Is U.S. health care violated the recent International Court of Justice climate advice? – Healthcare Blog
David Intocaso
In late July, the United Nations International Court of Justice (ICJ) announced its long-awaited highly anticipated climate advisory. The International Court of Justice ruling represents a historical moment in climate accountability.
“Obligation of the State on Climate Change”
In a rare unanimous decision, the ICJ concluded that “a clean, healthy and sustainable environment”, partly enjoying human rights, including the right to life and health. Therefore, the International Court of Justice, including its private participants, has an obligation to ensure that the climate is protected by anthropogenic greenhouse gas emissions (GHGs) and that it can be legally sentenced through other countries, groups and individuals that are victimized or uninjured to be punished.
The 140-page opinion is the result of the 2023 United Nations resolution, which requires the International Court of Justice to propose an advisory opinion to answer two questions: the State’s obligation under international law is to ensure the protection of the climate; and, what are the legal consequences of serious climate harm? In a failed attempt, the U.S. State Department opposed the resolution, believing that the International Court of Justice could only consider applicable climate treaties, such as the 2015 Paris Agreement and the exclusion of other international law rules.
In summary, the International Court of Justice found that states have substantial, urgent and enforceable obligations under the United Nations climate treaty, as well as international laws to prevent significant environmental damage from greenhouse gas emissions, including due to the use of fossil fuels. The courts broadly define the use of fossil fuels as laws, regulatory policies and programs that promote the production and consumption of fossil fuels through leasing, licensing and subsidies.
States must use “all means” to take action, including the adoption of appropriate legal and regulatory measures, the acquisition and analysis of scientific and technical information as well as risk and impact assessments, and the fulfillment of their obligations to cease; and, in good faith, including the obligation to cooperate and cooperate internationally. The ruling also allows legal action to protect future generations. The court rejected the argument that the case-by-case hazards were not possible, suggesting that it is “scientific” to determine the current and historical emissions of each state. Without naming the United States, the International Court of Justice confirms that parties that are not United Nations treaties still must fulfill their equal responsibilities under international law. (Colombia's Sabin Center Climate Change Law Blog examines ICJ comments in detail.)
The contribution of American healthcare to artificial warming
As the International Court of Justice recognizes the inherent link between artificial warming and human rights, the opinion means that the right to health cannot be secured without addressing U.S. health care’s own climate obligations. Meeting these industries poses a significant challenge to the industry for a number of reasons.
U.S. health care greatly contributes to artificial warming. According to Northeastern professor Matthew Eckelman, the industry accounts for the growth of greenhouse gas emissions and currently accounts for 600 million tons of carbon dioxide equivalent (CO2E), accounting for 9-10% of total U.S. emissions and 25% of global healthcare emissions. If U.S. health care is its own country, it may be ranked 9Thsmaller than Saudi Arabia, but more than Germany.
There are two reasons that explain the carbon footprint of U.S. healthcare to a large extent. The industry is huge. Despite providing care to 4% of the world’s population, it formed a $5.3 trillion market last year, accounting for about half of global health care spending. The industry wasted a lot of energy. Despite spending more than $5 billion on energy per year, equivalent to at least 15% of profit, hospitals are significantly inefficient as they continue to consume fossil fuels to generate heat first to produce less efficient electricity compared to renewable resources that directly generate electricity or work needs. Inefficient energy efficiency for the end use can complicate the problem. For example, only a certain number of hospitals are EPA Energy Star certified for energy efficiency. Over the decade ending in 2024, 85% or 1.4% of over 6,000 hospitals have been certified on average.
Regarding state obligations, Congress has not passed legislation or the government enacts regulatory rules to reduce health care emissions. The Centers for Medicare and Medicaid Services (CMS) has failed to finalize a regulation despite the Biden administration’s efforts to “respond to the climate crisis.” Like the 2015 Paris Agreement, the ICJ's opinion emphasizes that climate action “respect” and “promotes” the rights of “children, persons with disabilities and persons in vulnerable situations”. However, policymakers have gone beyond the biggest climate penalty paid by Medicaid children and Medicare seniors – which has become increasingly serious as inventory or supply of carbon dioxide and other greenhouse gases continues to accumulate in the atmosphere. U.S. policymakers also know that as a meta-problem, or the root cause of all other policies, without mitigating healthcare greenhouse gas emissions, they cannot claim that healthcare is improving, or that healthcare delivery does not harm doctors.
As for the industry, clinical healthcare has not yet developed climate-related diagnostic and procedural codes and quality metrics, factors for patient risk adjustments, and factors for paid performance plans. Operationally speaking, the Lancet’s countdown on health and climate change reminds readers of their insignificant progress in stripping fossil fuels. Last November, the now-lost Office of Climate Change and Health Equity was forced to acknowledge that the U.S. Department of Health and Human Services (DHHS) did not know to what extent healthcare organizations only publicly reported their greenhouse gas emissions. Because the National Medical College climate cooperation has made unmeasurable progress in three years, Dr. Don Berwick, a former CMS administrator, was forced to denounce his colleagues in October last year, saying, “The work…has had to be done now, and now no longer later, and now no longer complain about the excuse of liability for mandate, cost and cost and commercial cases and efforts in commercial cases, rather than to make her own rejection. The American Association for Healthcare Trade and Professionals, including the Association for Healthcare Trade and Professionals specialized in hospital care, infectious diseases, pediatrics and public health, has so far neither discussed nor recognized the 2023 ICJ solution, and now, despite knowing, despite knowing, ICJ’s opinion, although more than half of the known human pathogens may be restricted by climate hazards or pathways.
In addition to this, health care in the United States has both contributed and is affected by artificial warming, which means that the industry effectively poses a hazard-treatment-hazard cycle, increasingly exposed to systemic financial risks. In short, if or more likely, when anthropogenic warming or climate rupture, U.S. health care cannot absorb or transfer its own insurance risks, credit markets freeze, health care assets quickly and ruthlessly, and achieve market failure. The U.S. health care industry has become a victim of its own contradictions and a victim of its own moral harm.
Despite the highest legal, moral and political weights of the International Court of Justice, the impact of advisory opinions is uncertain. To be sure, climate-related costs will continue to increase and the ability to scientifically attributive emissions will continue to improve. The ICJ's opinion will affirm the plaintiff's complaints in 3,000 climate cases in more than 60 countries and provide the court with “massive consequences of legal consequences”, from which options include compensation, laws and regulations for abolishing greenhouse gas emissions, and far-sighted measures, including quitting smoking, ensuring non-repetitive and continuous compliance.
David Introcaso is a healthcare research and policy consultant in Washington, D.C.
