By W. Kyle Resurreccion
The single biggest health threat to humanity is climate change.[1] In 2018, the 24th Conference of Parties (COP 24) to the United Nations Framework Convention on Climate Change (UNFCCC) reported that health-damaging air pollution produced by the burning of fossil fuels kills over seven million people, making it the second leading cause of deaths from non-infectious diseases globally.[2] Climate change also leads to increased occurrences of extreme weather events; for example, between 2000 and 2016, the number of vulnerable people exposed to heat waves increased to 125 million.[3] The worsening climate also affects access, quality, and cost of healthcare.[4] In the United States, almost three-quarters of 158 hospital evacuations between 2000 and 2017 were due to climate-sensitive events such as hurricanes and wildfires, and over half required evacuating more than 100 patients.[5] Other factors essential to health are also worsened such as the spread of infectious diseases, water and sanitation infrastructures, and food insecurity and malnutrition.[6]
The future does not look any brighter. The World Health Organization (WHO) estimates that climate change will cause approximately 250,000 more deaths annually between 2030 and 2050 and threatens to undo the last fifty years of progress in development, global health, and poverty reduction.[7] Importantly, the people who will be harmed first and worst – people in low-income and disadvantaged countries and communities – contribute the least to its causes.[8]
The inherent disconnection between regimes that address climate change and human rights, like the right to health, adds to the difficulty of finding effective solutions.[9] While international climate change regimes focus mainly on preventing and mitigating environmental harm, they do not directly address a country’s responsibility to protect human rights.[10] One example can be found in the Kyoto Protocol of 1997, an international treaty that obligated countries to reduce greenhouse gas emissions but did not clearly state its health-related goals nor impose penalties on countries for human rights injuries due to climate change.[11] The dynamic nature of climate change and the web of legal and socioeconomic determinants across jurisdictions make attempts at unifying both regimes difficult.[12]
An important and increasingly necessary part of the solution may lie in the emerging use of health informatics.[13] Health informatics is the practice of using technological approaches to work with health data, information, and knowledge to improve health and healthcare.[14] Traditionally, health informatics has been used to inform developments in physically and politically established settings such as hospitals, primary care clinics, and biomedical research organizations.[15] For example, data and information provided by this approach enhanced our ability to respond, recover, and prepare for pandemics such as COVID-19.[16] But in recent years, this practice has been increasingly used to study environmental determinants of health and the human health aspects of climate change.[17] .[18]
Questions regarding the appropriate application of health informatics abound. A broad and important consideration is how such technologies can be applied ethically.[19] One small part of this issue asks how this approach may affect an individual’s right to privacy.[20] For example, in the United States, the federal Health Insurance Portability and Accountability Act (HIPAA) obligates various healthcare industry stakeholders to protect patients’ health information. Still, that law was passed in the late 20th century with no major updates in the past 20 years, leaving substantial gaps in protecting privacy in the advent of digital health.[21] Another consideration asks how to implement health informatics in developing countries with limited resources, infrastructure, and trained personnel.[22] There, the lack of legal regimes to address these novel technologies may, on the one hand, lead to an incentive to work more freely, but on the other hand, delay implementation due to lack of legal guidance.[23]
Change is fast approaching, however. In January 2022, the U.S. Department of Health and Human Services announced the Trusted Exchange Framework and Common Agreement (TEFCA), an initiative to establish a standard for interoperability between health information networks across the country to help facilitate the exchange of information.[24] Although still in its infancy and lacking specific climate change-oriented goals, projects such as TEFCA serve as a model for how more developed countries may embrace health informatics to protect the right to health in general and provide useful second-hand information for how health is affected by the climate.[25] A more direct and localized approach lies in creating frameworks such as the Green-MIssion, published in a 2022 study, that actively combines hospital information management theory with environmental sciences for application in healthcare settings.[26]
The use of health informatics brings the promise of novel and innovative solutions to address current and future threats that endanger one of the oldest widely recognized human rights. This promise comes with its own challenges, one that legal regimes worldwide must be prepared to tackle. As such, large and small jurisdictions must weigh the benefits and dangers of this approach using scientifically and ethically backed regimes that acknowledge the undeniable connection between one’s health and the planet’s health.
[1] World Health Organization [WHO], Climate Change and Health (Oct. 30, 2021), https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health.
[2] 24th Conference of Parties to the United Nations Framework Convention on Climate Change, COP24 Special Report: Health and Climate Change, at 16 (Dec. 3, 2018) [hereinafter COP24 Special Report], https://www.who.int/publications/i/item/cop24-special-report-health-climate-change.
[3] Id. at 20, 23.
[4] Renee N. Salas et al., Adding a Climate Lens to Health Policy in the United States, 39 Health Affs., no. 12, Dec. 2020, at 2063, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01352.
[5] Id. at 2064.
[6] COP24 Special Report, supra note 2, at 20.
[7] WHO, supra note 1.
[8] Id.
[9] Chuan-Feng Wu, Challenges to Protecting the Right to Health Under the Climate Change Regime, 23 Health and Hum. Rts. J., no. 2, Dec. 2021, at 121, 122-23, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694293/pdf/hhr-23-121.pdf.
[10] Id.
[11] Id.
[12] Id. at 129.
[13] Kathleen Gray, Climate Change, Human Health, and Health Informatics: A New View of Connected and Sustainable Digital Health, 4 Frontiers in Digit. Health 1 (2022), https://www.frontiersin.org/articles/10.3389/fdgth.2022.869721/full.
[14] Id. at 1
[15] Id. at 2
[16] Brian E. Dixon et al., Managing Pandemics with Health Informatics, IMIA Y.B. of Med. Informatics, 2021, at 69, 71, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416201/pdf/10-1055-s-0041-1726504.pdf.
[17] Gray, supra note 13, at 2.
[18] Id.
[19] Kenneth W. Goodman, Ethics in Health Informatics, IMIA Y.B. of Med. Informatics, 2020, at 26, https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1701966.pdf.
[20] Kim Theodus et al., Health Information Privacy Laws in the Digital Ages: HIPAA Doesn’t Apply, 18 Persps. in Health Info. Mgmt., no. 1l, Dec. 7 2020, at 1, https://pubmed.ncbi.nlm.nih.gov/33633522/.
[21] Id. at 7.
[22] Daniel Luna et al., Health Informatics in Developing Countries: Going Beyond Pilot Practices to Sustainable Implementations: A Review of Current Challenges, 20 Healthcare Informatics Rsch., no. 1, at 3, https://pubmed.ncbi.nlm.nih.gov/24627813/.
[23] Id. at 5
[24] U.S. Dep’t of Health and Hum. Servs., Trusted Exchange Framework and Common Agreement (TEFCA), HealthIT.gov (Feb. 8, 2023), https://www.healthit.gov/topic/interoperability/policy/trusted-exchange-framework-and-common-agreement-tefca.
[25] U.S. Dep’t of Health and Hum. Servs., Off. of the Nat’l Coordinator for Health Info. Tech, Trusted Exchange Framework (TEF): Principles for Trusted Exchange (2022), https://www.healthit.gov/sites/default/files/page/2022-01/Trusted_Exchange_Framework_0122.pdf.
[26] Marieke E. Sijm-Eeken et al, Medical Informatics and Climate Change: A Framework for Modeling Green Healthcare Solutions, 29 J. of the Am. Med. Informatics Ass’n, no. 12, Dec. 2022, at 2083, https://academic.oup.com/jamia/article/29/12/2083/6758454.
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