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Climate change calls for a new Hippocratic Oath


During the COVID-19 crisis, the healthcare industry found itself at the epicenter of our collective trauma. In addition to caring for people sick with the virus, medical professionals have served as messengers and revealers of the truth, providing the credible information Americans need to protect themselves. Health officials have also shaped real-time policies to reduce the damage to public health from the spread of the virus.

You could say that COVID-19 was a dress rehearsal for an even bigger crisis: climate change. Here too, health professionals are at the center of the community’s response and resilience. Given this central role, it is time to reconsider the roles and responsibilities of health care providers. In short, it is time for a new Hippocratic Oath. We have to ask ourselves: what does “no harm” mean in a world threatened by climate change?

Climate change is about many things: a drain on our economy, a driver of global migration, a threat to national security. It is also the greatest health threat we face today.

The burning of fossil fuels warms the planet, triggering new storms, deadly heat waves and epidemics of infectious diseases. And air pollution from the burning of fossil fuels is also a leading cause of illness and premature death in the United States and around the world. According to a recent report from the Harvard School of Public Health, in 2018, eight million people worldwide died prematurely from pollution caused by burning fossil fuels, far more than AIDS, malaria and tuberculosis combined.

All of these impacts are likely to increase in frequency, intensity and geographic scope in the decades to come, with disastrous effects on public health. Indeed, between 2030 and 2050, climate change is likely to cause some 250,000 additional deaths each year.

Burning fossil fuels has an economic and human cost. For example, the health costs of air pollution and climate change already far exceed $ 800 billion a year in the United States, a number that is expected to increase exponentially over this century.

And, like COVID-19, climate change is a force multiplier for the social, racial and economic disparities that disfigure our society. Weather disasters are increasing in frequency and severity across the country, and low-income communities and people of color are hit hardest. Climate impacts overlap with pre-existing conditions, such as high rates of asthma and diabetes, in vulnerable communities, resulting in poorer health outcomes. Additionally, polluting factories, landfills and diesel truck roads are more likely to be located in communities of color. Even the amount of tree cover to mitigate the heat island effect is less in black and brown communities, so the rate of heat-related deaths among blacks is up to 200% higher than that of whites. non-Hispanic.

In a warming and unequal world, it is impossible to look after the health of patients without addressing the larger environmental and social context, just as it would be absurd to ignore a raging pandemic. This is why doctors are increasingly speaking out in favor of measures to combat climate change. Doctors reframe the climate crisis to focus on people’s health, a story that people from all political walks of life can relate to.

And the health sector as a whole has started to leverage its power to shift the curve of greenhouse gas emissions. This is essential because the sector represents nearly 20% of the US economy and a tenth of emissions. Globally, if the health sector were a country, it would be the fifth largest emitter of greenhouse gases. So by decarbonizing the healthcare industry, we can immediately improve the health of Americans, reduce disease, and lower healthcare costs.

This work is well advanced. Members of the US Health Care Climate Council – a program of Health Care Without Harm, with representation from 18 health systems in 34 states – are reducing their carbon footprints and preparing their communities for the impacts of climate change. For example, a number of systems support home weatherization programs that can reduce the use of fossil fuels, reduce environmental exposures in low-income homes, and lower residents’ energy bills to free up energy. money for other essential expenses such as food and medicine.

They are also making progress in the transition from fossil fuels for their energy needs. In 2019, members of the Health Care Climate Council collectively produced or purchased over one million megawatt hours of renewable energy each year. The Cleveland Clinic, a member of the Health Care Climate Council with facilities in multiple states, has reduced its energy intensity by nearly a third since 2010, while serving more patients than ever.

At the same time, the healthcare sector is harnessing the enormous weight of hospitals and insurers to drive innovation and transform markets. Some health systems use their purchasing power to support the transition to renewable energies, sustainable food systems and a circular economy. Others “buy local” to diversify supply chains and support the economic health and wealth of the communities they serve. Twelve healthcare systems recently announced their participation in an impact buying pledge that requires them to double their racial diversity spending over the next five years, increase their local purchases and choose from a number of ‘other strategies to reduce their climate footprint and detoxify their supply chain. .

The past year has vividly illustrated the essential role of workers and health systems. It has also shown, once again, that our health as individuals cannot be divorced from the larger context, be it a pandemic, poverty, or a rapidly warming planet. Indeed, it is estimated that only 10-20% of health depends on clinical care; the remainder comes from “social determinants of health” such as income, racial disparities and the environment.

The healthcare industry occupies a unique position in American society both as an economic juggernaut and as a profession with an ethical commitment to “do no harm”. This power and this purpose can be harnessed to address the dual crisis of climate change and inequality.

To this end, we must expand the mission of the health sector beyond patient care, to include healing communities and the planet. It is the new social contract between the health sector and the communities it serves. This is the new Hippocratic Oath.

Author’s Note

The author is the co-founder and president of Health Care Without Harm, established in 1996 to help transform the health care sector to be environmentally sustainable and support the health and climate resilience of the communities they serve.

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