WASHINGTON -- Hospitals need to be part of the solution when it comes to combatting climate change, Ashish Jha, MD, MPH, director of the Harvard Global Health Initiative, told members of the House Ways & Means Committee Thursday.
"The healthcare industry represents about 10% of greenhouse gases; that's pretty substantial," Jha said at a hearing on "The Economic and Health Consequences of Climate Change." He lauded healthcare institutions such as Kaiser Permanente, which has pledged to become carbon-neutral by 2020, "but too many hospitals and nursing homes are not doing quite enough," he added. "In terms of healthcare leadership, I've seen physicians and nurses but not seen enough for hospitals and other institutions."
One problem might be financial, according to Rep. Terri Sewell (D-Ala.). "Many of my rural hospitals are struggling to keep the doors open and lights on" and may not have the time or resources to deal with climate change issues, she said.
"There are a lot of policy issues affecting rural hospitals [which are] struggling to stay open," Jha responded. "But ultimately these hospitals are safety net institutions for their communities. We need them to survive storms, to do a better job of predicting heat waves, and do a better job of staffing, so we need to spend a lot more time and energy on this." He noted that only 0.05% of the NIH budget is spent on studying the health effects of climate change.
Jha also addressed other healthcare aspects of the issue. Although weather-related events such as hurricanes have an immediate effect on people's health, "[many of] the health consequences come in the days and weeks that follow," he said. For instance, "with wildfires, we [see] substantial increases in respiratory diseases and asthma, and more hospitalizations for heart attacks, strokes, and heart failure. It's incredibly costly to their health and to our healthcare system."
These weather events can also cause disruption among the hospital staff, he added. "The hospitals are no good if the doctors and nurses who staff them aren't there," he said. "For people who are chronically ill, there's a huge effect."
Rep. Brad Wenstrup, DPM (R-Ohio), a podiatrist, said that as a physician, he understands the major role environmental issues play in people's health, adding that he has had his own problems getting traction in Congress for a bill to prohibit smoking in all Department of Veterans Affairs (VA) healthcare facilities. "Maybe we can get that through this time."
But environmental protection shouldn't mean pricing energy so high that it becomes unaffordable, Wenstrup said. He recalled one weekend several decades ago when he was in Chicago; it was during an intense heat wave. "Sadly, that weekend, 500 people [in Chicago] died from the heat," he said. "That was really because of brownout, because of a loss of air conditioning or an inability to afford air conditioning. Really, they died from loss of energy."
"Without energy, people die too, so that's the balance we have to have here," he said. "I think that needs to be a key part of the conversation. Without reliable, affordable energy, people die."
Jha agreed, noting that "energy is the lifeblood of the hospital, the healthcare system, and our society ... In Puerto Rico [after Hurricane Maria], one of the more interesting things was that after the [hurricane], the sun was shining, so places that had solar [energy] were able to continue to operate. It's a reminder that alternative energy can be useful at critical moments."
"For most Americans, asking them to choose between polluting energy that causes asthma, heart disease, and smoke, or no energy at all shouldn't be the choice," he said. "Clean energy -- I think we can get there. I don't think there needs to be a tension."
Rep. Judy Chu (D-Calif.) called the hearing "long overdue," noting that it was the committee's first hearing on climate change in 12 years. Since California is expecting more heat waves and droughts in the future, she asked Jha for more information on the effects of extreme heat on outdoor workers.
"Human bodies are not designed to sleep in outside temperatures of 110° to 115°," said Jha. "We can't adapt to it. ... This is one of the reasons why farm workers have a mortality rate that is 10 to 20 times higher than the average American." He listed short-term effects of extreme heat -- dehydration, asthma, and kidney failure -- as well as long-term ones like mental health issues and chronic kidney disease. "They are extremely expensive to take care of ... but we have to do it for health, not for the money, but the cost of all that is going to be borne by [the citizens]."
Rep. Bill Pascrell Jr. (D-N.J.) asked about climate change's effect on the food supply. "Climate change will lead to more frequent droughts and at the same time, it will also change precipitation patterns and lead to heavier downpours," said witness Katherine Marvel, PhD, an associate research scientist at the NASA Goddard Institute for Space Studies. "We [also] expect to see the range of certain pests expanding and changes to growing seasons, and all of these things could have implications for agriculture."
Jha also responded. "There is very clear evidence that nutritional aspects of the food that's grown in an environment with climate change is substantially diminished," he said. "So we may be able to decrease crop yields but that food's quality is going to be lower. ... It turns out we're also seeing increases in foodborne illness as a result of climate change. So the combination of worse quality and worse safety in the food supply are real issues that are going to affect the health of Americans."
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