{"id":8198,"date":"2025-09-15T05:01:00","date_gmt":"2025-09-15T05:01:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=8198"},"modified":"2025-09-15T05:01:00","modified_gmt":"2025-09-15T05:01:00","slug":"does-american-health-care-violate-the-icjs-recent-climate-advisory-opinion","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=8198","title":{"rendered":"Does American Health Care Violate the ICJ\u2019s Recent Climate Advisory Opinion?"},"content":{"rendered":"
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By DAVID INTROCASO<\/p>\n

In late July the UN International Court of Justice (ICJ) announced its long-awaited and highly-anticipated climate advisory opinion.\u00a0 The ICJ ruling represents an historic moment in climate accountability.<\/p>\n

\u201cObligations of States in Respect of Climate Change\u201d<\/p>\n

In a rare\u00a0unanimous decision<\/a>, the ICJ opinion concluded \u201ca clean, healthy and sustainable environment\u201d is in part a precondition for the enjoyment of human rights including the right to life and the right to health.\u00a0 Consequently, the ICJ ruled states including their private actors are obligated to ensure the climate is protected from anthropogenic greenhouse gas emissions (GHGs) and can be held legally culpable by other harmed or unharmed states, groups and individuals for failing to protect the climate.<\/p>\n

The 140-page opinion is the result of a 2023\u00a0UN resolution<\/a>\u00a0that requested the ICJ produce an advisory opinion answering two questions: what are states\u2019 obligations under international law to ensure protecting the climate; and, what are the legal consequences for causing significant climate harm?\u00a0 In a failed attempt the US State Department opposed the resolution\u00a0arguing<\/a>\u00a0the ICJ can only consider applicable climate treaties such as the 2015 Paris Agreement and to the exclusion of other rules of international law.<\/p>\n

In sum, the ICJ found states have substantive, urgent and enforceable obligations under UN climate treaties \u2013 and international laws to prevent significant harm to the environment from GHG emissions that includes those resulting from fossil fuel use.\u00a0 The court broadly defined fossil fuel use as the adoption of laws, regulatory policies and programs that promote fossil fuel production and consumption via leases, licenses and subsidies.\u00a0<\/p>\n

States must act using \u201call means at their disposal\u201d that includes adopting appropriate legal and regulatory measures, acquiring and analyzing scientific and technological information and risk and impact assessments, meeting a duty of cessation; and, acting in good faith that includes a duty to cooperate and collaborate internationally.\u00a0 The ruling also allows for legal action to protect future generations.\u00a0 The court rejected the argument attributing harm on a case-by-case basis is unachievable stating it is \u201cscientifically possible\u201d to determine each state\u2019s current and historical emissions.\u00a0 Without naming the US, the ICJ affirmed states not party to UN treaties must still meet their equivalent responsibilities under international law.\u00a0 (Columbia\u2019s Sabin Center Climate Change Law\u00a0Blog<\/a>\u00a0has examined at length the ICJ opinion.)<\/p>\n

US Healthcare\u2019s Contribution to Anthropogenic Warming<\/strong><\/strong><\/p>\n

Because the ICJ recognizes an inherent link between anthropogenic warming and human rights, the opinion implies the right to health cannot be secured without addressing US health care\u2019s own climate obligations.\u00a0 Meeting these pose a substantial challenge for the industry for several reasons.<\/p>\n

US health care significantly contributes to anthropogenic warming.\u00a0 Per Northeastern Professor Matthew Eckelman, the industry accounts for a growing amount GHG emissions currently at over 600 million metric tons of carbon dioxide equivalents (CO2e) or\u00a09-10%<\/a>\u00a0of total US emissions and\u00a025%<\/a>\u00a0of global healthcare emissions.\u00a0 If US healthcare was its own country it would likely\u00a0rank 9th<\/a>, less than Saudi Arabia but more than Germany.\u00a0 \u00a0\u00a0\u00a0\u00a0<\/p>\n

Two reasons largely explain US healthcare\u2019s carbon footprint.\u00a0 The industry is immense.\u00a0 Despite providing care for 4% of the world\u2019s population, last year it constituted a\u00a0$5.3 trillion<\/a>\u00a0market or roughly\u00a0half<\/a>\u00a0of total global healthcare spending.\u00a0 The industry wastes an enormous amount of energy.\u00a0 Despite spending over\u00a0$5 billion<\/a>\u00a0annually on energy, equivalent to at least 15% of profits, hospitals are significantly energy inefficient because they continue to consume fossil fuels to\u00a0first generate heat<\/a>\u00a0to produce electricity that is dramatically less efficient than using renewable resources that directly generate electricity or work demand.\u00a0 End-use energy inefficiency compounds the problem.\u00a0 For example, only a\u00a0trivial number<\/a>\u00a0of hospitals are\u00a0EPA Energy Star certified<\/a>\u00a0for energy efficiency.\u00a0 For the ten-year period ending in 2024, 85 or 1.4% of over 6,000 hospitals were on average certified.\u00a0<\/p>\n

<\/span><\/p>\n

Concerning state obligations, the Congressional has yet to pass legislation or an administration promulgate a regulatory rule to mitigate healthcare\u2019s emissions.\u00a0 Despite the Biden administration\u2019s effort to \u201ctackle the climate crisis<\/a>,\u201d the Centers for Medicare and Medicaid Services (CMS) failed to finalize a single regulation.\u00a0 Like the 2015 Paris Agreement, the ICJ opinion emphasizes climate action \u201crespect\u201d and \u201cpromote\u201d the rights of \u201cchildren, persons with disabilities and people in vulnerable situations.\u201d \u00a0Nevertheless, policymakers have looked past the fact Medicaid children and Medicare seniors pay the greatest climate penalty \u2013 that becomes increasingly severe as the stock or supply of carbon dioxide and other GHGs continue to accumulate in the atmosphere.\u00a0 US policymakers also know that as a meta-problem, or a root cause of all others, absent mitigating healthcare\u2019s GHG emissions they cannot claim healthcare is improving or that healthcare delivery does not impose iatrogenic harm. \u00a0\u00a0\u00a0<\/p>\n

As for the industry, clinically healthcare has yet to develop climate-related diagnostic and procedural codes and quality measures, factor in patient risk adjustment and in pay-for-performance programming.\u00a0 Operationally,\u00a0The Lancet\u2019s\u00a0Countdown on Health and Climate Change<\/a>\u00a0annually reminds readers healthcare has made trivial progress in divesting in fossil fuels. Last November<\/a>\u00a0the now-defunct Office of Climate Change and Health Equity was forced to admit the US Department of Health and Human Services (DHHS) did not know to what extent health care organizations were simply publicly reporting their GHG emissions.\u00a0 Because the National Academy of Medicine\u00a0Climate Collaborative<\/a>\u00a0made no measurable progress over three years, last October former CMS Administrator Dr. Don Berwick felt forced to reprimand his colleagues\u00a0stating<\/a>, \u201cstuff . . . needs to be done now, not later, now, stop complaining the excuses about mandates and cost and business case won\u2019t do the job, nature is unforgiving, she does not care . . . the time for resistance, the time for complaining, it\u2019s over.\u201d\u00a0 US health care trade and professional associations including those dedicated to hospital care, infectious diseases, pediatrics and public health have to date neither discussed nor recognized the 2023 ICJ resolution and now the ICJ opinion despite knowing, for example,\u00a0well over half of known human pathogens<\/a>\u00a0can be aggravated by climate hazards or pathways.<\/p>\n

Add to this, that US health care both contributes to and is impacted by anthropogenic warming means the industry effectively constitutes a harm \u2013 treat \u2013 harm cycle that increasingly exposes it to systemic financial risk.\u00a0 Explained simply, if or more likely when anthropogenic warming or climate breakdown leaves US health care unable to absorb or transfer its own insurance risk, credit markets freeze, healthcare assets reprice rapidly and ruthlessly and market failure is achieved.\u00a0 The US health care industry becomes victim to its own contradiction, victim of its own moral hazard. \u00a0\u00a0\u00a0\u00a0<\/p>\n

Though the ICJ carries the highest legal, moral and political weight what effect the advisory opinion will have is uncertain.\u00a0 What is certain is that\u00a0climate-related costs<\/a>\u00a0will continue to increase and the ability to\u00a0scientifically attribute emissions<\/a>\u00a0will continue to improve. The ICJ opinion will affirm plaintiffs\u2019 complaints in\u00a03,000 current climate cases in over 60 countries<\/a>\u00a0and provide courts a \u201cpanoply of legal consequences\u201d from which to choose including reparations, repeal of GHG emission-enabling laws and regulations and forward-looking measures including cessation, guaranteed non-repetition\u00a0and ongoing\u00a0compliance.<\/p>\n

David Introcaso is a healthcare research and policy consultant based in Washington, D.C<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By DAVID INTROCASO In late July the UN International Court of Justice (ICJ) announced its long-awaited and highly-anticipated climate advisory opinion.\u00a0 The ICJ ruling represents an historic moment in climate accountability. \u201cObligations of States in Respect of Climate Change\u201d In a rare\u00a0unanimous decision, the ICJ opinion concluded \u201ca clean, healthy and sustainable environment\u201d is in…<\/p>\n","protected":false},"author":0,"featured_media":8197,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-8198","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8198"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8198"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8198\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/8197"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8198"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8198"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}