Ep 198 – Build for Resilience: A Plan to Drive Health Value and Tackle the Climate Crisis, with Dr. Vivian Lee

The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.

In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.

This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.


Episode Bookmarks:

01:30  The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.”

02:00  Climate change burden falls disproportionately on historically marginalized populations.

02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.

03:00  Introduction to Vivian Lee, M.D.

04:30  One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks.

06:00  Climate change resilience as a lens for value-based transformation.

06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.

07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.)

08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.

09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)

10:00  How do we decarbonize healthcare in order to “do no harm”?

11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).

12:30  The strong business case for health care organizations to reduce their carbon footprint.

13:00  Tax credits offered by the Inflation Reduction Act to decarbonize hospitals.

14:30  “Renewable energy actually costs less than fossil fuel energy.”

14:45  The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system.  (Add another 10% each for serving underserved regions and buying American made!)

15:00  ROI in the tens of millions for health systems going green! (“doing good and doing well”)

16:00  Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!)

17:00  Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS!

18:45  Kaiser Permanente became carbon neutral.  (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“)

19:30  Boston Medical Center reduced carbon emissions by more than 90%.

20:00  Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health

22:00  “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.”

22:45  “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.”

23:20  How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs?

24:30  Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“)

25:30  “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as wellall in the spirit of bringing more value to our health care system.

26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change)

28:00  Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities.

30:00  An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study)

34:00  The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery.

35:45  Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories.

37:00  Lowering the health care carbon footprint through supply chain optimization.

39:00  The need for more engineering and technical innovation to support innovation in climate resilience.

39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050.

40:00  “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.”  — Greta Thunberg

41:00  Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are.  We can’t escape this issue of climate change.  We are all on this planet together.”)