My Climate Journey

Ep 75: Gary Cohen, President & Co-Founder of Health Care Without Harm

Episode Summary

Today's guest is Gary Cohen, President & Co-Founder of Health Care Without Harm. He was an outsider that entered the insular field of health care many years ago, determined to clean it up. They started small, and today have made a tremendous dent in helping thousands of hospitals clean up their acts across sustainability, pollution, decarbonization, and more. Tune in to find out how!

Episode Notes

Today's guest is Gary Cohen, President & Co-Founder of Health Care Without Harm.

Gary has been a pioneer in the environmental health movement for thirty years. Cohen is President and Co-Founder of Health Care Without Harm and Practice Greenhealth. He was also instrumental in bringing together the NGOs and hospital systems that formed the Healthier Hospitals Initiative. All three were created to transform the health care sector to be environmentally sustainable and serve as anchor institutions to support environmental health in their communities.

Gary was Executive Director of the Environmental Health Fund for many years. He has helped build coalitions and networks globally to address the environmental health impacts related to toxic chemical exposure and climate change. 

Gary is a member of the International Advisory Board of the Sambhavna Clinic in Bhopal, India, which has been working for over 25 years to heal people affected by the Bhopal gas tragedy and to fight for environmental cleanup in Bhopal. He is also on the Boards of the American Sustainable Business Council, Health Leads and Coming Clean.

He has received numerous recognitions for his achievements, including: The MacArthur Foundation’s Fellows Award (2015), the White House’s Champion of Change Award for Public Health and Climate Change (2013), the Huffington Post’s Game Changer Award for Health (2012), the Frank Hatch Award for Enlightened Public Service (2007), and the Skoll Award for Social Entrepreneurship (2006).

In today’s episode, we cover:

Links to topics discussed in this episode:


Episode Transcription

Jason Jacobs:                Hello everyone. This is Jason Jacobs and welcome to My Climate Journey. This show follows my journey to interview a wide range of guests to better understand and make sense of the formidable problem of climate change, and try to figure out how people like you and I can help. Today's guest is Gary Cohen, who's been a pioneer in the environmental health movement for 30 years. Gary is President and Co-founder of Health Care Without Harm which seeks to transform healthcare worldwide, so that it reduces its environmental footprint, becomes a community anchor for sustainability and a leader in the global movement for environmental health and justice.

Jason Jacobs:                This is a fascinating discussion in that one, it highlights just how environmentally unfriendly the healthcare system is, which was supposedly put in place to make us all healthier. Two, it shows how one person and their vision to help can start small focused on one hospital and one wedge to get in, which is mercury thermometers and end up ultimately expanding to serve thousands of hospitals across all areas of decarbonization and other initiatives to make people healthier. And three, it shows how we ultimately need to decarbonize our entire global economy, and here's a playbook to decarbonize one sector. So what is it that we all can learn from how Gary's gone about decarbonizing healthcare that we could potentially apply to other sectors across the economy? Gary Cohen, welcome to the show.

Gary Cohen:                  Thanks very much for having me, Jason.

Jason Jacobs:                Well, thanks for hosting me here at The Village Works and in Brookline village, Massachusetts. Kind of funny story of how we got together. So Bobby, who runs The Village Works, a friend from high school and he's been bingeing on the podcast. And he said, "You really got to talk to this guy Gary, who works out of The Village Works. He's doing the same Health Care Without Harm, he's a MacArthur genius, cares a lot about climate change. You've got to talk to him." So we had a conversation, and you got a fascinating story, and here we are.

Gary Cohen:                  Well, I'm happy to share what I've learned over the last 35 years with you.

Jason Jacobs:                I'm excited to hear it. So maybe we should just jump right in. So Health Care Without Harm. Tell me about it.

Gary Cohen:                  Right. So in the mid 1990s, I was a environmental health activists working with communities that were impacted by toxic chemicals around the country. And we were learning at that time new science around what exposure meant for people in terms of toxic chemicals.

Jason Jacobs:                Just one question, what drove you to do that, to become that activist in the first place?

Gary Cohen:                  That's an interesting story itself. When I got out of college, I was writing guidebooks to restaurants in Paris and pubs in London and hotels in New York. And after a few years of doing this and traveling in India, when I came back, a college friend of mine named John O'Connor said, "Gary, you're a guidebook writer, could you write a guidebook to toxic chemicals?" And I said, "Well, look, nobody wants to visit the places that are poisoned with toxic chemicals." He said, "No, no. But what if you're living in a polluted community? How can you organize your neighbors? How can you access government databases? How can you use the media? How can you hire a lawyer? How do you organize so that you can defend your family from these toxic threats?"

Gary Cohen:                  So I said, "Look, I'm a writer. I don't know about these kind of issues." He said, "You don't have to. There's all these communities around America that are living down the street from a Superfund site, or they're living next to an incinerator, or there's a big chemical plant down the street. Go talk to them." And so I did. I met lots of people all around America. Basically, they were moms and dads sitting around kitchen tables wondering why their kid had cancer, or why their daughter woke up late at night choking because the air was so bad, or why their kid had skin lesions after showering. I was so taken with their bravery and their tenacity. And they had no money, they had no technical skills, but they were willing to stand up against the companies that were polluting them and weakening their kids health.

Gary Cohen:                  I was so taken by it. I said, "I need to be part of this movement." And so in the mid 1980s, I joined this effort and it led to the first Right-to-Know law in the country, in the world, so that people in communities could learn about the toxic threats in the air and water in their communities. And was involved in this broad movement to address the toxic chemical threats that we face in our lives. And then about 10 years into that is when we started to learn that it was really not the dose of chemicals that made the poison, it was the timing. And at the first thousand days of life in the womb and in the first few years of a child's life, toxic chemicals could turn on and turn off hormones, and they could interfere with gene expression, and they could contribute to cancer later in life and chronic disease of all sorts later in life. And at the very same time, the Environmental Protection Agency said that medical waste incinerators, hospitals burning medical waste were the largest source of dioxin emissions in the United States and a large source of mercury emissions.

Jason Jacobs:                Crazy.

Gary Cohen:                  Yeah. And we said, look, how are we ever going to turn around our society to be healthier if the very sector of our economy that's supposed to be healing people is actually poisoning them? And that was the genesis to start Health Care Without Harm.

Jason Jacobs:                So when did it start?

Gary Cohen:                  We started in the fall of 1996. And we said we're going to help hospitals stop burning so much medical waste and stop using mercury. And so within a period of 10 years, we closed down about 4,500 medical waste incinerators, so there were less than 100 left in the entire country. We taught hospitals how to reduce their waste, how to segregate it. We created a market for what's called reprocessed medical devices that sterilizes devices and then sells them back to hospitals at half price, a half a billion dollar market. We saved them money and we also eliminated mercury from the entire healthcare system in the United States. No more pharmacy chain sold them, no more hospitals use them. And then we went out and changed the policies in Europe and ultimately partnered with the World Health Organization and won a global treaty phasing mercury out of healthcare by 2020.

Jason Jacobs:                And so when you first got going, what was the initial charter of Health Care Without Harm?

Gary Cohen:                  The initial idea was to help the healthcare sector clean up its own house, to detox its supply chain, its energy, to become an advocate also once they clean up their house for policies that would support environmental health and justice in the communities they serve, and in a broader state national, international level. Because the healthcare sector is incredibly powerful. It's 18% of the US economy. It's 10% globally. So it has enormous economic clout. In many, many communities, it's the largest employer, it's the largest purchaser of many goods and services. And ultimately, it also has enormous amount of political power because of that. Both because of their mission, which is based on health and healing, and also because doctors and nurses are the most respected professions in our society.

Gary Cohen:                  So we thought we need to leverage all of the assets of this sector toward building healthier communities in a more sustainable planet. But in order to do so, they had to clean up their own house first because they're major polluters. They represent all the contradictions of an economy built on fossil fuels, toxic chemicals and industrial agriculture.

Jason Jacobs:                And so when you first got the organization started with that charter, how did you figure out where to start? And why did you choose starting with mercury and with the kind of narrow but important lane that you did?

Gary Cohen:                  Well, it was so outrageous that hospitals were the leading source of dioxin, that seemed like an important place to start and a source of mercury. Why? Because dioxin is linked to cancer in virtually every part of the body that is impacting. We learned about dioxin from Agent Orange that was sprayed during the Vietnam War. And so many veterans came back and so many people in Vietnam were exposed, and it led to cancer, led to birth defects in the next generation. And so it's an incredibly powerful toxin.

Gary Cohen:                  The other is mercury. And mercury we know is toxic to the developing brains of children. And because of the pollution of mercury in our oceans, in our waterways, it's been taken up by the fish, and then we eat those fish and it's toxic. And so the Centers for Disease Control were telling us at that time that there was enough Mercury in children being born, that it could actually impact their IQ development. So those two issues, mercury and dioxin, were powerful issues that really identified healthcare is actually contributing to the very diseases that they're trying to solve for.

Jason Jacobs:                Why do you think that contradiction is so pronounced?

Gary Cohen:                  Well, first of all, people who go to medical school or nursing school, they don't really learn about the links between the environment and people's health. At most, a doctor in medical school will get four hours and four years of "environmental education" it'll be mostly linked to the exposure of tobacco or alcohol to human health, but nothing to do with climate change in health or toxic chemicals and health or industrial agriculture in health. So there's an ignorance in the sector that we found that was profound. That was one thing.

Gary Cohen:                  The other thing is that they were not understanding that the products that they were buying for their facilities were toxic. They just didn't understand that if you take a PVC IV bag and you put it into an incinerator, you actually create dioxin that goes out into the air and lands on the land, and it's taken up in the food supply. They didn't understand how toxic mercury was. So these were issues where we could get specific early wins, we could move the sector to address these things collectively. They could achieve an early win where they could see the connection between the environment and people health, and it could prime them for much broader set of issues that they could then work on with us.

Jason Jacobs:                And so you are essentially coming in as an outsider, correct?

Gary Cohen:                  Yeah, initially, we were environmental health advocates coming in as outsiders to this incredibly powerful large sector and identifying a problem for them. At the same time, we said, we're not going to blame you, we're not going to shame and blame you that you've got this problem. We're going to help you understand the links between these exposures and people's health, and we're going to help you find solutions together to address them. And so we took that attitude and because of that, we built very trusting relationships over many years. And as we brought new environmental health issues to the table, people said, okay, well, we trusted you the first time, you've held our hand and helped to solve these problems and even saved us money. Tell us what the next thing is we need to work on together.

Jason Jacobs:                Initially, when you're coming in as outsiders with these bold ideas, why did they take the meeting in the first place?

Gary Cohen:                  They took the meeting because we were highlighting because of these EPA reports and CDC reports that healthcare was a major polluter. And I think many of these healthcare systems, some of them were very mission aligned, some of the faith based systems, the Catholic systems in particular, were unaware of the problems they had. They saw themselves as really being part of some healing ministry, and they didn't want to be contributing to polluting people. Certainly, also they have a very justice orientation. So the idea that many of these medical waste incinerators were in poor communities and communities of color that were being exposed to these toxins was so against their mission, they wanted to get involved.

Gary Cohen:                  In other cases, the hospitals were concerned with bad publicity. Because at the time we started, there were local community groups that were actually protesting against hospitals in inner cities of American cities around the pollution they were causing. In Cleveland, in Detroit, in Lawrence, Massachusetts, in Oakland, California, in Seattle, Washington and many cities, community groups were protesting hospitals. And so we came in and help them solve their problem. After 10 years, they were no longer a large source of dioxin emissions at all. They were no longer a source of mercury emissions. And they then took on many other issues that we brought to their attention.

Gary Cohen:                  So for example, some of the plastics that they were using leached toxic chemicals into their patients when they were safer alternatives that existed. So pregnant moms, kids in the neonatal intensive care unit were being exposed to reproductive toxins as they were getting treatments. We were highlighting that there were toxic cleaners in floor cleaners in hospitals, and nurses were having the highest asthma rates of any profession in America. We were telling them that there were flame retardants, toxic flame retardants in the furniture they were buying that were off gassing into their facilities. We were showing them that by having donuts and sugar sweetened beverages in their vending machines, in their facilities, they were actually modeling a really poor food environment, that were missing the connection between healthy food and healthy people.

Jason Jacobs:                Shouldn't they know these things?

Gary Cohen:                  They should know these things. It was so shocking that there was so little education about the links between these exposures and their products and health. Their attitude was, hey, we're saving lives, don't talk to us about these issues. But as we brought these issues forward and said there are safer alternatives to these problems you have. In many cases, they save you money. In many cases, if we work together to build a broader movement in the healthcare sector, we can achieve much more widespread and large scale improvements, they came along.

Gary Cohen:                  As you said, Jason, I mean, we started as outsiders, as environmental health and justice outsiders. But what's happened over the last 23 years is that we built a movement inside of healthcare. And now there's advocates all over the world that are addressing environmental health issues, in particular, climate issues and toxics issues. So now we've got partners in 60 different countries and over 1,200 institutional members.

Jason Jacobs:                So how did you do that as an outsider to get the insiders on your side?

Gary Cohen:                  We started building champions inside of hospitals, environmental service people, dietitians, architects, nurses and doctors, administrative people, procurement people, there's so many different ways in to lead in this sector. There's so many opportunities to make changes. We started to build an ecosystem of actors inside healthcare in support of sustainability and environmental health.

Jason Jacobs:                And I think what I heard from you is that when you started it seemed to be initially focused on toxins, chemicals. But then over time, the purview has expanded quite a lot to include climate change and other things as well. Can you talk a bit about that progression and also the timelines in which that purview broadened over time?

Gary Cohen:                  Yeah. I think about the mercury in the incineration work was probably the first 10 years or so of the work. Sometime after that we also worked on safer building. So how to design hospitals to have more natural light, not have toxic chemicals, have more energy efficient strategies. After that, we were working on plastics and cleaners and a lot of toxic products. But then, about 15 years into it, we also started working on food. Because the largest cost to the health care system is actually food related diseases. Obesity, diabetes, heart disease, cancer, stroke, all preventable diseases, all food related. And hospitals were serving really crappy food that actually contributed to these very diseases. So it didn't give people, patients or employees or visitors any sense of the connection between healthy and sustainable food and healthy people.

Gary Cohen:                  Initially, we focused on meat because of the overuse of antibiotics and animal agriculture. 70 to 80% of all the antibiotics that are used in this country are used in animal agriculture, only 20 to 30% are used in medicine. And some of the same antibiotics are used in animal agriculture. So it was contributing to antibiotic resistant bacteria, which can kill people. In other words, we're rendering antibiotics ineffective because of our overuse in animal agriculture. So the fact that hospitals were buying lots of meat produced with antibiotics, and not making the connection between that antibiotic resistance in their patients was a big miss. And so we brought that to their attention.

Gary Cohen:                  And then they move toward only demanding antibiotic-free meat, and then moving toward meat that was produced with more sustainable grazing practices, in serving less meat. And now starting to serve more plant-based diets and leveraging their purchasing power to support more local and sustainable growers in their community. And linking with the schools and the universities in their communities to create more aggregated demand. And actually being involved in reweaving more sustainable food systems because our food production system is completely out of alignment with healthy people.

Jason Jacobs:                The organization is a nonprofit, correct?

Gary Cohen:                  We're a nonprofit organization with offices in the United States and Europe and Southeast Asia and partnerships in Latin America and China and India, South Africa, Nepal. Australia.

Jason Jacobs:                Are these hospital systems actually retaining you for an engagement or is it just more informal advocacy, kind of with more of a scattered approach where you're just kind of ... How does it work in terms of in practice?

Gary Cohen:                  Right. So we built networks. In the United States, we created a membership organization called Practice Greenhealth. And there's about 1,300 hospitals that are paid members of Practice Greenhealth. That's about 20% of the entire hospital market in the US. In Europe, we've built a membership organization of hospitals and health professional organizations in Europe. In India, we partnered with other organizations to create a network of hundreds of hospitals around the country. We're doing the same in Latin America and Australia and other places. So we're building networks of like-minded organizations in a geographic region.

Gary Cohen:                  We also have created a global network called Global Green and Healthy Hospitals, and that has 1,200 institutional members across 60 countries. So we're building an ecosystem of players and actors. Some of them are health ministry, some of them are private healthcare systems, some of them are public systems, some are physician organizations or nursing organizations. It's really a broad network of collaborators now across the world. So Health Care Without Harm is the parent organization. It's kind of the R&D and advocacy component. These different networks are the implementation and scaling vehicles. And we've also created in the United States purchasing cooperative of nine leading healthcare systems that are modeling what green and sustainable products look like, and trying to influence the rest of the healthcare market to move in that direction.

Jason Jacobs:                And how big is your internal team and functionally, what do they do?

Gary Cohen:                  We have about 120 people that are being funded by Health Care Without Harm in the United States and Europe and Latin America, India, China, Africa. Some of them are experts in different areas, experts in food, experts in chemicals, experts in climate, experts in technical assistance to hospitals so they can learn how to green their supply chains. They can learn how to move away from fossil fuels powering their facilities to renewable energy and energy efficiency strategies. We have specific people that work to build more nurses as advocates and physicians as advocates in our society. We have people that work on policy. So we've got a broad set of people.

Gary Cohen:                  We also collect a lot of data. So we're the biggest repository of data in the world of sustainability in the healthcare sector. So we collect data and can show progress. Over time of how hospitals are moving toward low carbon toxic-free products and technologies. We can provide market signals to companies that are trying to get into healthcare or trying to figure out where the market is moving, and how they can kind of sell into this powerful market that is greening itself.

Jason Jacobs:                What are the key metrics that you look at to measure success? How do you know how you're doing as you go?

Gary Cohen:                  We measure success by the number of healthcare institutions that are becoming involved. We're asking them to start tracking their carbon footprint, their greenhouse gas emissions, making commitments toward reducing that and making commitments toward 100% renewable energy. Making commitments to buying safer products and tracking the market. Making commitments to support a percentage of their overall food purchasing, that's local and sustainable food. So there's a lot of very specific metrics. Metrics to also even address things that we've just been learning about, like certain anesthetic gases are 2,000 times more potent than carbon dioxide. And so we've created a tool to help hospitals track their use of anesthetic gases and reduce the carbon footprint by moving to safer alternatives.

Jason Jacobs:                And you mentioned carbon footprint and greenhouse gases. Where does climate change fit into all of this, and when did that come into your purview as an organization?

Gary Cohen:                  Let's say over the last 10 years, we've come to understand that the climate crisis is the greatest public health threat that we face on this planet. It's a threat that is not just about polar bears on melting ice caps or shrinking glaciers, but it's affecting the health of everyone. And we're learning that the climate crisis is linked to extreme heat. It's linked to flooding and hurricanes that are affecting people all over the world. It increases respiratory diseases and asthma. It contributes to waterborne diseases, mental health threats, respiratory diseases, and it's creating more refugees on the planet than all the wars combined. So it's affecting everybody on the planet. And we're beginning to educate people that this is a existential threat that many, many people will experience through the health of their families and themselves.

Gary Cohen:                  In that drama, in that existential drama, the health sector is emerging as a central actor and catalyst for climate solutions. It's actually going to be at the center of this crisis. Why is that? One, people in times of trauma, which many people experience these extreme weather events, is traumatic, people turn to healthcare, to address their injuries and losses. So health care needs to be the last building standing in extreme weather events. They need to understand the vulnerabilities in their community. What does it mean if there's going to be 30 or 40 days of 100 degrees plus? Or the spread of mosquito-borne diseases in their communities? So healthcare is sort of the safe harbor in the storm and the rising seas of climate change.

Gary Cohen:                  Second, it's such a big part of our economy. It can drive the market toward renewable energy, toward low carbon solutions that we all need to adopt. And they can invest in those solutions as part of a broader healing mission. And third, as I mentioned, doctors and nurses are the most trusted professions in our society. And so we've been mobilizing doctors and nurses to be educated on these issues and to become advocates for policies to accelerate our transformation away from fossil fuels toward renewable energy as public health interventions, not environmental interventions. As public health interventions that will immediately reduce the burden of air pollution deaths and other chronic disease. It will lower health care costs. It will help drive a green revolution in renewable energy and green chemistry, and it will help solve the climate crisis. So the very things that will actually reduce our epidemic of chronic disease are exactly the same kinds of interventions that will help solve the climate crisis. We have to get off our addiction to fossil fuels and toxic chemicals.

Jason Jacobs:                If you look at things then from a health standpoint, I mean, obviously reforming the health care system is important as you're describing.What are the biggest levers either within the healthcare system or outside of the healthcare system that could change to accelerate this transition and better secure the health of our species for many generations to come?

Gary Cohen:                  We've found that leveraging the collective power of healthcare in the marketplace is a much faster lever than trying to win policy. Because in the policy realm, especially as you get to the federal level, you have the fossil fuel and utility industries that are arrayed against these interventions. And so they've put a lot of money into politicians that support their agenda. They've infiltrated the regulatory part of our economy, part of our government so that the regulatory systems is more favorable to the fossil fuel industry than to our children's health. And so what we've done is collectivize the purchasing power of hundreds of hospitals to drive and demand from the manufacturers that they produce low carbon, more sustainable products.

Gary Cohen:                  We're also partnering with the United Nations Development Program to develop globally validated standards for medical products technology so that we can drive global markets toward renewable energy, toward toxic-free products. So that when we're thinking about universal health care and how do we guarantee universal health care around the world, that we should be thinking about energy access as a component of that. So that we can solarize clinics all over of the Global South. We can have solar refrigeration to make sure that medicines are properly refrigerated. And all sorts of other bottom of the pyramid technologies that both guarantee people the right to health care, but also a drive toward a low carbon economy. So the economic leverage of healthcare is huge.

Gary Cohen:                  At the same time, because I said they're very powerful politically, we started to build in this country statewide health care climate alliances to bring the largest healthcare systems together in states to join with other parts of the business community and civil society to advocate for policies around renewable energy standards, around energy efficiency standards to build that political will in our society. And in places like outside of the US, in Europe, healthcare is a very powerful advocate at the policy level. So markets and policy are together. Very powerful to move and accelerate this transformation.

Gary Cohen:                  The other is that we've got a very misaligned kind of incentive system. So the International Monetary Fund estimates that the subsidies to the fossil fuel industry, both direct and indirect subsidies, is over $5 trillion a year. To put that into perspective, that means that's more money than all of the expenditures by governments all around the world on health care. So we're subsidizing the very industry that is poisoning us and destroying life on the planet. Half of those subsidies are in health care expenditures, health care costs, lost work time, loss of life. And so if we can eliminate those subsidies, those absurd subsidies-

Jason Jacobs:                The loss of work, loss of life, what does that mean?

Gary Cohen:                  So it means that nine-tenths of people on the planet are breathing poisoned air. They're breathing air that's not healthy. The majority of that air pollution is contributing by fossil fuels. So we haven't factored in the cost of that increased mortality, that increased asthma and respiratory disease, what that means for people not being able to work. So that's what loss work time means. Means that people's lives are being cut short because of air pollution and other issues related to fossil fuel exposure and emissions. And so those losses are not factored into the price of gas, they're not factored into the price of a kilowatt hour. And if we start to internalize those externalize costs and make the fossil fuel industry pay for it, it would change everything. That would be an incredibly powerful lever for change. Because at this point, society is subsidizing. We are subsidizing the fossil fuel industry with our health.

Jason Jacobs:                If we did make the fossil fuel industry pay for it, why would that make them accelerate to transition versus just passing that cost along to consumers and raising their prices?

Gary Cohen:                  What it would do, it would change the economics of the fossil fuel industry in a powerful way. And it would make the business case for the dramatic acceleration of renewable energy technologies all the more powerful. Already, there is a very powerful argument that's been accepted by economists around the world that even with the assets that the fossil fuel industry has, given the scientific limits of what's possible on this planet, these are called stranded assets. In other words, even though they may own certain rights to mine for more coal, to frack for more gas, to drill for more oil, given the limits on the planet, if they were allowed to do all of that and to increase the use of fossil fuels, it would make the planet uninhabitable. We would blow past two degrees centigrade and make it impossible to grow food and to have people be outside.

Gary Cohen:                  So the limits of planet are forcing some accountability of this industry. But even that is not enough. We need to make them pay for the damage they're causing. That will change the equation dramatically, because we're not paying the full price of fossil fuels. And I don't think they could pass it on to consumers.

Jason Jacobs:                So is that an area where Health Care Without Harm is getting involved? And if so, how?

Gary Cohen:                  We are getting involved in beginning to internalize those healthcare costs. So we've created a tool called the Energy Impact Calculator, which allows institutions to depending on where they are, it's US based, but where they are in the country to plug in their kilowatt hours and their zip code so to identify what the grid is made of in that geographic area. And it will tell them, what emissions they're responsible for because of their reliance on fossil fuels. What are the emissions? What are the health impacts related to those emissions? And what are the needed health care costs related to those emissions?

Gary Cohen:                  We had a beta version of this that we've shared with healthcare institutions around the country. And it's helped them to see that they're actually contributing to disease and increased healthcare costs. And it's helped them make commitments toward renewable energy, toward energy efficiency strategies, toward making very powerful goals, climate reduction goals for their institutions. So that's a version of beginning to internalize those externalized costs. And we also are getting involved in policy initiatives at the state level to put a price on carbon that reflects its true cost.

Jason Jacobs:                And when you say getting involved, in what form does that take?

Gary Cohen:                  Getting involved, for example, in California, we've created a health care climate alliance. It includes the five largest healthcare systems in the state of California that are the largest employers in the state. We've now engaged in policy to begin to Help them accelerate their own transition to low carbon strategies, but also policies that would start to put a price on carbon. Similar in Washington State, we've created an alliance. We're about to launch that in a couple of weeks. We've created a similar alliance in Massachusetts. In other states, we're building clinician advocacy organizations so that groups of doctors and nurses can weigh in at the statewide level, around why these policies are crucial to the health of their patients in the communities they serve.

Jason Jacobs:                Overall, when you look at the carbonization and cleaning up their act, if you will, or I think cleaning up their house, as you said earlier in this discussion, how is the healthcare industry doing overall? Where are they in that transition?

Gary Cohen:                  A few years ago, we created a health care climate challenge to get hospitals and health systems to adopt these three-part strategy of leadership around being resilient, around decarbonizing and around advocacy. We launched it just before the final negotiations in Paris for the Climate Treaty. And so over the last few years, we've now got 200 participating health systems and hospitals that represent 18,000 hospitals across 31 countries. They're racking up a powerful number of climate commitments and commitments toward renewable energy that we've already identified as saving 1.7 million lives and contributing to probably overall 3% initially of the overall footprint of the healthcare sector.

Gary Cohen:                  I mean, we've just done an analysis of the global footprint of the healthcare sector, and we found that healthcare is responsible about 4.5% of global greenhouse gas emissions. And to put it in perspective, that means the emissions of over 500 coal fire power plants per year. So we had some pretty early wins. There's enormous amount of momentum as people are seeing the wildfires and the hurricanes and the flooding, more and more health professionals and systems are realizing that they need to expand their healing mission beyond treating individual patients, and they need to get engaged in this broader healing process that really involves healing the planet.

Jason Jacobs:                I think I know the answer to this next question based on the ground we've covered so far in this discussion, but if one thing could change that would dramatically accelerate the progress of this transition in the healthcare industry, what would that be?

Gary Cohen:                  I got a few answers, not just one. One has to do with this country. This is a policy that we're actually promoting. If hospitals were required to do climate resilience planning, in the same way that they're required to do emergency planning, every hospital in America, every health system in America would start to begin to understand the threats to their infrastructure and to their communities around the climate crisis. And it would get them focused on this broader agenda that they need to adopt. So in this country, that would be a very significant change.

Jason Jacobs:                Required resilience planning?

Gary Cohen:                  Climate resilience planning for their infrastructure and for their communities.

Jason Jacobs:                I've never heard that answer before. But I don't want to stop because you said you have others.

Gary Cohen:                  Another would be that the WHO and the international infrastructure around loans, the world bank loans for health strengthening around the world, UNDP Global Development Program, the WHO assistance to healthcare institutions all around the world, would adopt a climate smart strategy to guide their loans, guide their development, guide their guidance to healthcare systems, do that the whole global multilateral infrastructure would start selling to support this transformation. Because there's billions and billions of dollars, for example, that the World Bank and other multilateral development bank's give to organizations, health systems in middle and low income countries. If they required it to be climate smart, to embed a climate strategy into the health systems, they would have a huge impact. Of course, if we could make the fossil fuel industry pay for their externalized costs-

Jason Jacobs:                That's the answer I thought you were going to give.

Gary Cohen:                  That's also going to change the game all across the planet.

Jason Jacobs:                Two final questions. One is if you had $100 billion and you could allocate it towards anything to maximize this impact on the climate fight, where would you put it and how do you allocate it?

Gary Cohen:                  I would put it in several places. One, I would put it into the legal fight to hold the fossil fuel industry accountable for the damage that it's caused, and for the fact that it's known since the 1970s, what its impact would be but the consciously built a climate of denial and an infrastructure of denial to delay action on climate. So a legal strategy. I would build a global movement, as it's happening already, among young people, among health professionals among, faith-based people, among the business community, among universities to have a robust global society movement for global survival. I would change the financing infrastructure for healthcare so that we're funding prevention, that we're moving from a sick care system to actual health care system that is actually prioritizing preventing disease, rather than treating people once they're sick. There are a few strategies there I would go for.

Jason Jacobs:                My last question is just, and I might have one more after this, we'll see. But the one final question is, I think it's amazing what you've done and what you're doing and it's super important. And it's also different because we need to decarbonize every sector. And so you happen to have picked very substantive, important sector. And that's your area focus, and it's a beast, and it's a hard one. So therefore, you're very focused. And I think that's smart. But I can't help but think that some of these tactics and learnings and stuff could be quite relevant as one would look to other sectors as well. So are there groups like Health Care Without Harm, equivalent type groups for financial services or for insurance or for the energy industry or for automotive or for aviation or for agriculture or for any other sectors besides health care?

Gary Cohen:                  Yeah. I think we see our work is crucial because the healthcare sector is the one sector that has healing as its mission. It has an ethical framework to do no harm. And we've said, what is the hippocratic oath to do no harm mean at this exquisite moment of global crisis. So what we see is that we can move the healthcare sector and it could have a lot of lessons and a knock-on effect in partnering with other sectors. So, in the investment and financial services sector, there's an organization called series that's working to get-

Jason Jacobs:                Based here in Boston.

Gary Cohen:                  Yeah, based in Boston, that's getting them to understand climate risk as fundamental to business risk. There's another organization called Second Nature, also based in Boston, it's working with universities all around the country to get them to adopt energy strategies, clean energy strategies. There's other organizations that are working to decarbonize the agricultural sector. There's organizations focused on the Forest Stewardship sector. There's indigenous groups all around the world that are defending their land from encroachments for timber industry, for the fossil fuel industry. So I think there's a lot of lessons of taking a sector-wide approach, and looking at other sectors and decarbonizing other sectors in a systematic way.

Jason Jacobs:                So do those sector-specific approached organizations collaborate?

Gary Cohen:                  Yeah, we're collaborating more and more when we are working on these statewide policy campaigns. We're partnering with Series. So they're building ... They're bringing the business community and we're bringing the healthcare community. And groups like Second Nature are partnering in many places where they're bringing the universities to the table saying, yeah, we're committing to greenhouse gas reductions, and we're bringing the hospitals to the community ... We're committing to greenhouse gas emissions. So more and more, we're weaving together an integrated movement for climate strategies at the local, state, national and international levels.

Gary Cohen:                  It's going to take an entire global movement to make this change. And I think what we're seeing is the largest movement in human history coming together for survival. And I think that although it's overwhelming, and the threats to the planet are biblical in nature, there's a lot of reason to hope. And hope not because it's just about optimism, but hoping the way that the check poet Vaclav Havel talked about, hope as a sort of orientation of the spirit. A kind of deep seated understanding that what you're doing is right without being necessarily attached to the results of your actions, being committed to do what's right and good and is in alignment with our deepest values.

Jason Jacobs:                And that brings us to what is the last question which you just kind of answered it, but I want to ask it more directly, which is just, are you an optimist that we're going to figure this out?

Gary Cohen:                  I'm a hopeful warrior of the spirit. So I know that the work that I am doing is important to do for the planet, and that as I do this work, I step into a river of justice. And I know that millions of people have come before me and millions of people will come after me, and I'm a vehicle for that larger transformation.

Jason Jacobs:                I want to thank you so much both for coming on the show, but also for all the work that you do. It might not have come through as much as it does for me typically given that I have a sore throat and a sinus infection, but I'm very excited about the work that you're doing and I wish you every success with it.

Gary Cohen:                  Thanks so much, Jason, I wish you success with your podcast series because you're hopefully educating thousands and millions of people about why the climate crisis is so important and how there's so many angles in which to understand it and address it.

Jason Jacobs:                And you're helping that another way then just by doing your work by taking the time to come on the show.

Gary Cohen:                  Thanks, again.

Jason Jacobs:                Hey everyone, Jason here. Thanks again for joining me on My Climate Journey. If you'd like to learn more about the journey, you can visit us at Note, that is .co not .com. Someday we'll get the .com, but right now, .co. You can also find me on Twitter @jjacobs22, where I would encourage you to share your feedback on the episode or suggestions for future guests you'd like to hear. And, before I let you go, if you enjoyed the show, please share an episode with a friend or consider leaving a review on iTunes. The lawyers made say that. Thank you.