Rae Woods (00:02):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. Climate Change is a health issue. Deaths from particulate emissions alone already exceed deaths from all hospital related harm. And let's be honest, a large part of the problem is our own making. Healthcare is responsible for a good chunk of US emissions, and US hospitals are the largest emitters of carbon per square foot than any other building in the world. Now the last time we talked about climate change on this podcast, we focused on accepting that reality. But I want to make sure we don't stop at just explaining healthcare's role in the problem. Today I want to focus on action. To do that, I've brought Neal Hogan, the chairman of Healthcare Climate Action Works, a firm dedicated to researching and sharing best practices in emissions reductions. Hey, Neal, welcome to Radio Advisory.

Neal Hogan (01:06):
Hey Ray, thanks very much. Great to be here.

Rae Woods (01:09):
I want to ask you before we get into this conversation, in your personal life, just kind of naturally speaking, do you find yourself an optimist or a pessimist?

Neal Hogan (01:19):
So my theory on that is that those are forecasts. Okay. And so you are either making a forecast of optimism or pessimism. So it depends on the thing you're talking to me about. If you have to talk to me about my marriage, I'm very optimistic. But on other things, I'm pessimistic. But if I am pessimistic and I believe in it, then I believe in hope. And that's where you just roll up your sleeves and you get to work so that you adjust the forecast.

Rae Woods (02:00):
Well, that's a lovely way for us to get started into this. Because I will say, many people have told me that I tend to have a pessimistic mindset. Frankly, I think that that is what makes me a good researcher, that I can poke holes into things. But I found myself, as I was reading your book, kind of having several moments where I just went, whew, this does not look good. My husband said, so what are you reading about? And I said, I'm reading about how we're screwed. So I am so happy that you are here to actually tell us how we can have hope when it comes to climate change.

Neal Hogan (02:33):
There's a huge amount of hope. There's so many good things happening now in climate change, and there's a sea change. And I think anybody under 40 is working on climate change at this point. And once we get those older people to die off, then everything's going to go great.

Rae Woods (02:49):
Wait, how old are you?

Neal Hogan (02:50):
I'm 61. I'm 61. But yeah, my peer group is not as active on this. It's so interesting when I talk to people, it's really true. If I talk to somebody in their 30s they're just all over it. And if I talk to somebody who's 65 or 70, they frequently don't even know much of what I'm talking about.

Rae Woods (03:10):
Well on that note, let's make sure that everyone who's listening to this episode is actually on the same page.

Neal Hogan (03:16):
Excellent plan.

Rae Woods (03:17):
What are some basics that all our listeners need to understand so that we can actually have a productive conversation about climate change?

Neal Hogan (03:23):
Yeah, I would say the very first basic is what causes climate change. And it's essentially, we have an atmosphere. The moon does not have an atmosphere, so that temperature ranges from minus 300 degrees to positive 400 degrees. We have an atmosphere, which is a wonderful blanket around the earth, and it's made up of different gases like carbon dioxide and methane and nitrous oxide. And if you increase those, you thicken the blanket and it gets hotter. And so what's causing climate change is we produce an enormous amount of carbon dioxide, methane, nitrous oxide, fluorinated gases, and so on.

Rae Woods (03:59):
That's right.

Neal Hogan (04:00):
And so we need to decrease that and then stop doing it. And if you add all those up, it's called the greenhouse gas equivalent, which you measure in CO2, carbon dioxide, and we produce about 53 billion tons per year of greenhouse gas equivalent. 82% of that is carbon dioxide, so we need to stop doing that, and shrink it.

Rae Woods (04:20):
Yes.

Neal Hogan (04:21):
The second thing I would highly recommend people understand, and that is the scopes of emissions. So when we talk about those emissions and we're wanting to reduce them, we all have sort of three components of emissions. So every company, every household has three components of emissions. The first component is what comes out of your smoke stack.

(04:40):
So for a health system, health systems usually burn natural gas in order to heat and cool their buildings, and that comes right out of their own smoke stack. That would be scope one. For my house, it would be, actually my house, because I don't believe in preaching temperance from a bar stool, my house is actually net zero.

Rae Woods (05:00):
Wow.

Neal Hogan (05:01):
But a general house would have an oil or a gas burner, or a gas stove, that's scope one. Scope two is you use electricity, and it has to come from somewhere, and it has emissions if it's coal or natural gas. And then scope three is your whole supply chain. You buy a lot of stuff, and to make that stuff, you have to have emissions. And so for health systems, it's their own smokestack, it's where their electricity comes from, and it's their huge supply chain. Which is somewhere between 60 and 80% of a health system's emissions come from their supply chain.

Rae Woods (05:34):
And since this conversation is going to be about climate action, we're going to be talking about reducing emissions across those three scopes. The third of which is obviously the most complex, because it's everything generated from the entire supply chain. But before we talk about how to do that or the kinds of actions we want to take, I want to make sure that we have a clear goal in mind. I find that when we talk about these big kind of lofty goals in healthcare or in general, there's this feeling of, oh my gosh I've got to save the world. What is the goal or maybe the timeline that all health leaders should share when they're thinking about climate action?

Neal Hogan (06:11):
When I talk to health leaders, and I do that a lot, my first thing I try to explain to them is that the climate crisis is a healthcare crisis. So what happens when you warm up a community, as anybody who's been through a heat wave knows, is you increase visits to the emergency room.

Rae Woods (06:30):
Neal, I will tell you that we are recording this in late February. I am in Washington, DC, it is 79 degrees outside.

Neal Hogan (06:39):
Yeah, yeah. That's the nice part of climate change, isn't it?

Rae Woods (06:43):
No, no, no, no, no. Too hot.

Neal Hogan (06:45):
Yeah. So when you have a heat wave, it gets to be 100 degrees, you start to have people show up in the emergency room with a huge variety of disorders. I mean, it's mental health issues. It's not just heat stroke. It increases those things. And then producing things with fossil fuels and burning those fossil fuels causes particulate matter to come out, pollution, and the small particles of that particular matter called PM 2.5 go into your bloodstream, cross the blood brain barrier, get into your lungs, and cause another huge range of health problems. So my first thing I want healthcare leaders to understand is this is a big health issue, and we need to work on it to improve the health of our communities.

Rae Woods (07:28):
And work on it fast. Right?

Neal Hogan (07:29):
Yeah. I mean it's a terrible paradox that our goal is to improve the healthy communities, and then by our very operations, we are poisoning our communities. So that's one. And then if the goal of the world is to by 2050 get to net-zero emissions so that we do not have an increase of temperature above, now we're hoping for two degrees. It was 1.5, most people don't believe that's possible anymore, so we're hoping two degrees. I look at this when I talk to anybody who's my friend who says, what are you really trying to do? And I say, if I can contribute to 1/10th of one degree reduction in warming, that's worth having shifted my career to focus exclusively on climate change.

Rae Woods (08:16):
I want to talk more about this, and maybe this is where my pessimistic side is going to come out a little bit. But I want to talk about why. Not why we should care about climate change, which of course if anyone's listening to this episode, I hope they believe that's true. Or maybe if you're under the age of 40, you already believe that that is true. But I want to talk about not just why healthcare, because of course you said it is a health issue, but you've been specifically talking about health systems, and that was a big point that you made in your book. Why should health systems in particular lead the charge here? What are the mission reasons? What are the business reasons?

Neal Hogan (08:52):
First, health systems, by and large as you know, being at the Advisory Board, something like 80+ percent are organizations, and so they have a responsibility to their community. I'm on the board of a health system, Integris Health in Oklahoma, and I take that very seriously about trying to improve the health of Oklahomans. And so first, they have a real mission to do that.

(09:17):
Second, there's a lot of good business reasons to do this. Health systems float bonds, the purchasers of bonds, the largest buyers of bonds, for example, CalPERS in California or the New York State Pension Fund or BlackRock, or many other investment houses have said they want to buy bonds of organizations that are practicing ESG principles. Now that's an entire hornets nest, the environmental, social and governance world of ESG, of what that means, and it's been gamed and so on. But despite that hornets nest, those investors are looking for things that have changed the climate. And if you are working on that, that's better. Second, as we talked about, if you're under 40, you are very concerned about climate change, and you want to work for an organization that is trying to reduce climate change.

Rae Woods (10:06):
That's right.

Neal Hogan (10:06):
We have a workforce crisis in healthcare. I'm not saying if you suddenly go green, you're going to not have a workforce crisis. I am saying if your competitor is going green and you have not, they are more likely to pick up workers than you are, and they're less likely to lose them. And all the research shows that to be the case.

Rae Woods (10:25):
Yeah, I was going to say there's real data behind this. This is not anecdotal about what millennials and Gen Z want, there's real data behind this. Not just in terms of where employees want to work, but I think what kinds of customers you actually ultimately attract.

Neal Hogan (10:38):
Yeah, that's the next line, which is customers want to buy these things. If you look at Patagonia, their entire business is built really out of the fact that we cannot buy consumer products and be good for the planet.

Rae Woods (10:51):
Yep.

Neal Hogan (10:51):
It's not possible. You cannot do it. However, you want to be as least bad as you can for the planet, and Patagonia has really worked on that and said, that's what our goal is. And that's happened across many industries. So now every one of the FANG companies, Google, Apple, Netflix, Microsoft, those companies, have dedicated themselves to reducing their emissions. Microsoft is not only net-zero, it's net-negative. They have moved back to going zero to the origins of Microsoft. And so they are saying to their customers, we care about this, and customers are looking at that and buying that. And that includes actually B2B. Because if you're a business who's trying to lower its carbon footprint-

Rae Woods (11:36):
That's right.

Neal Hogan (11:37):
You want to work with other businesses that are trying to lower their carbon footprint.

Rae Woods (11:41):
And then of course, sustainability over time lowers costs. The cost that it takes for you to keep the lights on and run heat and A/C your house is, let's just say different than mine at this point.

Neal Hogan (11:54):
Yeah, yeah, absolutely. In fact, I look like a genius at this point. Because I have a huge solar array behind my house, because just my rooftop wouldn't cover my needs. So for example, we drive a Rivian, which is an electric SUV, and that car plugs into our house. Well, charging up an electric SUV uses about 4 to 5,000 watts of power. So we need a lot of power to charge two electric cars, run our heating and cooling, our lighting system and so on. So we have a big array back there. If you talk to folks at Kaiser Permanente or Boston Medical Center or New York Langone or any place who's kind of gotten advanced on this, they'll tell you they're reducing their costs as they work towards sustainability. And in fact, one way they do it is maximizing the use of their existing footprint. As Kate Walsh says, the-

Rae Woods (12:54):
The CEO of Boston Medical Center. That's right.

Neal Hogan (12:54):
Yeah, Kate Walsh. The cheapest square footage in healthcare is the square footage you don't build. And so if you figure out a way to use existing capacity, you've saved money. If you're reducing the energy intensity of your buildings, that's good, it's reducing your carbon footprint. It's also cheaper because you're not having to use those fuels. And certainly any health system can start working on this as a money savings initiative.

(13:20):
One of the things I find frustrating about health systems is because we're a billion dollar, $2 billion, $10 billion, $20 billion organizations, it's odd that saving a million is frequently not that big a deal. And so when you say you can transform your lighting system and save a million dollars a year, people kind of snooze. Like oh, a million dollars, that's really not enough. We want to do something bigger and save more money. But I always point out that if you have a 1% margin-

Rae Woods (13:49):
That's good today.

Neal Hogan (13:50):
80% of health systems don't even have a 1% margin.

Rae Woods (13:53):
Yeah. Oh yeah.

Neal Hogan (13:54):
That would take $100 million in revenue to get that $1 million. So people love to go after $100 million in revenue. And so I really think sustainability is a place where you can save millions of dollars and be doing the right thing, and be able to advertise that to your customers and your employees.

Rae Woods (14:14):
I don't think anyone who's listening to this episode would disagree with you intellectually, but you brought up the margin piece. And I want to go deeper on this because you and I both know that the reality on the ground for health systems, I'm going to ignore the rest of the healthcare ecosystem at this moment and just focus on health systems. The reality on the ground is pretty bleak. It's pretty bleak. There's not a single health leader that I talk to that is not like, when the hell am I going to stop feeling like I'm in a crisis, or six crises at the same time? And that's where I start to hear people push back and say, do I believe that climate change is a problem? Yes. Do I believe that I could take climate action? Yes. Do I believe that long term it can meet my business and mission needs? Yes, but I just can't do it right now. What do you say to that pushback?

Neal Hogan (15:04):
I am very respectful of it. I've been working in healthcare since 1990, and I think probably hundreds of times I've stood up at a podium and told people we're in a crisis. It's terrible because we've had 1990, we had just passed legislation that decreased the amount of money that went towards Medicare. It really hurt the industry. Go to 1999, we had a major nursing crisis. There's been so many crises in the industry. Nothing is what we're having right now.

Rae Woods (15:33):
Yeah.

Neal Hogan (15:34):
I mean is, we are seeing a structural transition in the volumes of the industry. It may not come back. That's devastating to any industry. So I'm very respectful of it, and I don't push people to do large things. I basically say, you don't have to take it off the table. You've got people in your health system, the grassroots, some of whom are just chomping at the bit to do something, and they just want to do something.

(16:01):
And so unleash them a little bit to do something. There's a wonderful organization, Practice Green Health, which really focuses more on the other poisons that are put into the world, but still they do focus on climate change as well. But they really look at things that like plastic and so on. And using less plastics also reduces your greenhouse gas emissions. So if you've got folks that really want to work on recycling, or working on the blue wrap and recycling the blue wrap in the surgical suite or small things, that's where I would go. And it's going to make them more engaged with their work, it doesn't cost you anything, and it can be money saved on those things.

Rae Woods (16:45):
I guess I still want to understand, why health systems? All of those challenges that sincere and deep crises that health systems are feeling today are not necessarily the story of other stakeholders in healthcare. So it kind of surprised me as I was reading your book that you just kept coming back to, it's not pharma that should be leading this, it's not necessarily the health plans or the life sciences companies, the medical device makers. It still is the health systems. And I want to understand why, because they are in such a poor place.

Neal Hogan (17:15):
So if you take out the fact that they're in a poor place at the moment, and you just look at the industry as a whole, the reason I picked health systems is they're the end of the line. So if health systems push pharma to reduce their greenhouse emissions, and remember we talked about scope three, which is your supply chains, greenhouse gas emissions.

(17:38):
If health systems push pharma to do that, then pharma will do it, right? Because they want to sell their drugs into health systems. If they push the carpet manufacturers to do that before they build a building, if they tell their contractors. Amazon has told their contractors when possible, they don't do this in every part of the world, but when possible, they are asking for zero emissions concrete. So the thing that man has made more of than anything else is carbon dioxide.

(18:09):
We have made more tons of carbon dioxide than any other substance. Number two is concrete. And to make concrete, one pound of cement produces one pound of carbon dioxide. One ton of cement's one ton of carbon dioxide. So Amazon said, we push that. So I think health systems are at that spot where they can push all the levers in healthcare to drive this down.

(18:30):
One of the things we're working on now is trying to work with the Veterans Administration because they like Kaiser Permanente or Providence are a huge purchaser, and they're a government purchaser. And if the government shifts its purchasing, and obviously under the Biden administration, there's a lot of momentum to do this, that will force the manufacturers of goods, MRI machines, so Phillips would be involved in this, the pharmaceutical companies, all of the companies that make things for healthcare, to reduce their emissions. And they're going to have to do it anyways. If they're publicly traded companies, there's a lot of pressure on them to do this anyways.

(19:08):
This is another area. So while health systems are in crisis right now, they can turn to their suppliers and say, you are not in crisis. You're making great money. What are you doing to help us out to fix this? Because by the way, we've calculated our emissions, and we think that you are, whatever, 70% of our emissions, and so we'd like to push you to do it. And that would be a cost free item. But it is not a time free item. So I'm very respectful of health systems, that's a contracting process, you've got a thousand different contracts, you got to get that in there, and that's not easy.

Rae Woods (19:48):
Where do you want health systems to start in their path to taking climate action?

Neal Hogan (19:53):
The number one first thing that I wish every health system would do, and we are pushing CMS to do this, and Don Burwick and some folks wrote a fantastic article in the New England Journal of Medicine a few weeks ago about this is, just to measure your emissions. So you need to find out, how much gas are we burning, oil, the transportation for our vehicles, those fuels and so on. How much electricity do we use, where does the electricity come from? It's not impossible to figure this out. So you calculate that out.

Rae Woods (20:25):
But how often is that done? I mean, you've named a couple of organizations that are perhaps exemplars, but my sense is they are uncommon in their action, and that most people are, maybe they haven't even started thinking about how would we get our hands around measuring this or getting good data for this?

Neal Hogan (20:46):
Yeah, I think that's 100% correct. Most organizations, I mean I would say 80% of organizations in healthcare have not really moved down this road yet. And so we're far behind other industries in working on this. So it's really, you can have someone in-house do this, you can get outside companies to do it, which would be a more accurate version. Scope one and scope two, not that hard. Scope three, incredibly complicated and difficult.

(21:15):
So Kaiser Permanente, which is carbon neutral in Scope one and Scope two, I don't want to say they just started to work on Scope three, but they just committed to be carbon neutral on Scope three, because they realize that's going to take another few decades for them to grind out all of their suppliers to do that. But if your organization can do Scope one and Scope two, so you just have to understand your fuels and your electricity, then you have a number. And then I would say tell your board what that number is.

Rae Woods (21:47):
Make a commitment.

Neal Hogan (21:49):
And then measure it every year. And once you've measured it the first time, it gets a lot easier. I have some friends that are actually working on software for this that are just going to make it very easy for people to do it. Once they plug in their numbers, it'll immediately show them every year what they're doing. And it will also forecast if they're doing things, it will project how to reduce it.

(22:10):
So if systems will do that, at least they're thinking about it, they're talking about it. I was told once several years ago that the number one thing to do about climate change is to talk about it. And I think if having that conversation at your board level, then your board's going to say things like, maybe when we build that new building, it is worth spending a little more money to make it carbon neutral.

Rae Woods (22:32):
And you can't make a commitment to action if you don't actually have data or understand where you are, what stage you're in, how your emissions actually break down into scope one, two, and three. And I'm going to repeat. We need to get to net-zero by 2050, which is going to take a lot of work, and is going to take a commitment, which we cannot make if we do not understand what our emissions are.

Neal Hogan (22:56):
And this goes back to why I obsessed in the book with health systems. Because I actually, I believe in health systems. I think health systems are amazing organizations and the people who work in health systems really do want to do the right thing. And they're in a very difficult position to do that.

(23:15):
But you have to remember in the world, the predominant instinct for most people is not to ensure a just society for all, but to focus on what they and their tribal interests want and will help them thrive. And so this 50 year transition we're going to go in, there's going to be a lot of people that fight against it. If I'm an oil company or a natural gas company, if I don't take all that stuff out of the ground, then I'm not getting my investment, right.

Rae Woods (23:45):
That's right.

Neal Hogan (23:45):
And I think health systems have to be the voice to say, it's really bad for human health, so we really need to work on it. And that's why I'm pushing on health systems. Unfortunately I decided to do that right at the moment of the greatest crisis in the history of healthcare. But I still believe that health systems are the place to get to work.

Rae Woods (25:15):
Are there easy steps that health systems can take? You mentioned you've got somebody that's really motivated by a recycling program, for example. Beyond this initial step up, you've got to get the data, make a commitment. Is there a such thing as, I'm going to use the phrase everyone hates, is there such a thing as low-hanging fruit in climate action?

Neal Hogan (25:35):
Yeah, if you think of those three scopes, I call each of those scopes has a little nickname. Scope one, which is your own emissions out of your own smokestack, your natural gas and your vehicles and oil or whatever. I call that the land of a thousand projects. It's doing things like shifting your anesthesia gases. So desflurane , the most commonly used anesthesia gas, is a very highly heating gas. So when you give someone desflurane or any anesthesia gas, about 95% of it goes out of their body and into the atmosphere.

Rae Woods (26:11):
Which is a good reminder, again, back to your point about health systems. Health systems are actually big emitters in terms of their role.

Neal Hogan (26:18):
Oh yeah. Absolutely. Yes. And healthcare as an industry is around 10%, somewhere about, it's between 8 to 9.5% depending on who you read. So the land of a thousand projects, you've got to get your anesthesiologist to see all the data and research to understand that sevoflurane is 1/10th the emissions of desflurane. And then to understand that sevoflurane is just as safe as desflurane. And there's a thousand projects like that inside the health system.

Rae Woods (26:49):
And will a thousand projects add up to our big goal?

Neal Hogan (26:51):
Yes, a thousand projects will get you to zero on scope one.

Rae Woods (26:55):
Just on scope one though.

Neal Hogan (26:56):
Right. And then scope three, there's a thousand contracts, right? You've got to work through a thousand contracts. And then scope two is what I call flipping the switch, which is working with someone to build that solar or wind generating plant through what's called a power purchase agreement, in which you shift all of your electricity needs to a renewable. And I'll talk a little bit more about that when we have a minute later.

(27:19):
But the way I would start, and the reason I say this kind of grassroots, is if you're having trouble starting, and it's not a top down thing from the board or the CEO, but you're someone, you're running the emergency department or you're someone in the health system you want to get to work on this, is start working on one of the thousand projects. And there's so many that you could work on, and in many different departments.

(27:42):
So I've talked to people who have switched to using reusable gowns, and found out that it was actually cheaper to use the reusable gowns than it was to be purchasing the gowns all the time. It's a very small thing to do, but it does have an emissions impact, and they can tout, working on something. Same thing for if you're in contracting and you're buying things and you're working with suppliers, talk to the supplier and say, what are you doing about ESG? What are you doing about environmental issues?

(28:13):
Your supplier might say, actually, that's something we really have a commitment to. And then you can say, can we put that in the contract so that we can take credit that we're reducing our emissions through reducing your emissions? Suppliers, some will look at you like you have a third head, they've never heard of this. But others will say, oh my gosh, we've been working on that for five years. So there's many small things you can do that I think will add up. And we've got a 25-year runway here that we've got to work on.

Rae Woods (28:40):
What do you want leaders to put at the bottom of their to-do list? What should they not do?

Neal Hogan (28:45):
What they should not do is what's called greenwashing. Greenwashing is a term used throughout the environmental industry for when you say you're doing something big, but you're not really. And so there's nothing wrong with, for example, putting electric vehicle chargers in your parking garage or even putting solar panels on top of a building. Those are good things. If you trumpet those as huge things you're doing to reduce your carbon emissions, that would be greenwashing because electric vehicle chargers aren't probably reducing any of your carbon emissions. They're reducing the emissions of the guy who bought the Rivian or the Tesla or the Bolt.

Rae Woods (29:26):
That's right.

Neal Hogan (29:28):
And the solar panels, while they are a good thing, and I think Kaiser Permanente has something like a thousand buildings with solar panels on top of them in addition to owning four full size power plants, two wind and two solar, they're going to take up probably less than 1% of your greenhouse gas emissions. So trumpet it as we're starting to work on this, we want to be working on this, but don't trumpet it as look at how great we are, we put some solar panels on our medical office building.

Rae Woods (29:57):
Overall health systems have quite a bit of work to do when it comes to understanding their emissions and starting to take action on climate. But you keep kind of mentioning these organizations who aren't just ahead of the curve, I mean they're leading the charge. What in your mind is different about those organizations or maybe even the leaders themselves that have pushed them to the front of the pack to really make change here?

Neal Hogan (30:23):
Yeah, it's very interesting. Rame Hemstreet is the head of facilities for Kaiser Permanente, which is obviously an awful lot of buildings. And he's also, I can never quite get his title, but he's something like the Chief Energy Officer to really, really think about this. And when I was working on the book and I interviewed him about this I said, how did Kaiser do it? And he said, we're in California. That's how we did it.

(30:49):
And it really struck me that California has the right set of laws, and it's got a population that's very dedicated to working on climate change. And it probably has board members, Kaiser probably has board members come in and ask about climate change. So I think some of those breakthrough places have been positioned in places which makes it easier for them. Think of Boston Medical Center, in the heart of liberal Massachusetts. Now, it doesn't mean it was easy for Boston Medical Center, but it's certainly easier than to do it if you're in Houston, Texas, I think, right?

(31:22):
So the leaders, one were positioned well. But two, the leaders, and this is... Now if you're quick, if you're very sharp Rae, you're going to realize I'm contradicting myself. The leaders were tops down. The leaders were a board member or a CEO said, I actually care about this, and I want to make something happen, and we're going to do something.

Rae Woods (31:45):
I mean frankly that's the exact same thing that we hear when we talk about health equity. There's a lot of parallels to making immense change, doing thousands of projects, making it part of your business and not just your mission statement, making commitment without just kind of gauzy press conferences, that remind me of health equity as we're having this conversation. And I would tell you that a lot of that is also the leader who says, no, no. They've frankly, they've been on this podcast telling me, we tore up the mission statement and said, start over. Because we're not actually practicing what we preach.

Neal Hogan (32:19):
But I think what happened there, and I haven't really dug into this to figure this out, so this would be a great thing to start to work on. If there's any graduate students out there listening, please go do a research paper on this.

(32:30):
It's not like CEOs or board members have an angel visit them in the middle of the night and say, you should go work on health equity or go work on climate change. Somehow they get moved on this. And I actually think it's probably from some grassroots things, right? So I won't mention the organization, but there's an organization that I've worked with that they have made a big commitment to climate change. But three years ago, I was talking to their head of the ED, who had put together a little group to try to get the organization to work on climate change, and they weren't getting anywhere.

(33:06):
So it took them a couple of years of working on it and talking to leadership and convincing leadership, and then leadership was able to come out and say, we've made a big, we're changing the mission statement. We're making a big commitment to climate change. So to me what that says is, every person who works in healthcare can make a huge difference on this. And one of the points I make in the book is, every person in healthcare is a leader on climate change. Because you can come in and start saying, this is what I want to work on, this is how I want to do it, this is important to me, and what are we doing about it? Just ask those questions. If you're a CRNA, go into anesthesia and say, why are we using desflurane instead of sevoflurane, when it's 10 times more warming than sevoflurane? And you will be the one who leads that change.

Rae Woods (33:55):
You've given me hope that health systems should actually be the ones who are leading the charge here. But I do want to be mindful of the fact that the folks who listen to this podcast cover every corner of healthcare, and I want you to speak to them directly. If health systems should lead the charge, what is the right role for other stakeholders in healthcare? Maybe it's how do health systems engage with or better partner with other parts of the ecosystem?

Neal Hogan (34:21):
Yeah, I don't want to say that no one else should work on this. I'm going to absolutely think that everybody else needs to work on this. I think that if you're looking at, think of CVS, right. So CVS is an enormous purchaser of pharmaceuticals.

Rae Woods (34:37):
Are they technically a health system now?

Neal Hogan (34:38):
No, no, no, they aren't. They aren't. Well, yeah. Well, no, not really.

Rae Woods (34:42):
They don't have a hospital, I guess.

Neal Hogan (34:43):
They don't own hospitals. So health systems are the ones that are saddled with the incredible burden of owning hospitals.

Rae Woods (34:48):
That is right.

Neal Hogan (34:50):
And so CVS is a huge purchaser of these things, and it also can go and talk to its purchasing agents and say, we want to work on climate change. But I don't think there's anyone in the world who should not be starting to address this.

Rae Woods (35:04):
In healthcare or otherwise.

Neal Hogan (35:06):
Or otherwise. And there's a billions and billions and trillions actually now dollars going into working on this through startups. And what I think we'll see with some of the larger organizations, take Salesforce. Salesforce has now developed all sorts of tools for addressing climate change through accounting and technology and measurement. That's not Salesforce's business, but they did it because they believe in reducing climate change.

(35:33):
Bill Gates, his whole thing was health. Remember he left Microsoft, he took his billions of dollars and said, I'm going to work on global health. He's really shifted to working on climate change now. So it's not, and it's because it's a health issue. And his company, Breakthrough Ventures, has invested billions of dollars into companies like Terra CO2, which is trying to figure out how to make concrete without limestone, and it's the limestone production that causes the huge escape of CO2. And he's invested in fusion companies and small scale fishing plants, and a bunch of things. So those large companies will, like CVS, I could see them also acquiring some of these small startups or investing in those startups that will help us in healthcare that are doing things I can't even imagine yet, how it's going to work.

Rae Woods (36:29):
Well, Neal, I feel like I could talk to you about this for hours, but I do have one final question for you before we close this episode, and it's a tough one. What is the biggest thing that is holding health systems back from taking meaningful climate action, and what are the steps that they can take to overcome that barrier?

Neal Hogan (36:49):
Well, I think the number one thing is that there's a financial armageddon happening in healthcare. So I think that's the most difficult one. And so there's a million steps that health systems have to take in order to work on that financial again. So let's just set that aside, because that is just a crisis of epic proportions.

(37:07):
But the number one thing is to make that commitment. So we have a large number of organizations now that have committed through health and human services to cut their greenhouse gas emissions by 50% by 2030, and to be net-zero by 2050. And that ranges from Dana Farber to Henry Ford to Kaiser, to Tufts Medicine to Stony Brook, to Seattle children's, I mean it's a very large list of health systems. The first thing they're doing is making a commitment. I've talked to a lot of those organizations, they had not even measured their emissions when they made that a commitment.

Rae Woods (37:43):
Oh wow.

Neal Hogan (37:44):
So they made the commitment before they knew how bad it was. But they kind of felt, well it doesn't really matter how much our emissions are. We need to get to half by 2030 if we're going to get to zero by 2050. So we're going to make the commitment and then we're going to go measure. And so that's the number one thing health care organizations can do. And then as individuals working in health systems, if you're a physician or a nurse or work in environmental services or wherever you work, it's trying to figure out, what could you do in your area to try to reduce emissions?

Rae Woods (38:12):
What's the one in a thousand projects you can do?

Neal Hogan (38:15):
Yeah one in a thousand projects. And I see it, in health systems I also see in reverse which is, once health systems get the fever, they should be helping their own employees make the transition to air source heat pumps and electric cars, and they can use the money that the Biden administration got passed through the Inflation Reduction Act to get that.

(38:36):
So an individual family can get $28,000 in reimbursements if they do all the things that are available to them to do it. And health systems can help their employees figure that out. It's complicated, but someone in HR who's really into climate could say, I'm going to figure that out and produce the material to help people do that. You could do it for your patients. You can roll arms together with organizations like the United Way in your community to try to figure out how do we help other not-for-profits work on this? And ultimately, every health system that I work with of which are usually large health systems, is the largest employer in their community, if not their state.

Rae Woods (39:17):
That's right.

Neal Hogan (39:17):
And so they have huge throw weight in their state. If you just start talking to your representatives about emissions as a health issue and try to stay out of the politics of climate change. No climate change and just say look, we're really concerned about people breathing in this particulate matter, and we're trying to figure out a way to transition over, and talk to people about climate change as a health issue, that's going to have a big impact on your state politics.

Rae Woods (39:45):
Well Neal, it is safe to say that when it comes to climate change, maybe I should say climate action, you're an optimist. So thank you for helping our listeners kind of see that hope and frankly, helping me do that. I really appreciate the conversation.

Neal Hogan (40:00):
Well Rae, thanks so much for having me on, and someone once welcomed me to team trillion tons because we need to stop a trillion tons of carbon dioxide from going into the atmosphere, and you're now on the team helping us do that, so thanks so much-

Rae Woods (40:13):
Oh, great.

Neal Hogan (40:13):
... for doing that.

Rae Woods (40:15):
Thanks. Neil is obviously encyclopedic when it comes to climate action. I highly recommend everyone read his book, Leading on Climate Change. In fact, I'm going to actually give Neil the last word here. This is an excerpt from his book. He writes, it is a tragic paradox that while health systems missions speak to health improvement, they emit greenhouse gases that have a devastating impact on human health. Health systems need to align their actions with their mission. To improve community health, we need to avert a climate disaster. Health systems should be the ones leading the charge.

(41:06):
To learn more about healthcare's impact on climate change and why we shouldn't wait for government action to start making progress, go back to episode one 19 in our archives. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson and Kristin Myers. The episode was edited by Dan Tayag with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Miles Cottier, Carson Sisk, and Leanne Elston. And one more thing. The pod team still wants to hear from you, and understand how we can make the podcast better. We created a quick listener survey at advisory.com/podsurvey. Please take it and let us know what you want to hear on Radio Advisory. Thanks for listening.