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

December 05, 2019

Information

Hosted by the Yale Climate Change & Health Initiative

November 21, 2019 at the Yale School of Public Health

Yale is a member of The Lancet Countdown, a multi-disciplinary collaboration of 27 academic institutions and UN agencies from every continent, dedicated to monitoring the evolving health profile of climate change, and providing an independent assessment of governments’ delivery of their commitments under the Paris Agreement. Learn the latest findings on: how climate change is affecting our health; the consequences of delayed action; and the health benefits of a robust response.

Presenters: Dr. Nick Watts, Executive Director, Lancet Countdown and Lead Author of the 2019 Report (via Zoom); Dr. Robert Dubrow, Professor of Epidemiology, Yale School of Public Health and Co-Author of the 2019 Report; Dr. Jodi Sherman, Associate Professor of Anesthesiology, Yale School of Medicine and Co-Author of the 2019 Report.

Note: There was a technical issue with the recording of Dr. Nick Watts’ presentation, and therefore it is not included in this video.

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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)