.
• 17:06Secondly, remember what happened
• 17:09in Paradise, last year
• 17:11where all the the homes that were destroyed
• 17:14happened to be, mainly of homes of people that were retired.
• 17:19And what does homelessness do to people?
• 17:22In terms of health.
• 17:24It's really bad for people's health.
• 17:26Remember, in that situation
• 17:29people had to flee their houses, like, within minutes.
• 17:32These are older people,
• 17:34a lot of them are taking multiple medications,
• 17:36didn't have time to grab their medications when they left
• 17:38right?
• 17:39And then couldn't necessarily get to a pharmacy
• 17:42within the next week or two to refill their medications
• 17:45if they even remembered what their medications were.
• 17:47A lot of people don't remember those things.
• 17:49So those are health issues.
• 17:52And finally, mental health is being
• 17:57increasingly appreciated
• 17:59as a climate change and health issue.
• 18:02So, if you think about the stress that would be involved
• 18:06if you're sixty-eight years old,
• 18:08your home has just burned down
• 18:09you don't know where you're gonna go.
• 18:12So that creates long-term mental health concerns.
• 18:18So that's wildfires.
• 18:23Infectious diseases are also a concern
• 18:26and so, we don't have time to really go through the details
• 18:29of some of these graphs
• 18:31but what this Vibrio is a type of bacteria
• 18:34that causes gastro-intestinal illness, wound infections
• 18:39and sometimes lung infections.
• 18:41And actually, you've probably heard of cholera, of course
• 18:44Vibrio cholera is one species of Vibrio that's probably
• 18:48the most important one.
• 18:49But there are other pathogenic species as well
• 18:52of Vibrio.
• 18:53And, what this shows is for both the Baltic area
• 18:57and the United States North East.
• 19:01We're looking at tracking climate suitability
• 19:04for Vibrio infections.
• 19:07Or for growth of Vibrio.
• 19:09And the simple thing is that Vibrio grow better in
• 19:13warmer, they live in the water, they live in the ocean.
• 19:18And they especially like coastal waters,
• 19:21brackish water.
• 19:23And they grow better when the water is warmer.
• 19:26And the oceans have been warming, and so you can see
• 19:30that where we're tracking here,
• 19:32are both the percentage of coastal area
• 19:35suitable for Vibrio infections,
• 19:37you can see it has increased about 30% in both areas.
• 19:41And the number of suitable days per year
• 19:44in the Baltic
• 19:45for Vibrio infections and that approximately doubled
• 19:49between the early 1980's and 2018.
• 19:53And in fact,
• 19:57the number of Vibrio infections diagnosed
• 20:00in both the North East United States
• 20:03and in the Baltic region
• 20:04has been increasing over the years.
• 20:06Now, there's some question, always,
• 20:08whenever you see those kinds of increasing trends
• 20:10in a disease,
• 20:12whether it's due to increased reporting of the disease
• 20:15or due to a real increase in the disease.
• 20:17But nevertheless,
• 20:18you know,
• 20:19it has been increasing.
• 20:24Okay, I'm gonna skip some things
• 20:27just because, I wanna make sure we cover everything.
• 20:30So, food insecurity, as was mentioned in the video
• 20:35is a really important concern about climate change
• 20:38leading to under-nutrition, malnutrition, etc.
• 20:43And so, this shows trends
• 20:45in global yield potential
• 20:48which is measured by crop growth season duration.
• 20:51And that for four major crops:
• 21:00maize, winter wheat, soybeans, and rice.
• 21:03There's been approximately 2-4% decrease from the 1960's
• 21:06to the present day.
• 21:08Now, this doesn't, these graphs per se don't prove
• 21:12that's due to climate change
• 21:14but there's other kind of, independent analysis
• 21:17that do link decreases in yield
• 21:19to climate change.
• 21:28So this is an important indicator.
• 21:30So, coal is bad for two reasons.
• 21:33Of the fossil fuels,
• 21:35when you burn coal, it emits more CO2
• 21:39than the other fossil fuels,
• 21:41that being oil and natural gas.
• 21:43So, coal's really bad for the climate.
• 21:46And when you burn coal, you produce particulate matter,
• 21:50sulfur dioxide, pollutants, more so than when you burn oil
• 21:54and natural gas
• 21:56and those pollutants kill people.
• 21:58That's the air pollution.
• 22:00And so, we're trying to track
• 22:03what we hope will be a coal phase out
• 22:05but if you just look at the bars
• 22:07just to keep it simple
• 22:10this is global total primary energy supply
• 22:14from coal.
• 22:17And you can see that there was an increase from
• 22:22around 2000-2010 or so, let's say 12.
• 22:28But then there was some encouraging signs of a decrease
• 22:31but now it's kind of leveled off
• 22:33and it's increasing again.
• 22:34So that's another bad sign.
• 22:40So this is related to the coal.
• 22:41Premature mortality from ambient air pollution by sector,
• 22:45let's not worry about the sector,
• 22:46so the main point here is that in 2016
• 22:49there were about 3 million premature deaths
• 22:52due to ambient particulate matter.
• 22:55Pollution.
• 22:57And the comparison here isn't a long-term comparison.
• 23:00It's between 2015 and 2016,
• 23:04but they're all only very slight improvements.
• 23:17Those are some of the pessimistic trends
• 23:19and there are others that, just due to time, I had to skip.
• 23:23And there were others that I wasn't even planning on
• 23:25covering to begin with that are pessimistic.
• 23:28So, just a minute on some of the more optimistic.
• 23:31So, now we're on to the second key message.
• 23:35A second path, which limits
• 23:36the global average temperature rise
• 23:38to well below two degrees centigrade is possible
• 23:41and would transform the health of a child born today
• 23:44for the better, right the way through their life.
• 23:48So these give a glimmer of hope.
• 23:51So first of all, what do we need to do?
• 23:53This is what we need to do.
• 23:55And this is from last year's
• 23:56Intergovernmental Panel on Climate Change Special Report.
• 24:00To limit warming to 1.5 degrees centigrade
• 24:03which is the aspirational goal of the Paris agreement.
• 24:07We need a 45% decline of greenhouse gas emissions
• 24:11from 2010 levels by 2030
• 24:14so about half
• 24:17and net zero by 2050.
• 24:20And obviously, this is not my words,
• 24:23it's the conclusion of the report,
• 24:25that will require rapid
• 24:26and far reaching transitions in energy, land use,
• 24:29transportation, buildings, and industrial systems.
• 24:34Okay, so a few examples of the hopeful indicators.
• 24:39So this is zero-carbon emission electricity.
• 24:43So that would be renewables, and would also include
• 24:46nuclear and hydro.
• 24:48So, in 2018 renewable energy counted towards
• 24:5145% of growth in electricity generation.
• 24:55That's still a very small share of electricity generation
• 24:58but at least it's counting for a big share of the growth.
• 25:03Okay, this is really,
• 25:06we are really grasping at straws here
• 25:08but, as you know, fossil fuels dominate transportation.
• 25:13So this graph is showing from 1971 to the present
• 25:17the fuels that are used for transportation
• 25:21and you can see that the gray is fossil fuels
• 25:25and the green is bio fuels.
• 25:28And I don't know if you can see the top one,
• 25:30but there's a little bit of black
• 25:32and that's electricity.
• 25:34But then the bottom graph
• 25:37separates out the bio fuels and electricity
• 25:40and you can kind of see how the electricity is growing.
• 25:44And so, between 2015 and 16
• 25:47the latest years where data were available
• 25:50there was about a 21% rise
• 25:52in fuel from electricity.
• 25:54So obviously, we need to greatly accelerate this,
• 25:58we really need to transform the transportation system
• 26:01to electricity.
• 26:04And it's kind of just a glimmer of this starting to happen.
• 26:08This is another really important indicator
• 26:10that coal is critical.
• 26:12And so this is looking at investment
• 26:14in new coal capacity.
• 26:16So you can see, just focus on the blue line.
• 26:20You can see that there's been a decline in investment
• 26:23in new coal-fired power plants since about 2011.
• 26:27That's an optimistic sign.
• 26:32Okay, this is maybe more controversial one,
• 26:36but it's one of the indicators.
• 26:38So the Lancet Countdown thinks that divestment's important
• 26:42for two reasons.
• 26:43One is that it removes the social license
• 26:46of the fossil fuel industry.
• 26:48So, saying, you know, we don't think
• 26:50that the fossil fuel industry
• 26:52is just like every other industry.
• 26:54There are special problems with the fossil fuel industry.
• 26:56And the second reason,
• 26:58that's kind of a more practical reason...
• 27:00So at some point, hopefully sooner rather than later
• 27:04fossil fuel reserves that are in the ground
• 27:08are gonna be worthless.
• 27:10Because we're not gonna use fossil fuels anymore.
• 27:13And so therefore, they're worth a lot of money.
• 27:16But there's the concern
• 27:18about investments of fossil fuels, at a certain point,
• 27:21really tanking.
• 27:23And so that's kind of a practical reason for divestment.
• 27:27And so, there were 2.1 trillion dollars in new funds
• 27:31around the world
• 27:33that were committed to fossil fuel divestment in 2018.
• 27:42So, another optimistic one
• 27:44is the revenues from carbon pricing.
• 27:48So these are revenues from what are called
• 27:51cap and trade schemes
• 27:53which are basically a way of making
• 27:55fossil fuels more expensive.
• 27:57And also direct carbon taxes.
• 28:00And so revenues increases by 10 billion
• 28:03between 2017 and 2018, reaching 43 billion dollars.
• 28:09And more than half of that was allocated to climate change
• 28:12mitigation activities.
• 28:13So that's a positive sign.
• 28:17Okay, so now
• 28:19I'm gonna turn it over to Jodi
• 28:22to talk about the third indicator
• 28:25and then I'll be coming back to kind of finish up
• 28:28with some final words.
• 28:53- Well, good afternoon
• 28:54so, as Dr. Dubrow said, I'm an anesthesiologist
• 28:58practicing down at Yale across the street.
• 29:00And the things that motivate me to work on this issue
• 29:04are every time I take care of a patient,
• 29:07I suffer immoral injury
• 29:10because I know I'm causing indirect harm
• 29:13at the same time
• 29:14through the pollution I'm generating
• 29:16through the care that I'm giving.
• 29:18And so, I feel motivated to try and help
• 29:19clean up the health care industry itself
• 29:21and also to engage health professionals
• 29:23because not only is this issue not taught at medical schools
• 29:28not taught in nursing schools,
• 29:30but health professionals are dedicated to their patients
• 29:35and busy with their patients
• 29:36and so most of them may not feel motivated
• 29:38to be engaged with trying to affect policy
• 29:41or even administrative changes in their own facilities.
• 29:43But if you can enlighten them
• 29:45about the pollution that they're generating
• 29:47through the care that they're giving
• 29:48I think that this is how we
• 29:50can help engage health professionals
• 29:53which are trusted members of society
• 29:55like everyone in this room here
• 29:57to help make the transition in short order.
• 30:01And so, the questions I ask have to be
• 30:03what does climate change have to do with health care?
• 30:05Well, you just heard some
• 30:07about what it has to do with health.
• 30:09What it has to do with health care includes
• 30:11increasing demands for services
• 30:13increasing costs, and then a positive feedback loop
• 30:15also increasing pollution.
• 30:17And also, what does health care have to do
• 30:21with climate change itself?
• 30:22And how much pollution are we generating?
• 30:24And these were all unknowns when I was just starting
• 30:27and so it motivated me to collaborate
• 30:29with environmental engineers such as Matt Huckleman
• 30:32to try and put some numbers behind
• 30:34and guide
• 30:36help us understand what we can do
• 30:37and that's really what started this whole path.
• 30:39So here in Connecticut,
• 30:41Yale New Haven health system is all along the coast
• 30:43along the coastline between here and Providence.
• 30:47We are very vulnerable to weather related events.
• 30:49And if you talk to our disaster management
• 30:53and emergency preparedness division
• 30:56which is very robust
• 30:57and they're in agreement, it is not a matter of if
• 31:01but when we are going to be suffering these events.
• 31:09And so, Hurricane Sandy
• 31:12which mostly impacted New Jersey
• 31:17and New York
• 31:18kind of quickly disrupted health hospitals
• 31:22and health systems that never thought
• 31:24they would have to deal with such a thing.
• 31:27On the right, you see hundreds
• 31:30of patients were evacuated down the stairs
• 31:32by flashlight
• 31:33including nineteen patients
• 31:36out of the neonatal intensive care unit
• 31:38requiring hand ventilation down several flights of stairs.
• 31:41That made international news.
• 31:43On the left, you already heard from Dr. Dubrow
• 31:46about the campfire in Paradise,
• 31:49you see evacuation occurring out of Feather Meadow Hospital.
• 31:54That was completed just before
• 31:56the hospital burned to the ground.
• 31:57And so, this is also already impacting,
• 32:00disrupting our health care services.
• 32:02Now, with health care Maria, I have to be honest
• 32:06I didn't know until then
• 32:07that the majority of several of our drugs
• 32:10and bags of fluid saline
• 32:11were actually manufactured on the island of Puerto Rico.
• 32:15So when Hurricane Maria hit
• 32:17it very much disrupted the supply chain
• 32:19affecting care even here in New Haven, Connecticut
• 32:23where we feel probably immune to it.
• 32:25So, the vast majority of hospitals across the country
• 32:29reported that they were suffering major supply shortages
• 32:34changing the care that they deliver
• 32:36which actually increasing the risk in the care
• 32:38that we deliver.
• 32:39Things like medication substitution,
• 32:40different concentration,
• 32:41different drugs can have different impacts
• 32:44and result in errors.
• 32:46Inappropriate substitutions of drugs,
• 32:47improper handling of drugs,
• 32:49so splitting vials between patients
• 32:51in non-sterile conditions
• 32:53and then shortages when there's no substitution available.
• 32:56And then this odd phenomena
• 32:58where actually, we saw some increased drug waste.
• 33:00So for example,
• 33:01here is a two ml vial of a local anesthetic
• 33:03named Mepivacaine that we use for spinal anesthetics
• 33:06when that was absent,
• 33:07we actually had to substitute a 30 ml vial
• 33:10and because of concerns for cross-contamination
• 33:13of microbial risk, that had to be thrown away.
• 33:17And until we create an infrastructure
• 33:20for pharmacy to split these drugs.
• 33:21So this odd phenomenon of increasing waste.
• 33:25So health care is an enormous industry,
• 33:28here in the U.S. 3.65 trillion dollars
• 33:31near 20% of our gross domestic product
• 33:33goes toward health care.
• 33:34It's a very energy intensive industry,
• 33:39not only the manufacturing of all the things,
• 33:41but with the energy we use to run the hospitals
• 33:43which are two and half times
• 33:45as energy intensive as the average commercial building.
• 33:49They operate 24/7, they have complex
• 33:51medical devices and equipment.
• 33:53We have unique requirements to prevent
• 33:56the risk of cross-contamination,
• 33:58so infection prevention.
• 34:00And so we use more chemicals
• 34:02and we use disposables.
• 34:04And there's this really disturbing trend
• 34:07in some of these disposable devices
• 34:09because a lot of it's not evidence-based
• 34:11there just seems,
• 34:12if we can get to zero-risk we should go there
• 34:14but we're actually ignoring the secondary harm
• 34:17to public health.
• 34:19And so, we're at a balance there.
• 34:22There is a risk stratification of
• 34:24what things need to be sterile,
• 34:27what things don't need to be sterile
• 34:28and yet we're going toward more and more disposables.
• 34:31And so conservative estimate by Health Care Without Harm
• 34:34said that there was about six million tons of solid waste
• 34:38generated from hospitals in the United States annually.
• 34:41This is a very conservative estimate.
• 34:43So many years ago now, we're doing more and more disposables
• 34:46so surely that number is much bigger now.
• 34:50And then we have so much regulatory complexity
• 34:52and complex business models.
• 34:54All these things contribute to systematic waste.
• 34:57And finally, culture.
• 34:59We're a rich society.
• 35:01So we are excessive
• 35:04in the resources
• 35:06that we use and have
• 35:08and this disposability is normalized.
• 35:10So there's a real need for a culture change
• 35:13to help engage around cleaning up health care
• 35:15and engaging health care professionals.
• 35:17This is an image of a robotic surgery.
• 35:19Some things to notice,
• 35:21there's a lot of disposables here
• 35:23including all the linens
• 35:24and the complex medical devices.
• 35:26All of these instruments here that are attached
• 35:28to the robot arms
• 35:29are single-use disposable.
• 35:31There are options for reusing them
• 35:34but that is not the norm currently.
• 35:39And so, Rob mentioned Dr. Eckelman
• 35:42so he's an environmental engineer
• 35:44from Northeastern University and also has an appointment
• 35:46here in environmental health sciences,
• 35:48specializes in life cycle assessment.
• 35:50We started collaborating several years now
• 35:53trying to understand
• 35:54what the footprint is of drugs and devices
• 35:58and entire health systems.
• 36:00And life cycle assessment is
• 36:02an internationally standardized scientific modeling system.
• 36:06So it's not just all the stuff that you throw away,
• 36:08it's not just that we generate six million tones
• 36:11of solid waste annually.
• 36:13But there's emissions involved
• 36:14in raw material extraction, production, transportation
• 36:17as well as disposal.
• 36:19So unless you put all those pieces together
• 36:21we can't really understand where the hot spots are
• 36:22and what the alternatives are.
• 36:25So a couple of different approaches to
• 36:26life cycle assessment,
• 36:27including a bottom up approach where you essentially
• 36:30look at all the materials that you're using,
• 36:33there are international data bases that tell you
• 36:35what the emissions are for those materials.
• 36:37And then you can add them up and understand
• 36:39where in the life cycle you're having your impacts.
• 36:41And another approach is sort of a top-down
• 36:44where you're looking at something
• 36:45like an entire health system
• 36:47you can't really measure any single material
• 36:49that's going into that system.
• 36:50So we use national statistics to help expenditure data
• 36:53coupled with economic material flow analysis
• 36:57both nationally and multi-regionally.
• 37:00And then, that gets linked to environmental initiatives.
• 37:03So top-down and bottom-up approach
• 37:05to come to some understanding
• 37:07of what the footprint is.
• 37:09And I think it's worth highlighting
• 37:11one study that we did looking at different anesthetic drugs.
• 37:15There's a lot to absorb here, so if you allow me to tell you
• 37:18these are four different anesthetic drugs.
• 37:21The first three are gases, or actually four
• 37:24because Microsoft site is not moving the bars.
• 37:27These are inhale drugs,
• 37:28this is propofol, an intervenous drug.
• 37:31So we look at the life cycle footprint of an hour's worth
• 37:34of this drug to keep a patient asleep.
• 37:36And, first thing to pay attention to is the fact that
• 37:40you can't see propofol here at all.
• 37:42It's there, but its greenhouse gas emissions are
• 37:44four orders of magnitude less than inhalent anesthetics.
• 37:48So these drugs have different properties,
• 37:49why we would chose them under different conditions.
• 37:52But this is just to help guide environmentally
• 37:54preferable choices as a clinician.
• 37:56So if you have a choice
• 37:58between these,
• 38:00and often we do, chose the one that is least harmful
• 38:02for the environment.
• 38:03The other things to note are
• 38:04that if you just look at the pink
• 38:07that this drug desflurane has about twenty times the impact
• 38:11of isaflurane.
• 38:12And nitrous oxide, if you add it
• 38:14short story is if you add it, it makes everything worse.
• 38:17So take homes include:
• 38:19avoid desflurane and nitrous oxide
• 38:22when you have the ability to do so.
• 38:24And I should say,
• 38:26inhaled anesthetics are very potent
• 38:28greenhouse gases.
• 38:29Hundreds to thousands more potent than carbon dioxide
• 38:32and they're simply vented off of hospital rooftops.
• 38:35So, the blue here is the non-waste phase.
• 38:39So, the manufacturing, transportation, utilization phases.
• 38:44Everything else is the waste phase.
• 38:47So we can look at things like
• 38:48waste and anesthetic gas technologies which exists.
• 38:52That's another solution.
• 38:53And another study done by Sandra Thiel
• 38:56from New York University
• 38:57compared different surgical approaches.
• 39:00So again, there are different reasons why you'd choose
• 39:02an open technique versus a minimally invasive technique.
• 39:05The first techniques in a hysterectomy on the left are open.
• 39:08The two on the right are minimally invasive,
• 39:11one being laparoscopic and one robotic.
• 39:13Some take homes here include the purple
• 39:16which are inhaled anesthetics.
• 39:18So depending on the approach
• 39:19one third to two thirds the footprint of
• 39:21everything happening in the OR
• 39:22the energy to run the building, the equipment,
• 39:24all the disposable and reusable devices.
• 39:27Inhaled anesthetics are a pretty big piece of that.
• 39:29Another take home is this light green here
• 39:32which is all the single-use disposable instruments.
• 39:35And the error bar is because a couple of these cases
• 39:37had propofol.
• 39:38So if we took this out the error bars would be much smaller.
• 39:41So I showed you a picture of a robotic surgery for a reason
• 39:45that's really interesting.
• 39:46Because there's this increasing trend
• 39:48to push toward robotic surgery.
• 39:50It is not has been shown to improve outcomes
• 39:52over a laparoscopic approach
• 39:54but it is becoming sexy to patients.
• 39:58They want to go to an institution that is doing the most
• 40:01technologically advanced procedures.
• 40:03So now there's this competitiveness that we have to be
• 40:05more and more technologically advanced.
• 40:09And so that is also contributing part of the problem.
• 40:12And so I mentioned that we do these
• 40:14national health sector studies
• 40:16so the first one we did was on the U.S.
• 40:18And so this was really not astonishing,
• 40:20we know we spend more per capita on health care
• 40:23than any other industrialized nation.
• 40:25And we found that the U.S. health sector in 2013
• 40:28was nearly 10% of our nation's greenhouse gases.
• 40:31Nearly 9% of our criteria air pollutants.
• 40:33If the U.S. health sector were a nation itself
• 40:36it would rank 13th in the world for greenhouse gas emissions
• 40:39ahead of the entire United Kingdom.
• 40:42And we also looked at other emissions
• 40:44notably air pollutants as I mentioned.
• 40:46If we were to translate that into public health damages
• 40:48614 disability-adjusted life years lost annually
• 40:52especially due to air pollution and also climate change.
• 40:55And this is similar magnitude to deaths
• 40:59due to medical errors.
• 41:00This was first reported by the Institute of Medicine
• 41:02"To Err is Human" in 1999.
• 41:04Those deaths lost on average ten years of life.
• 41:07By calculations we're seeing the same magnitude.
• 41:10This was important, this IOM report "To Err is Human"
• 41:14is a landmark report that sparked the
• 41:16whole patient safety movement.
• 41:18The fact that people are dying
• 41:19from preventable medical errors.
• 41:21So there are institutions that pay to see
• 41:24health care research and quality was formed and funded.
• 41:26So it totally transformed every aspect
• 41:28of how we deliver care.
• 41:30Patient safety is formalized in how we deliver our care.
• 41:34And so what we are trying to say is
• 41:36pollution is just as big and just as important
• 41:38to how we deliver care.
• 41:41And that this is the new patient safety movement.
• 41:45I'm gonna go ahead and skip ahead to
• 41:48we then worked with The Lancet team
• 41:52and there's a new indicator
• 41:54we wanted to essentially make this an international metric.
• 41:57And so, surprisingly globally take homes here include
• 42:01that global health care greenhouse gas emissions
• 42:05are 4.6% of global emissions.
• 42:08I mean, I just like to let that sink in.
• 42:11The other takeaway here is that the United States
• 42:15is a top player.
• 42:16And not in a good way.
• 42:18So on the left we see,
• 42:20this is per capita gross domestic product
• 42:24by per capita health care emissions.
• 42:27And the bubble with those is the expenditure on health care.
• 42:30So again, we know we spend twice as much on health care
• 42:33in the U.S. as any other nation.
• 42:34And on the right is over time,
• 42:36so trending upward.
• 42:37So roughly a quarter of these emissions
• 42:40are coming from the U.S. alone.
• 42:42We are not number one in health outcomes
• 42:44in terms of outcomes such as
• 42:49maternal deaths,
• 42:51life expectancy,
• 42:53the money we're spending on health care is not
• 42:56being spent wisely.
• 42:58And so that's part of why
• 43:01there are a lot of opportunities here to save money
• 43:06as well as reduce pollution.
• 43:07We really need to look at globally how health care sectors
• 43:10are performing,
• 43:11and obviously particularly in the U.S.
• 43:14And we wanna get some positive news, right?
• 43:16So Kaiser Permanente is a large non-profit health system
• 43:19in the United States.
• 43:2012.3 million people.
• 43:22They have a very robust sustainability division
• 43:24looking at improving their entire organizations' footprint
• 43:28between 2008 and 2017,
• 43:30they reduced their greenhouse gas emissions by 20%
• 43:32while increasing their membership by 36%.
• 43:35In 2018, they started hosting on-site solar panels
• 43:39and have a commitment by 2020 to have 100% renewable energy.
• 43:47And 3% of their health sector emissions are coming from
• 43:50inhaled anesthetics.
• 43:51That is consistent with national work out of the U.K.
• 43:55and other health organization work.
• 43:56So inhaled anesthetics was a big part of its footprint.
• 43:59And I should say the U.S. numbers I gave you
• 44:01and also the global numbers I gave you
• 44:04do not include inhaled anesthetics.
• 44:06And so K.P. reduced this by 25% by progressive
• 44:10elimination of that one drug desflurane.
• 44:13And we're actually working on a campaign to reduce
• 44:17their nitrous oxide use.
• 44:18So we're working together on that.
• 44:20And the other one worth mentioning
• 44:22is the U.N. National Health Service.
• 44:24They're leading the world with the division
• 44:27of sustainable development
• 44:28and the division's dedicated to reducing the footprint
• 44:31of health care.
• 44:32And since their start,
• 44:34they've actually reduced their emissions
• 44:36measurably so
• 44:38by 18.5% between 2007-2017 while increasing their
• 44:42clinical activity.
• 44:43And they have a very robust action plan
• 44:45that is a global exemplar.
• 44:48And so, you talk about delivering health care
• 44:52which is delivering the maximum health gain
• 44:54or experience of care
• 44:56at the least cost, while adding value for the most people.
• 44:59And we're talking about that we need to add
• 45:02environmental and social benefits as well.
• 45:06(distant murmuring)
• 45:35- Okay, so just to finish up.
• 45:37So the third key message,
• 45:39an unprecedented challenge demands
• 45:42an unprecedented response.
• 45:43I thought it would be worth taking about that
• 45:47a little bit.
• 45:48So first, I think we really need optimism.
• 45:51Pessimism, and this is me talking,
• 45:57not the Lancet Countdown, but I think they'd agree
• 46:00with most of it.
• 46:02Pessimism is self-fulfilling prophecy.
• 46:03So it's really morally imperative that we be optimistic
• 46:06about achieving this.
• 46:09And there are some reasons for optimism.
• 46:11We see that solar and wind are actually happening.
• 46:16They're becoming economically competitive.
• 46:19They're technologically feasible.
• 46:23We can do solar and wind.
• 46:26Transition to renewable energy is possible.
• 46:31We have the Pope's encyclical,
• 46:33that was a powerful document.
• 46:35That's still resonating.
• 46:38With all of its flaws,
• 46:40we have the Paris Climate Agreement
• 46:42that right now, every nation on earth is part of
• 46:45the Paris Climate Agreement.
• 46:46There's one nation that's in the process of withdrawing
• 46:49(laughter)
• 46:50Unfortunately.
• 46:51But even so, we have states, cities,
• 46:54collages and universities, businesses, etc.,
• 46:57that have said, "We are still in".
• 47:00So these are in the United States.
• 47:02They've pledged to do their part for the climate
• 47:06and essentially stay in the Paris agreement.
• 47:11There's ongoing divestment.
• 47:12New York City divested its entire pension fund last year.
• 47:22One of the things we have to do is stop building
• 47:24new fossil fueled infrastructure.
• 47:26That's essential in order to achieve this transition.
• 47:31There have been a lot of defeats,
• 47:33but there have been some victories.
• 47:35Like this one victory here in New York state.
• 47:39The Juliana vs U.S. climate lawsuit is still alive.
• 47:44This is where young people are suing the United States
• 47:48to do more about climate change.
• 47:53And young people around the world are rising up
• 47:56around this issue.
• 48:02In the U.K.
• 48:06Outside Speaker Pelosi's office.
• 48:12So to me, that's the most hopeful thing of all
• 48:15it's like, well the young people
• 48:17they understand that their future's at stake.
• 48:19Or, a lot of you are young people
• 48:21you understand that your future's at stake.
• 48:23(laughter)
• 48:24You understand that your future's at stake.
• 48:26And people are rising to the occasion.
• 48:28So I'd like to end with this quote from Martin Luther King.
• 48:31Which was not about climate change obviously
• 48:34but is applicable to climate change in my view.
• 48:37We are now faced with the fact that tomorrow is today.
• 48:41We are confronted with the fierce urgency of now.
• 48:44In this unfolding conundrum of life and history,
• 48:47there is such a thing as being too late.
• 48:50So time is not on our side, time is our enemy
• 48:53in this case.
• 48:54We have to do things faster.
• 48:57The transition's going to happen.
• 48:59Really, the question is
• 49:00what is the pace of the transition?
• 49:01There is no time for apathy or complacency.
• 49:04This is a time for vigorous and positive action.
• 49:10Okay so thank you.
• 49:11And if people are particularly interested
• 49:14and you do have some hard copies of the report here
• 49:17so if you're interested come up and get a hard copy.
• 49:20(clapping from the audience)
• 49:28(chatter throughout the room)