UN Climate Summit Fell Short, But Gary Cohen Says President Biden’s Build Back Better Act Holds Great Promise

Gary Cohen

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Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the healthcar e of the future.

This week Mark and Margaret speak with Gary Cohen, Founder and
President of He alth Care Without Harm, a leading nonprofit dedicated
to eradicating toxic waste produced by the health care system and
leading health systems in this country an d around the world to net
zero emission. Fresh from an appearance at the UN COP26 Climate
Change Summit, Cohen says the new US commitment to addressing
climate change is a bellwether moment.

Lori Robertson also checks in the Managing Editor of FactCheck.or g
looks at misstatement spoken about health policy in the public
domain, separating the fake from the facts. We end with a bright idea
that’s improving health and wellbeing in everyday lives. If you have
comment please email us at [email protected] or find us on
Facebook, Twitter or wherever you listen to podcast. You can also hear us by asking Alexa to play the program. Now, stay tuned for our interview with Gary Cohen here on Conversations on Health Care.

Mark Mass elli: We’re speaking today with Gary Cohen, Founder and President of Health Care Without Harm, an international organization promoting environmentally responsible health care. He’s built a coalition and networks in more than 70 countries, dedicated to redu cing the impact
of health industry pollution on climate change and health.

Margaret Flinter: His work has earned him the MacArthur Foundation’s Genius Grant, the White House Champion of Change Award and the Skoll
Foundation Social Entrepreneurship Award. H e just presented at the
UN’s COP26 Climate Summit in Glasgow. Gary , welcome back to
Conversations on Health Care.

Gary Cohen: Thank you very much for having me.

Mark Masselli: All eyes were on Glasgow recently, world leaders came together for
the UN COP26 Summit. A number of commitments were made to
bring us closer to net zero carbon emissions globally. What do you
think about the agreement? I know there was some controversy as
India and China had some language change around coal. But tell us
what the outco me was and what in your mind was the most
significant agreement to come out of the gathering?

Gary Cohen: Yeah, so I would say the overall conference was a mix bag. On the one
hand the level of ambition require to keep the planet warming from
being catastr ophic, we didn’t get there, so the commitments that
were made a fall short of the desire and need to keep temperatures

Gary Cohen

within 1.5 degree centigrade. In fact, the commitments would actually
increase global temperatures potentially up to four degrees, that’s
abstract. But the point is this, is at 2 degree centigrade the estimates
are that it will expose one billion people on the planet to extreme
heat. However, there were some positive things that happen there.
There was a strong commitment to stop deforestat ion. There was a
strong commitment of 30 different countries to stop selling gas
powered or diesel powered cars by 2040 and companies committed
to that, Ford, General Motors, Mercedes - Benz, Volvo. Other car
companies didn’t commit to that including Toyota, Volkswagen and
Nissan.

In our space more than 51 countries committed to a health program
that we established with World Health Organization and the British
government, they committed to make their health care systems
climate resilient to the extreme weath er that we’re all facing, and also
to decarbonizes their health care system. In an interesting way health
care for the very first time really came to this event and made very
serious commitments to its role, so that’s huge.

Margaret Flinter: Well, Gary at the COP26 you were with another recent guest of ours
assistant HHS Secretary Rachel Levin and talking about this very
critical issue of the role that climate change plays, it’s already playing
in health and equity. You’ve said that the Biden Administration ’s new
initiatives will address what you call the moral wound of health
inequity that is now fueled or accelerated by climate change. Maybe,
talk with us about the role of climate change in health equity and
contributing to health inequity and how do you s ee these initiatives
having an impact in that area?

Gary Cohen: Right, so what we learn from COVID is that it exposed all the racial
and social inequities that we face in our society. Black people died at
twice the rate of white people, native people died at three times the
rate of white people. People who are vulnerable already who had a
preexisting conditions especially respiratory conditions were more
likely to die. If you look at the climate crisis we see that force
multiplier playing out in the same wa y.

T he most polluted communities in America, many of them are in
communities of color. If you look where the petrochemical plants are,
where a lot of the refineries are, where a lot of the incinerators are,
where the truck roots are, where there’s lack of tree cover because of
decades of red lining, those are all symptoms and consequences of
structural racism in the country. In some neighborhoods of Baltimore
in the summer it’s 5 or 10 degrees hotter because there is no tree
cover.

As we start to understan d the health impacts of the climate crisis, it
runs right into our racial reckoning as a nation, and so as we move

Gary Cohen

away from our reliance on fossil fuels we also have this incredible
opportunity to heal some of the racism that we’ve lived with for
generati ons. That’s the special role of the health care sector, and it’s
also thankfully a goal of the Biden Administration where they want to
put some of their investments in clean energy and addressing the
decades of environmental injustice in those communities. Put some of
the money to address those injustices and write those communities.
Invest some of the clean energy strategies in those communities, so
that’s the first time we have a government in this country that’s
centering itself in a climate solutions an d centering itself in racial
equity.

Mark Masselli: The President this week on the White House lawn signed a bipartisan
$1.2 trillion Infrastructure Bill, really I think did a lot. But help our
listeners understand what is so vitally important for climate change in
that legislation. Also on deck is the Build Back B etter B ill that’s
hopefully coming out of the house and then over to the senate.
What’s at stake here?

Gary Cohen: Well, so the Infrastructure Bill that did pass create some important
upgrades in clean energy and transportation sectors. It includes
electric grid modernization, electrical vehicle charging infrastructure,
some kind of carbon management and research into new
technologies, it goes a piece of the way. But the real transformation is
in t his other Build Back Better Bill which would put the United States
on a very robust pathway to move toward a clean energy economy in
many, many dimensions.

There’s 320 billion for clean energy and transmission and vehicles and
manufacturing. There’s money to address air and water pollution
focused in frontline communities. There’s clean energy and
sustainability accelerator like a $30 billion that would put some of
these investments in disenfranchise communities, the sort of
Justice40 Initiative.

There’s a hundred billion in resilience in terms of climate smart
agriculture, forestry, coastal restoration, it’s creating a whole civilian
climate core with a diverse workforce of 300,000 members. Another
110 billion in cleaning globally competitive industrial fac ilities, clean
energy and vehicle manufacturing, so there’s so much more in that
other bill that is being negotiated that would been enormous signal to
our economy, stimulus to our economy. It would demonstrate
enormous leadership to the world that we coul d meet the goals that
the administration has to reduce our greenhouse gas emissions by
50% from 2005 and a 100% by 2050 at the latest. It’s a big deal.

The first bill doesn’t come close to doing that, that stimulus that’s
required. It would have been ideal if Biden would have been able to
go to Glasgow and say we got that all wrapped up, but it’s still been

Gary Cohen

haggled over obviously.

Margaret Flinter: Right. Well, Gary toxic waste in health care is certainly a big problem
in people of a certain age, and probab ly half the people that work
with us have never seen a mercury thermometer, right, something
that was just -- it was everywhere. That was one of your most
successful campaigns at Health Care Without Harm that we all owe
you a debt of gratitude, eliminating mercury thermometers across the
health care landscape which really were a big contributor to toxic
waste.

But health care itself is a big contributor and in so many communities
health care is the biggest employer, it’s a real economic engine. What
are you seeing in terms of the work that the health sector, the health
care sector can do at reversing that trend of being a contributor to
toxic waste?

Gary Cohen: Well, so the amazing thing about the health sector in this country is
that it’s the biggest part o f the economy sites of US military, and it’s
the one part of the economy that lives within this ethical framework
of the Hippocratic Oath to do no harm. There’s this opportunity to as
its addressing its toxic climate footprint, it can achieve health
outcom es that are positive. We can actually improve the health of all
Americans by addressing our reliance on fossil fuels, for example.

Fossil fuels independent of their climate contribution globally are
killing eight million people a year because of the partic ulate matter
according to the Harvard School of Public Health. That’s more than
AIDS, malaria and tuberculosis combined. Just cleaning up the air and
moving away from coal and oil and gas will actually improve
Americans’ health. Also, health care is a huge user of petrochemical
plastics which are choking our waterways which are full of toxic
chemicals and additives which create dioxin when they are burned.
Moving away from petrochemical plastics can help stimulate a green
chemistry economy to move away from those.

As we move away also from the overreliance on meat, if we move to a
little more plant based diets, it’s good for peoples’ health, it’s good
for agriculture, it’s good for the planet. There’s a lot of different
interventions that hospitals and healt h care can make and aggregate
its power to signal the rest of the economy of the direction we need
to go. Because they are anchors in their community, their economic
engines, we are working with them to say as you’re doing energy
efficiency in your own fac ilities, support energy efficiency in low
income housing in your community so that you reduce the incidence
of asthma and respiratory disease.

As you’re offering healthier food for your patients, your employees
and your visitors, support more local sustai nable and equitable

Gary Cohen

farming that’s more climate resilient that doesn’t use pesticides.
There’s way in which they can see themselves as sort of the epicenter
of creating healing beyond their four walls into the communities they
serve and into the planet tha t sustains us all because what health care
needs to come to grips with now is that it needs to operate at three
levels at the individual’s health, the community’s health, and the
planet’s health.

Mark Masselli: We’re speaking today with Gary Cohen, Founder and President of
Health Care Without Harm, seeking to mobilize the health care sector
to address the climate crisis as a medical emergency and to
decarbonizes health care. You know, Gary I was listening to you sort
of the Build Back Better for the health care system strategy, and
you’re really talking about some of the operational elements of it. But
the whole design of the health system seems to be in need of change.
The pandemic has certainly provided some opportunities to be force
multiplier both in ter ms of access to health care, but also in terms of
our carbon footprint, telehealth been one of them, right? People do
not have to drive in.

Now, we’re in the primary care side, certainly the rural community
health centers play 1500 of them 10,000 locations and guess what, all
those locations are in those targeted environmentally sensitive
neighborhoods that you talked about. But what about the design of
the system, but isn’t it that we have to sort of reimage the delivery
system in ways that use distant com munication so patients can be
monitored. What are your thoughts on that, who would you say is a
best practice?

Gary Cohen: I mean you’re exactly right, we have to redesign the health care
system so that it’s not focused on treating chronic disease, so they ’re
always sort of in the mop up operation. We’ve got a society that has
got structural racism that’s got vast amounts of unemployment, it has
polluted environments, it has toxic stress, and we have chronic
disease, and so the health sector is at the back end of this system.
What it needs to do is it needs to be about health, creating health and
that means changing the financing and the incentive system to move
up stream and address the housing, address the food systems,
address the violence, address the po llution in communities that are
making people sick in the first place. That’s a fundamental redesign,
because we are facing this climate crisis, it needs to anchor the
resilience of communities.

It’s not only does it need to be the last building standing i n the next
Hurricane Katrina or wildfires in California, but it needs to understand
the vulnerabilities of the communities that it serves, who is on
ventilators, where are the communities that are already in the -- living
with air pollution so that if ther e’s wildfires it’s going to be much

Gary Cohen

worst. There’s a kind of a redesign in culture and in thinking and
financing so that we’re using this money to create health. There are
some important kinds of mechanisms that we need to instill at the
highest level of t he Department of Health and Human Services that
does that. If we said to every hospital in America, you know, you do
emergency planning but you need to do climate resilience planning
because there’s new realities, heat stress, wildfires, hurricanes.

You ne ed to understand the vulnerabilities of your community, the
social determinants of health. In order to get Medicare
reimbursement you need to measure your carbon footprint and make
progress toward the goals of the Biden Administration. There are
some very, very fundamental problems with our health care system.
I’d say the system that has the potential and the mindset to make this
transition is Kaiser Permanente because it’s both a health insure and
it runs hospitals and clinic.

From the point of view of a m embership of a health insurance and
agency, they want to keep people healthy, save them money, and so
they don’t want people showing up in their emergency rooms. The
other system is the Veterans Administration, it’s the system we
control, and so we have a strong national interest in helping veterans
be healthy and deal with the trauma that they come with from being
in Iraq and Afghanistan and other places. Having control over the
entire systems gives the system a chance to actually promote health
as oppose to just treat disease.

Margaret Flinter: Well, I think you’re absolutely right Gary, these are all leverage points
and I think you’re absolutely right, we need to push those levers to
get the results that we want. One of the partners that you have that
we were interested in hearing about is the National Academy of
Medicine which is looking to address climate change in the health
care setting. A big piece of this is going to be about how we train the
next generation of health care providers.

One thing we hav e on our side I think is young people tend to come to
us pretty environment aware with a bit of an activist format. But
what’s your vision for how the work of the National Academy of
Medicine and their platform to address climate change in the health
care setting, what’s your vision for that approach and what do you
think some of the outcomes of that might be?

Gary Cohen: I think National Academy has got a strong focus on decarbonizing
making it climate resilient, focusing on equity issues. The other
dimens ion of their initiative is how can we educate the next
generation of clinicians, doctors, nurses and others. The current
generation is to make them advocates, make them messengers for
changing the narrative around the climate crisis so it’s not seen as
pol ar bears on melting ice caps etc, but it’s about asthma, it’s about

Gary Cohen

heat stress, it’s about wildfire. They’ve done a lot of opinion research
around climate, a nd it turns out that when you focus on health,
people care because they care about their own healt h, they care
about their family’s health, they are more likely to act. Inside of that
narrative, new narrative, health professionals are the best
messengers.

What COVID showed us is that they are truth tellers. When you have
politicians lying about the sev erity of COVID or telling you to do some
cockamamie kind of solutions that aren’t going to be good for you,
the public health and health professionals of the countries have been
truth tellers. It’s like no this is -- we’re going to give you the real story,
the real advice. We want to leverage that trusted voice for climate
solutions, because it maybe that health maybe the one lever in
addition to jobs that helps to unlock the partisan dividing the country
and say, you know, actually we all care about health , don’t we?

The National Academy of Medicine is been incredibly helpful because
they are convening all of these incredibly important players, say let’s
solve this together. The American Hospital Association, The American
Medical Association, all these big industries that are supplying health
care, joint commission, the right parties who are at the table to
actually do some of the redesign you were talking about and
accelerating this transformation because we don’t have a lot of time.
We need to make this ch ange in a very profound way over the next
decade.

Mark Masselli: Gary, I think our listeners are asking themselves, I really like what I’m
hearing, tell me more about how I can participate in health care
without harm or that you talked about the need for a dvocates , so
maybe layout some opportunities for people starting with the
organization that you founded.

Gary Cohen: Yeah, so Health Care Without Harm has a lot of tools and strategies
and case studies that demonstrate that there are so many ways to
enter into changing the health care system from food to energy to
buildings to plastics to waste to -- and so for people that are in the
sector, there’s lots of places to engage and to advocate within the
systems they’re operating in whether that’s a clinic or w hether that’s
an acute care hospital to make this kind of transformation. In the
clinical advocacy space, there’s a number of initiatives that exist.

W e launched with an organization called The Alliance of Nurses for
Healthy Environment a thing called Nur ses Climate Challenge a whole
website with materials and op - eds and ways to engage people in the
facilities who are working, but also to become advocates in the
communities that you serve to bring that trusted voice forward.
There’s a partner organization called the Medical Society Consortium
on Climate and Health that’s got half of the doctor, physician

Gary Cohen

organizations in the country all which signing on to climate as a
strategic comparative, and there’s lots of materials in those places
and in others to get engage and to short - circuit our learning curve so
that we are bringing forward health professionals as heroes, as
planetary healers.

T here are so many other opportunities for just engaging in your local
community. Like everybody says, well, what can I do as an individual?
I would say what can you do as a community, like band together.
There’s all these renewable energy standards that are coming at local
level and state levels, so there’s ways to engage wherever you find
yourself.

Mark Masselli: We remind everybody who’s in the health care leadership that unless
you’re talking about climate and the environment you’re not going to
attract the next generation of young people who are leaders. They’re
going to go to elsewhere. If you don’t get the bigger pictur e, you’re
just going to lose out to all that talent that’s out there.

Gary Cohen: It’s true. Actually, it’s turning that sustainability is one of the
interesting kind of drivers for people making decisions about their
employment, especially this new genera tion. But one of the things
that has happened as a result of COVID, COVID was -- hospitals and
clinics were the epicenter for dealing with the trauma of this, not as
visible to the public but inside of hospitals and clinics there were so
much trauma that d octors and nurses had to face that there’s a real
people leaving the profession, especially nurse. When you talk to
hospital leaders around the country now they’re saying we have
dramatic workforce shortage, and so part of the healing that we need
to do is also to heal the people that have actually taken care of people
in the last two years. One of the things we’re trying to explore is are
there organizations we can partner with that can offer some kind of
trauma related kind of care for the nursing staff a nd others who have
just witnessed so much crisis.

Mark Masselli: Yeah, real tragedies, yeah.

Margaret Flinter: Yeah, absolutely.

Mark Masselli: Well, thank you so much.

Gary Cohen: We’ve got work to do. A lot of work to do

Mark Masselli: Yeah, a lot of wor k to do.

Margaret Flinter: We’ve been speaking today with Gary Cohen, Founder and President
of Health Care Without Harm, an international campaign that
promotes environmentally responsible health care. Learn more about
his award winning work by going to no harm.org, or follow them on
Twitter @HCWHGlobal. Gary, we want to thank you for your vision, by

Gary Cohen

your leadership, your passion for addressing health care within the
context of climate change, for your commitment to building a
healthier planet while addressi ng the crushing weight of health
inequity. We want to thank you for joining us again today on
Conversations on Health Care.

Gary Cohen: Thanks so much for having me.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US p olitics. Lori,
what have you got for us this week?

Lori Robertson: Aaron Rodgers, the star quarterback of the Green Bay Packers made
headlines when he contracted COVID - 19 and then defended his
decision not to get vaccinated with a string of false and m isleading
claims. In a November 5 interview Rodgers drew a distinction
between vaccination and immunization saying that he had not
previously lied about being vaccinated because he had been
immunized via a homeopathy protocol. But there is no way t o have
i mmunity to the coronavirus without either being previously infected
or being vaccinated. Homeopathy is a form of alternative medicine for
which there is little evidence of effectiveness for any health condition.

In the interview Rodgers asked, “If the vacc ine is so great, then how
come people are still getting COVID and spreading COVID and
unfortunately dying from COVID?” The answer is that no vaccine is a
100% effective. While the COVID - 19 vaccines in use in the United
States are highly effective, some cas es hospitalizations and even
deaths are expected among vaccinated individuals. However, the data
show that the risks of getting the disease and dying from it are higher
among the unvaccinated.

In the month of August during which the Delta variant accounted for
nearly all infections, unvaccinated people were six times more likely
to test positive for infection and 11 times more likely to die from
COVID - 19 than the fully vaccinated. Rodgers also said he was taking
the antiparasitic drug Ivermectin and wrongly said medicines been
tested by Merck and Pfizer were, “Expensive versions of Ivermectin.”
They’re not. Pfizer and Merck have announced positive trial results for
easy to take pills to combat the disease. But those antiviral
medications are very different f rom Ivermectin.

So far, studies on whether Ivermectin can effectively treat COVID - 19
have been inconclusive. Health officials have warned people not to

Gary Cohen

self - medicate and not to inject Ivermectin intended for livestock.
Rodgers also baselessly cited concern s about the COVID - 19 vaccines
and fertility as one reason why he remained unvaccinated. There is no
evidence that the COVID - 19 vaccines having negative impact on
fertility. That’s my fact check for this week. I’m Lori Robertson,
Managing Editor of FactChec k.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked e - mail u s at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week Conversations highlights a bright idea about how to mak e
wellness a part of our communities and everyday lives. According to
Michigan organic farmer Michelle Lutz, health care spends too much time and money trying to fix the problems that are caused by a poor diet. (Inaudible 00:27:27) at the Henry Ford West B loomfield Hospital
agree with here. For year she had offered organic food growing and cooking demonstrations at the health care facility just outside of Detroit. But when officials drew a plans to renovate the hospital, they decid ed to take it to the next level. A million dollar certified organic
hydroponic greenhouse and garden were built and Lutz was hired away from her farm to run the operation.

Michelle Lutz: When you have the opportunity to heal someone, it is very important that what they are eating b ecomes part of that plan. That cliché saying we are what we eat is absolutely true.

Margaret Flinter: The facility now provides most of the nutritional organic greens, vegetables, fruits and herbs used in the food that is prepared there, not just for patie nts who have come there to heal, but for their
families and hospital staff as well.

Michelle Lutz: The layout was very important so that we could have a very complex
diverse variety of herbs and produced for the kitchen to use. In the winter time and in th e fall we changed to more of a cold tolerant
crop, and then in the summertime we are now transitioning to the point where we’re picking cherry tomatoes and we have sweet
peppers and things like that.

Margaret Flinter: Lutz says there is an educational comp onent to the program that’s
ongoing and multigenerational.

Michelle Lutz: Right now we are averaging 3000 students per academic school year
that go through our Healthy Habit Program. We are lucky enough to
have kind of dual combination here of offerings. W e have a

Gary Cohen

demonstration kitchen and then we have the greenhouse right behind
the hospital. It is not uncommon for a nice day for us to have a nice
stream of doctors and nurses out there just to be in a beautiful setting
and how therapeutic that can be. But to also have them ask questions
about what it is that we’re growing and how is that being used.

Margaret Flinter: The nation’s first hospital based year - round certified organic
hydroponic greenhouse, one that provides fresh fruits and vegetables
to patient s who are healing and the clinicians working to heal them
and teaching the next generation about the benefits organic produced
for a healthier diet.

Michelle Lutz: The idea of being just a hospital doesn’t work anymore. You have to
be a community center fo r wellness.

Margaret Flinter: Now, that’s a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health .

Marianne O’Hare: Conversa tions on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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