Waste and the effects of Climate Change on seniors. Good morning, everybody. Are those in the back if you would take your seats. I would like to welcome everybody. It is a light to have you a delight to have you here at the bloomberg center. I am daniel and i am the director of the hopkins Business Health initiative. The hopkins Business Health initiative integrates the scholarship on Hopkins University around a shared vision of health care america. We do this within and across the partner school, the Carey Business School in the Bloomberg School of Public Health and the school of medicine and school of nursing in pursuit of this patient vision focusing on business incentives through rigorous none partisan interplay dysentery research. We are very excited to be hosting this special event on earth day. Dedicated to raising awareness of the importance of longterm ecological sustainability. Today we seek to raise this awareness from the perspective of the Health Sector. Our focus consistent with the focus of hbhi will be addressing the Health Care SectorsCarbon Footprint. We will start this event with a fireside chat and then continue with an expert panel. The moderator for the fireside chat, joann is a noun Health Care Journalists who has brought National Attention to this issue. She is member of our staff and a contributing editor of politico. And of forced of course our honored guest, Xavier Becerra sarah, the 26th head of health and Human Services and the first latino to hold the office in the united states. We are honored to have you with us. [applause] joann hello. So people often ask me how i learned so much about health care and Public Health and i often tell them that if you spend as many years as you did on the hill listening to the ways and Means Committee and the Senate Finance committee, there is a lot of theater and fair amount of substance and that is probably where you learned this too. Thank you for joining us. You have really made climate a signature issue, when i started to when i started writing about this i was astonished how big a problem it was. The Health Care Perspective the Health Care Sector is responsible for 8. 5 of emissions. Health Clinic Health care globally if it was a country it would be the fifth largest emitter in the world in the u. S. Is responsible for one fourth of that. It is also he established the office of climate and health and also the environmental equity, climate equity. So, we will talk about both of those issues, equity and about how do you begin to decarbonize health in an era where it is hard to mandate things and everything is political. So, the issue, you represented california in congress for many years and you where the attorney general of the state of california. So fires mudslides and all that has become routine. How did you begin to connect these environmental things that seem to be a series of oneoff disasters to really understand that this was something that is contributing to acute and aggravating chronic disease . And when and how did you make that connection, which is something that you have created at hhs . Sec. Becerra i did not connect the dots until i was probably already in elected office in the state assembly in california back at the beginning of 1990s. And i began to see the connections. My father was a farmworker. After that he went on to do other jobs, always manual labor and always outdoors and california can get very hot. He used to do a lot of paving of roads in the heyday of freeway construction, the 5 and 80. If you ever stood underneath asphalt when it is baking, first being laid on a day that is already 110 degrees it can get very hot. And that is what he did a lot. He also did a lot of pipe digging and i am talking not the little pipes about the threefoot ones. And outdoors outdoors, outdoors. I got to work as a construction worker like him as a laborer to help pay for college and one day we were working on a bridge. And i just happen to see a whole bunch of men gathering and i asked one of my colleagues what is going on . And he said and i forget the gentlemans name and he said just past. And i said what . And he said he died. Heat exposure had taken him. Uction worker and i said that was too bad and he went back to work. You take that, take my dads experiences and my dad was already dark latino but he had a permanent tan. And you begin to put those things together. And then you hear about how mean people die of heat exposure, smoke inhalation over the course of time and it starts to add up and that is when it came to me that a lot of the folks i grew up with our dying a little bit sooner than others. And you start to get into it. And then you find out that the sector that is supposed to keep us healthy is leading close to 10 of the exposure to some of the worst chemicals and heating up the environment and the climate. And you knew that you had to do something. When we established the office of Climate Change and Health Equity, it was having connected so many dots to do what we can. It should not surprise you that we are trying to work to see what we can do to provide better information to outdoor workers when it comes to heat exposure, smoke inhalation, the things that today are happening even more than way back when i was working with my dad in the construction zones back in the 1980s. Joanne last summer in arizona during that horrible heatwave of 120 degrees out in the field. All of us, the changes in climate affect all of our bodies, they affect all of our communities and they affect the entire planet. Some communities are harder hit. Can you sort of really explain sort of why Environmental Justice is how do we address that and why do we have to address that . The other population that is very affected is seniors, and all sorts of ways, not just the heat but the electricity goes out and you are on an oxygen machine, there are all of these things that we do not even think about. Sec. Becerra i have not seen the numbers recently but i am willing to wager that the number of people who die from some sort of climate exposure, the cohort that is the largest is seniors because during heat waves they do not have the air conditioning. During cold waves they do not have good heating and cannot afford to pay for the heat and they freeze. I suspect they are not connect with folks who are actually outdoors working who are exposed the way my dad was. It is fascinating that hss has a chance to do a great deal and the legislation that the president made possible for us to become law has given us far more money then we have had before. The office of Climate Change and Health Equity essentially is saying to america wake up, this is all of our concern, people are dying every day. And we have been trying to change that. When you see a farmworker picking crops you will not notice that it is backbreaking work but look at the year that they are wearing. It is stuff from home. What it is is a broad based hat. And if you look underneath you will probably find it has some swarm some form of cloth underneath, typically it is a wet cloth before they go onto the field and they soak it and they put that over their head and they put the hat on. That is the way they keep the heat down in their bodies because the actual cloth, the rag on their head is wet. So it will last for a while before it finally dries out because of heat exposure. Joanne you are just referencing the Inflation Reduction Act having a huge amount of climate and more than a lot of people understand. And it gave some of the things that it does is providing resources for the Health Sector, including nonprofits that do not get tax credits but financial assistance. The next panel will go into the nittygritty of changing the supply chain. You are not a materials engineer. Think about Health Care Everything is thrown out, it is single use and disposable. Most of you have an Innate Health care setting. Everything that touches you and a lot of things that do not end up getting thrown out and there is a huge amount of waste in a big challenge is changing that. Can you talk about some of the tools. You cannot mandate very much. We are in an era where it is extreme partisanship. If you try to mandate something you are in court for 10 years or getting impeached. How do you make people want to do this . How can you use, u. S. Hhs secretary, the climate office, the tools that you have in the ira, how do you give how do you make the early adapter become the norm . How do you create change agents . It will have to be voluntary. Sec. Becerra you are right. We have very little authority to require anything so we do two things. We reach out because these are essentially stakeholders who are all about making you and i healthier. So it is tough to make that your cause if you at the same time are throwing away a lot of trash that becomes part of what damages the environment and the health. We have a lot of actual voluntary support in moving forward when we put out the call to the Health Care Sector to join us to deal with climate. We had a pretty good response, especially since they knew we would not be free. The second thing we do is what we usually do. We throw money at it. We put money on the table and say if you join here is what we can do and this is where the president s efforts to get us real resources has been tremendous. We can, for example can support a project that can help us collect solar energy. That can benefit not only the Health Care Facility let a neighboring residential area and talk to the folks and i believe it is Boston University that is doing something similar. There are projects that we can undertake. I was visiting a Childrens Hospital where they have set up an array of solar panels and they have done in conjunction with the high school nearby. So it was a science project for the students at the same time as it is benefiting the whole community to have access to more energy. Joanne some of the things are relatively nothing is easy but some are easier than others. Changing a lightbulb, buying electric vehicles if your fleet gets replaced, composting. Think of how much food is thrown out, think of all of the meals that a Health Care System does and a lot of it is garbage. Some of these things are not easy but easier. How much do we know about i mean intuitively, my intuition is not always right. But it seems like if you make these changes you should it should make that case. It is expensive to change and hard to do this. The margins are not great and we are still recovering from the pandemic. How much can you reassure them or do we know about yes, this is not just a moral and health care issue, this is financial. Sec. Becerra it doesnt take long because look at the financials of any facility and you will see that one of the expenses that continues to grow is disposable waste. So they get it, their costs are continuing to rise and they have to do something about it. When they see someone pitching an idea that maybe provides them with the money to do what they have to do to save money in their bottom line, it is a great marriage. We are getting there and we have to give credit to the Health Care Sector. They recognize that you cannot pitch that health and be creating egg bunch of waste. Joanne early adopters and people who enthusiastically embrace this, but a lot of people are not doing a lot. They are doing the easier things like recycling doing a better job recycling and that is an important amount of waste. But what are you seeing in terms of getting to Critical Mass because the Health Sector is not yet at Critical Mass . Sec. Becerra it is not surprising, one of the facilities and hospitals that took us up on our offer was in boston massachusetts where you have such a large and profitable Health Care Sector. Do not be surprised if it takes is a wild to get into rural hospitals or the hospitals that are caring for the most disadvantaged who are always on the margin. You got a look at your bottom line at the end of the day. We hope that we can encourage with some support financially that ideas and the sector to get there. And quite honestly the sector has to take care of itself. It cannot be if you are financially well healed you get to move quickly and move and leave everyone else behind. There has to be a Sector Movement and Sector Support but it is just connecting the dots faster for them and it should not take them decades. They should connect the dots sooner that it is in their interest to do this right because at some point if they continue to be 10 of the problem they will start paying 10 of the price. Joanne when you talk to Hospital Administrators or nurses, does this come up spontaneously . When they come to hhs they care about the payments and the perpetual medicare payment wars. How much does it bubble up from not you going to them but lets show you i do not know if you are talking about the conflict, lets show what we are doing and this is how we are using that because i do not think some hospitals understand what is available. If you go on the website they are all of these webinars and toolkits and lots of things that the office has put out to make it how to and the money that goes with the howto. How much in the three years in office, how much is that changing . Sec. Becerra honestly, the folks that most people encounter in a hospital or medical facility are not going to say by the way, after we take your Blood Pressure i want to tell you about what we are doing to reduce the Carbon Footprint in our facility. Sec. Becerra even me. Joanne the Hospital Administrator, the Hospital Administrator and the folks responsible for innovation, they are into it and they recognize. Because this is a sector that has not really been early into making these investments. When they do it is a big deal, it is almost like christmas because they are giving gifts. And they can show it. But, does the interest that you encounter to Start Talking about the Carbon Footprint . Not yet. Joanne we are also living in the era of incredible political partisanship. We are very redblue. Youd never have the funding for what you need to do in this area and you are moving people around to make things happen but not the resources. And yet, the planet is not divided into red and blue. People who get sick are not divided into red and blue. His arrow way like you mentioned is there a way, and like you mentioned Rural America which is more disproportionately underserved. Is there a way to talk across the aisle on this issue and it is so hard to break through the partisanship on anything. That is your life, correct . Youve seen it get worse. But they should not be. So, do you have any allies on the other side and people understanding that this is really existential and health care as part of a . Sec. Becerra if you go beyond the borders and you speak of this issue on global terms, it is not really political, it is have and have not more than anything else. It is we have capacity. Even Rural America facilities have capacities compared to the developing world. The issue is not so much the politics of Climate Change. It is the politics of financial capability. And what you find is that most places around the world are barely trying to keep their places sanitary let alone reduce the Carbon Footprint. And so, that is both tough but also exciting because it means it does not take a lot for us to introduce these ways to be cleaner without them having to improve the cost or having to undo everything they did to move forward. If we are smart we will as we always do begin to Share Technology and the knowhow with the developing world so they do not go through a process of developing a facility that only uses a coal alternative plant when the electricity goes down and they have to use generators to fire up and get more electricity. They will figure out that the solar panels that they can use. We will be there with them to help out. The good thing is that it is not political in most cases. Even in the u. S. You talk to a rural Health Facility they would love nothing more than to save money on their waste budget they are having such a hard time just meeting their budget needs on the beds that they have that they do not have the kind of bandwidth to think about that. And that requires the boston, massachusetts and the los angeles, california and the san francisco, californias to step up. Those facilities in those places that have the Large Academic Health Centers to step up and say this is how we do it, let us share this and to some degree let us share some of the well to get everyone to,. All boats get lifted. Joanne i mean i know that you cannot mandate, but you can partner with people who can help create. And one of the important partners is the joint commission for the organization is the credits hospital and they have come up with a voluntary system that Health Systems can get a joint certification for sustainability which gives you something, the accreditation it is not just status but meaningful within the Health Care World and that is an important partner going forward. I am sure that you were quite confident that President Biden will be reelected. Sec. Becerra im glad you said it and i do not have to say it. Joanne in the hypothetical possibility that we have a different white house in a year, this is unlikely health care or climate or just in the carbon , unlikely to be speaking hypothetically again what can you do to make this irreversible or just get people on board . The train is going, not just talking about going . When i write about it, i am seeing a lot more activity in the local states and democratic states. Literal liberal states. Is that zero in more conservative it is not zero in more conservative states but there is a balance. I dont want to make a pun make it sustainable. How do you make sustainability sustainable . Sec. Becerra there has to be will because there is not law in place to require this at the speed we need it. You have to continue to cultivate the will to get there. We will get there just as we always do because economics requires folks to get there. At some point the price become too unbearable to not be clean but i dont think any of us wants to wait until we get to that point. Ill think any of these facilities and providers want to wait until we get to that point. It is always tough to be the first one to take the leap. It can be expensive. Dont know where you are going to go. Once people start taking the jump into the water and they find they can swim, more will come. It has to come sooner. What we are doing and i hope incentivizing the process to move faster. I wish we had my money to incentivize it more but what we are doing is putting in place infrastructure. We are making sector components, making investments, commitments to move in this direction. Once you Start Building the array of solar panels, you have got to keep going because you have already expended money rather than go toward some coalfired alternative. There are things we can do that move this forward. It is just moving at a pace of will versus the pace of law. Joanne one thing i learned recently is it is not hhs. It is energy and epa. There is this whole energy star thing for hospitals, how to redesign because it helps. Hospitals use and a lot of energy. I could not learn until recently you cannot turn off an mri. You can be smarter about when you can power things down but that is a government wide thing. This is the first time in december this was the first time the International Climate conference had a health day in the u. S. Did send a delegation. What did that we have been having climate conferences forever, for a couple decades now. There was this International Recognition a time was declared the health day. I dont know if you helped make that happen but what is the significance that climate health, the climate decarbonizing health link it is a problem around the world. It is a biblical a bigger problem here in terms of waste. That was different. Talk about why it was important. I know you have a tight schedule. We are going to let you go. The global optimism. There is a lot of work to do. Sec. Becerra the good thing is that around the world people get it. They have the same issue in other countries we have and that is making enough of an investment that the world gets it. You can see at. As they say you can go up in one of those satellites and when you take those images and shoot them back home, you can see the damage we are doing to mother earth. People get hit. Here is the important point i want to make about the international community, International Work on climate and global cleanup. The world wants to know if we are in this for good. If we are serious about coming back in because we left. We left so many of the International Fora when it came to not just climate but health. We were awol for a while. People got accustomed to us not being present which is tough because typically we are the gorilla in the room. They got accustomed to it. Now we are back and President Biden made it clear we are back with a vengeance because we cannot afford to be gone, you can see in the back of peoples minds are you sticking around . That is the worst part. If they dont know we are sticking around, it is harder for them to make commitments. Always the u. S. Was there to make a commitment and always our commitment was the biggest and it was the anchor that made everyone say i will jump in the water. When we were no longer jumping in the water, everyone went back from the edge. The most important thing i can tell you is regardless of who is at the helm at the white house, we have to continue jumping in the water because that is the only way you get the rest of the world to make the commitment. More and more our health facilities, our Health Sector is recognizing we are collectively the largest power plant the nation. Each one of those hospitals is a powerplant. Their own separate many powerplant. You add them up, it makes one major collective powerplant. We have an obligation to show how we can use our technology to show the rest of the world when you jump in the water you will be able to swim. The most important thing i can tell you about anything dealing with Global International affairs is we have to be ready to stay in the water. Joanne thank you very much for joining us. The water is getting hotter. [applause] thank you so much again, secretary becerra and joann. That was fabulous moderation. We will get more in a minute. I am the dean of the Business School at Johns Hopkins and it is a delight to have you here. Looking forward to the panel as we dive even deeper into the warming waters here. I want to thank dan polsky who leads our hopkins business of Health Initiative i know all of you are familiar with. Dan has done a fabulous job again together all the interests related to business of health at hopkins. This is a wonderful collaborative effort of the Business School together with the three schools of east baltimore. The school of medicine, school of Public Health and the school of nursing. When we talk about the business of health, we are not just talking about roi and margins and profitability. We are talking holistically about intersection of business and health. Even beyond the Health Sector. Todays theme is indicative of how deep the issues are that we care not only about customers but also about our employees and our communities as well. It is fabulous we are able on earth day to focus deep into this issue. With that i would like to focus i would like to introduce joanne back. While i do that, let me also introduce our three panelists who are going to dig deeper into the issues we introduced a few minutes ago. I believe we are going i dont think youre going to share these two chairs so well be bringing up a couple more shares i a couple more chairs i believe. Let me do the introductions. We have diana bender who is a Womens Health practitioner at christiana care in delaware. She is also cochair of christiana cares environmental sustainability caregiver community. We have dr. Jeremy green who is the William H Welch professor of medicine and history of edison at Johns Hopkins. Jeremy is also director direct director of institute of medicine and medical humanities at hopkins. Dr. Jody sherman who is the associate professor of an astute ideology and epidemiology at the yell school of medicine the yale school of medicine. And director of the program on health care environmental sustainability at the yale center on Climate Change and health. As you can tell from those introductions, we have three individuals who are deeply thinking about the issues introduced earlier. We look forward to their discussion. Thank you so much for moderating this panel. We look forward to and engaging conversation look forward to an engaging conversation. [applause] joanne getting everybody micd up and they will be up here in a minute. At the same event hosted by johns Hopkins University, Health Care Professionals discussed reducing waste from their sector and speak about a potential transition to reusable medical supplies. This is about one hour and 15 minutes