The Health Management Academy

Episode 8

Why Healthcare Should Lead on Climate Change Action

Featuring Neal Hogan

Episode Description

In this episode, Neal Hogan, founder and chairman of Healthcare Climate ActionWorks, joins Renee at The Table. Neal shares advice for organizations looking to take the first step, the forces that can help health systems move the needle more quickly, and Neal’s belief that the climate crisis is in fact a healthcare crisis.

About Our Guest

Neal Hogan, Founder & Chairman, Healthcare Climate ActionWorks

Neal was first introduced to the problems of climate change during the 1980s when he was studying and teaching at Harvard University’s Department of the History of Science. For the last ten years, Neal has worked with and other organizations in his home state of New Hampshire to move the state on environmental policy. Last year, he founded Healthcare Climate ActionWorks, which is focused on helping health systems achieve their environmental goals effectively, and in a way that lowers costs, increases revenue, improves the bond rating and creates access to ESG capital.


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Renee DeSilva 0:07

Welcome back to The Academy Table. I’m Renee DeSilva, CEO of The Academy and your host. This week I had the pleasure of speaking with Neal Hogan. Neal is a leader on healthcare, climate change and sustainability. Last year, Neal founded Healthcare Climate ActionWorks, a national organization that partners with health systems to understand their role in fighting climate change and to help the industry reach net zero greenhouse gas emissions. Neal is also an author, “Leading on Climate Change: How Healthcare Leaders Stop Global Warming.”

I learned a ton from my time with Neal. And reflecting now, we should feel empowered that our industry can and should lead on this issue. I also left the conversation going a bit overwhelmed at the complex challenges and how much progress we need to make in a relatively short period of time. Here are my takeaways from the conversation.

First, Neal is encyclopedic on this issue. Pay attention to his recommendations for organizations looking to take the first step. It starts with the basics, educating the C suite, the board and other decision makers. And then a baseline understanding on current emissions and energy use. If you’re like me and knew very little, he does a very good job of walking us through key terms, Net Zero, scopes of emissions, ESG scores – among many, many other terms. So listen and learn from Neal on that.

Next, I liked Neal’s assessment of the external and Government forces that can help health systems move the needle more quickly. He’s a fan of climate risk scores, and SEC mandating emission disclosures. But at the other end of the spectrum, thinks that HHS and CMS should treat climate action the way that we did quality mandate and incentivize performance to drive faster progress, and loves that analogy.

And finally, the core of Neal’s work is his belief that the climate crisis is in fact a healthcare crisis. As he said, there’s a true moral imperative here. And inaction is not an option. I know that each day our members work to create healthier communities and patients. And it’s clear to me that climate change climate action ought to be a part of our commitment. So with that, join me at the Table.

Good morning, Neal. Welcome to the table.

Neal Hogan 2:43
Good morning, Renee. It’s a pleasure to be here.

Renee DeSilva 2:46
It is. So you and I have had the pleasure of knowing you now for probably more than 20 years, and you’ve had such a broad healthcare, career strategy, work consulting, so we get a number of executive roles. But most recently, you co-founded the Healthcare Climate ActionWorks. Tell me a little bit about that organization.

Neal Hogan 3:04
Sure, well, the Healthcare Climate ActionWorks really is ultimately designed to help healthcare organizations understand the challenges of climate change, and think through their role in dealing with climate change, reducing their emissions, and ultimately to give them practices to engage with and solve that problem. Health systems have gotten started on this work, there is sort of a leading group. They’re always incident, every endeavor that we see in healthcare for the last 30 years, there are 10 or 20 that gets started. They break a lot of ground, and then you have 20, or 30, fast followers. And then you have the 400 other health systems that start to get lessons from those organizations. So we’re trying to make that happen a little bit faster.

Renee DeSilva 3:53
That’s great. So in addition to your day job, you found some time across the last couple of years to write a book on this topic. And so I wonder just how did you become interested in sustainability and climate change? Where did that interest come from?

Neal Hogan 4:07
So I have a Ph.D. in the history of science from Harvard. And when you’re being prepared in a Ph.D. program party where you’re being prepared for research and writing. And the other part is to be prepared for going to some college university and teaching it when you’re limiting the history of somebody, they recognize that you’re probably going to end up somewhere and be the history of science versus have to teach the history of nuclear physics and the history of medicine, history of environmental science. So you need to take courses across a pretty broad array of disciplines. And that’s where I really was first introduced the discipline of environmental science. So that was back in the 80s. And it really was pre big concerns about climate change that we do publicly in the book. I talk about how this goes back to the early 20th century. But that’s where I first got introduced to it and I tracked Do that for quite a long time didn’t make it a central part of my life until about 20 years ago where I really started to become concerned. And my friends who had been in that program started talking to me more about it. And I started to do all the things that you do. So I’m running houses completely powered by the solar field that I built out behind it. And we’ve got electric cars, electric heat pumps, and all that stuff. But several years ago, I have a business partner, Jonathan Fullerton, and we were talking about things we might like to do next, we were sort of serial entrepreneurs. And he suggested that get into climate change and work on climate change. And I said, Well, I’ve kind of separated my work in climate change, where I’ve been involved in three, which is a sort of action group on politics and climate change, or the New Hampshire healthcare workers for climate action, from my healthcare, business life. And he said, I think you’ve really got to look at it from the perspective of the business impact of climate change on health systems. And that really started the whole journey. I started working on the book before we launched the company, and really learned that healthcare is a little bit behind on this one and two, I can’t imagine industry that should be more focused on this than healthcare because this I’d say the climate crisis is a healthcare crisis.

So let’s stay on that for a moment. Why is the climate crisis a healthcare crisis?

Yeah, I go back to the beginning of this. It’s just we have fantastic lives because we have access to energy. I just was reading a book last week, Vaclav Smil has a new book out called how the world really works. And he calculates the benefits we get from the energy we’ve developed across the last 200 years. And every person in the US, because of the energy we have, we can throw food in a microwave chop on our car and goes to the place that fly across the country. We have the equivalent of the services of a staff that’s larger than Louis the 14th at the Iona Versailles. So I’m energy has been fantastic for us. The problem is most of our energy, the vast majority comes from burning stuff. So oil, coal, natural gas burning, that step does two things. One, it creates pollution, which is the little particles of junk that you see in the air, and the other it creates carbon dioxide or co2, well, those particles of junk smaller than 2.5 microns, they get in our lungs in our bloodstream, and the increased morbidity and mortality for cardiovascular and pulmonary conditions even caused brain damage, and are estimated to kill about 8 million people every year, including 100,000 in the United States. So right now, forget about climate change, just burning that stuff is killing more Americans than medical errors do. So we shouldn’t have a big concern about that. And then we get to the co2 part with climate change. I think everybody knows, and we read about it every day, more fires, more drought more heat up right now you’re probably seeing stories about Indian Pakistan, seeing the impact of more heat than humans can’t survive above a wet bulb temperature of 95 degrees, that’s when you have 100% humidity and 95-degree weather, you will just die. There’s no way around it unless you can get into air conditioning, and only 10% of Indians have air conditioning. And it’s approaching a wet bulb temperature at 95. So you’re starting to see weaker people who can’t get to air conditioning die from that. And we saw that in Chicago a few years ago. So that’s why I think it’s a healthcare crisis.

Renee DeSilva 8:27
You know what my next question was gonna be. When you frame it that way, certainly, there’s also maybe I’ll call it a moral imperative, just given the toll that it takes on lives and on people. But let’s also talk through how have you seen organizations frame up the business case for taking the steps required to move forward on this issue?

Neal Hogan 8:49
Yeah, one of the things I really was interested in when I started to do research on this is— I hadn’t really thought of is very political, and I didn’t really want to wait into it because it’s a very political issue, and it’s very divisive. But then I started to read more about business organizations and the Business Roundtable, which if you’re familiar, that business roundtable is not a far-left group of street huggers, it issued a statement on climate change, that said, unchecked climate change poses significant environmental, economic, public health and security threats to countries around the world, including the US. And I started to realize there is an entire business movement to address climate issues. And there are two big problems for companies including health services. One is mitigation, that’s trying to figure out how we continue to lead the fantastic lives, we lead and have the fantastic things that we have, but to do that with renewable energy rather than burning fossil fuels. And the other is adaptation, which is we’ve already increased one degrees. There’s a study that just came out last week, there’s a 50% chance within the next five years we’re gonna get to one point I have degrees, which we’re trying to prevent happening by the end of the century, we’re moving up pretty fast, and things are going to change and 10 companies deal with that. So there’s a huge movement among the fortune 500 companies, among investors in Fortune 500 companies and so on, to figure out a way to reduce their emissions, and to reduce their risk from the impacts of climate change.

Renee DeSilva 10:25
There’s a lot of vocabulary and nomenclature that is thrown around, but I think it’s just worth having—I’m just setting some definition—so when many companies have made either carbon neutral or net zero commitments, what does that mean?

Neal Hogan 10:39
Yeah, I think that’s a great question, Renee. And that is one of the things I’ve learned in the last year, talking to health systems. There are a couple of dozen health systems that have sustainability directors, and those people know, more than I do. I mean, they know it in and out. But then you have boards and executive teams and health systems. And when you speak to boards, to the executive teams, they don’t know a lot of sort of fundamental things. And I don’t expect they should yet I mean, I think they really, this is a time to start getting educated on it. So net zero is when a really was originally gonna globally, the globe has to get to net zero by 2050. And that meant that we had to stop burning coal, oil, and gas. But there would probably be a few things that we couldn’t do, and keep the great lifestyles we have unless we burned coal, oil and gas, they’d have to be a couple of things we’d be stuck with maybe making steel, it’s one of them. And so in that case, we’d have to offset it’s another one of these definitions or buy credits to offset the emissions from that oil, coal or gas, you’re using them to make that steel. And you do that by taking carbon out of the atmosphere at the same rate that you were putting it in. You can do things like plant trees is one of them, you can change the way you tell soil, you can build farms to grow kelp in the ocean absorbs carbon. So you that zero for a company has come to me in that as well. If there are things we can’t get to zero, we’ll offset it by doing other activities that take carbon out of the atmosphere.

Renee DeSilva 12:21
Okay, that’s really helpful. Thank you.

Neal Hogan 12:23
And if you want one or two other definitions, I think it’d be really helpful for this conversation. So one would be ESG. I think a lot of people are familiar with this. Now, this is environmental, social, and governance, investing, the amount of money invested into ESG, has increased tenfold, from 2018 to 2020. And last year, it doubled again, about $120 billion went into sustainable investments last year. That’s double what 2020 was about a third of all assets have sustainable investments. So investors are saying, we are looking at how companies deal with social issues. Do they have a diverse board, but very importantly, are they accounting for and lowering their emissions? So ESG is a driving force on the business. And then the other thing, I think, concrete definition, so we’ve done net zero, and we’ve done ESG is scopes of emissions. So when you do account for your emissions, there are three scopes that you have to think about. The first is what comes out of your own smokestack. So for a health system, anesthetic gases, for example, are warming the atmosphere. Health Systems usually burn natural gas to do their heating and cooling of their buildings. So that’s scope one and their transport things like that. scope two is where does your electricity come from? So if you’re getting your electricity from coal-fired plant, you have very high emissions if it’s all solar wind yet zero emissions. And then scope three is your entire supply chain, in Downstream use of your product. scope three for just about every company is 80% of total emissions, it is much more and our friend and chess Rhodes grist actually did a great infographic recheck some research that was done by nail showing for a health system where they stand on these different scopes.

Renee DeSilva 14:18
And is scope three generally the hardest to get to zero on this given that some of that is not necessary directly within your control?

Neal Hogan 14:26
Absolutely. So Kaiser Permanente no I would say is the leader in this, which has gotten to net zero and scope one and scope two built two giant solar farms, two giant wind farms, but solar and many many of their buildings has built a zero emissions medical office building. They have not even laid out their goal for scope three yet because it is incredibly complicated and difficult and they want to be careful to not put out a goal I can reach so they’re still in the research and instead what that goal should be.

Renee DeSilva 14:59
Fascinating. So you mentioned Kaiser Permanente as an exemplar on the health care side. Are there a lot of industry organizations that come to mind that are set apart and their commitment in progress on this front?

Neal Hogan 15:13
Yeah, there were so many when I wrote the book— I would say about 80% of Fortune 500 companies are engaged in emissions reductions of some level at this point. And I, I focused on four just to take sort of emblematic things, and one that comes to mind very quickly for people is Patagonia, Patagonia has made the entire environmental issues central to its business model, it attracts people who are outdoorsy, and it wants to make sure that people believe in that honeymoon, yes, mission statement, is actually one sentence, which is we’re in the business to save our home planet. Definitely, it was our full touch, that’s pretty clear and powerful. And they have value statements that have things like conduct operations causing no unnecessary harm. So they made a mission commitment to this, but then I look at other sort of parts of the postal IKEA, they realized they’re very large, complex organization, 1,000s of different components, that they sell a very long supply chain process, they have stores, and they relate to they’re gonna get up to make this part of every leaders job. And so instead of just having the director of sustainability, they have a Sustainability Council, which is essentially all of their executive leaders. And that looks at metrics and see, are they achieving what they’ve said they were achieved. And then ani wells, the third one in the book that I talk about, they actually have a fantastic system for tracking their projects. So they have gotten to 85% of the way of reducing your emissions to zero. That took 5700 discrete projects. And they started about a tight, loose, tight approach where they sent a metric, and let you go out and figure out how to solve it as your team that understands the local problem. And then it come back, say did you achieve that metric. And then the last one I talk about is Disney because they are very, very thorough about their purchase of credits, or offsets. There’s a lot of greenwashing that goes on, when people buy their offsets that it looks like they’re doing something. But if you can get deeper into the forest they planted, it really is going to die next year, or it doesn’t really remove carbon from the atmosphere with everything done. And Disney is being really careful about buying excellent credits. But I couldn’t looked at hundreds of companies. And I think out of industry, we are lucky. And healthcare, we have a lot of great examples of ways to get at this.

Renee DeSilva 17:44
It’s fascinating. As you were talking through some of these, it’s these examples where it’s it’s probably been decades of effort, right, that that start to culminate, I wonder for maybe organizations that are earlier stage, how do you think about advising on where to start, maybe hit that both from the action practice, but also just what’s the right way to think about governance and decision making around all these discrete initiatives?

Neal Hogan 18:10
Yeah, I’m really be a broken record when people talk to me about this, and I’m hoping I don’t turn into the broken record today, which is, I think there’s so much education, that’s gotta be done. And it’s taken me a lot of education to get to my understanding of this where I am now. I mean, it’s an unbelievably complicated product process, if and when you think about what I said in the beginning, in our whole life search, our whole lives are built upon fossil fuel energy, everything we do. And to transition out of that is incredibly complicated. And just the things like we talked about earlier definition. So I think, number one, you gotta get your board and your executive team to get a little deeper into this and understand what’s going on and get an understanding how many other companies are engaged in this, that this has passed the political argument. And it’s really now looking at business solutions for that. So it’d be number one on one thing, and then second, companies have to find their baseline, what are they emitting? And this sounds so simple. But when you talk to any organization, any large health system, this is incredibly complicated. Here’s one of them difficulties. Most large health systems who might own hundreds of buildings do not know their rolled-up electricity use, right? That’s not that important. They have divisions in the divisions have PNLs, and that division has a medical office building and they know about their electricity there. But we don’t compare that to the hospital. Rolling that up can actually take two years to just getting started to find your baseline and I don’t think you want to do I think you want to do things in parallel, but that’s one that you really got to get started on. And then the biggest thing you can do is any organization any individual do is understand where your electricity comes from, and transition that to a renewable source. So Intermountain Healthcare just recently partnered with the utility in their states and said, We want you to go build renewable generation, and we will guarantee we will buy all those electrons from you. And that’s a huge step that can eliminate their largest emissions. Aside from scope three.

Renee DeSilva 20:30
Really interesting. As you’re talking, I’m also aware of external forces that are better at play that are sort of converging on putting greater executive attention on it. And I know that you’re tracking all of this. So last year, Fitch Ratings established a climate risk score. In March, the SEC opened comments on mandating climate and emissions-related disclosures, think HHS has a voluntary climate change pledge for hospitals? What’s your general impression of all of these actions? And is it sufficient to move us as quickly as we need to move?

Neal Hogan 20:56
Since I’ve become immersed in this, I don’t think there is something that’s quick as not saying we need to move back to that I cannot press on people that once you start to get further educated about this, you start to really realize we are so far behind. And we have a lot to do. So for example, if you just went with the IPCC the UN’s organization that’s been working on this for 25 years, they we put about 50 billion tonnes of carbon dioxide equivalent into the atmosphere every year, we’ve got to go to zero. They say that, if we go 400 billion more tonnes, we will exceed two degrees. And remember, the typical temperature of the Earth is about 13 degrees centigrade. So two degrees increase is about 15%. Increase, that’s a lot of extra heat. So 400 billion tons. Well, that’s delete eight years of our current rate of emissions. So we’re not going to make that. Right. So we’ve got a big problem, we’re going to move faster. So what do I think about those different things you notice and so Fitch says climate risk school scores are fantastic Fitch Standard Poor’s, Moody’s, they’ve all acquired companies that can more effectively evaluate the accounting of emissions and more effectively evaluate the risk. So this has to do with that mitigation and adaptation, they want to be careful about investing in a company or reading a company that is, in a flooding area, or an area of sea level rise or an area of lots of fires. That’s the adaptation part. So that’s the risk. So that’s that’s their klenner risk score. The SEC, I think this is the most important thing that will happen in the next few years is when the SEC standardize how we account for emissions, that is going to be a bellwether for the entire world, because then every company will use the same format. So if you follow, let’s say, Apple, and you look at Apple, which is trying to do a really good job of accounting for their emissions, if you go year to year through their sustainability reports, there’s a wide variation from year to year, what they think their emissions are because they keep adapting their accounting because they’re trying to be honest about it. But there is no standard. So they keep on adjusting to be more honest. So when the SEC does, I think there’s nothing more important, it’s going to be the battle of the century, when they determine what the accounting standard is, it’s just think of a company that’s going to be evaluated will be Exxon Mobil, or BP or shell. And they’re gonna be accountable for scope three, which includes, you want to like burning that gas in our cars. So they’re going to be very aggressive on not wanting standards to be too tough. And on the other hand, there’s gonna be a bunch of people trying to push it to be tougher itself. Those are very important. The climate pledge from the Department of Health and Human Services, I was very disappointed in to be honest. We have an Office of Climate and Social Equity, and the thing that’s come out of them is could you all volunteer to do this? We need CMS to do what it did on quality in our lifetimes. We used to have no metrics on quality, then the first metric was aspirin at MI. And for those of you who were in the industry, like I was back then, about 60% of patients got an aspirin at MI when they first tested for that metric. The moment that they measured it and gave an incentive to hospitals to change, it went to 95% within the next few years. We need CMS to do the same thing. We need them to say, here’s the standard. Here’s our expectation. And here’s the incentive because the places that want to volunteer to do this have already volunteered. They’re not being driven by CMS.

Renee DeSilva 24:50
So interesting. Well, let’s zoom in a bit. So one of the roles that you play as you serve on a board for a large health system And so I wonder maybe just reflecting on that experience, you also do a lot of advising to boards and CEOs. So what is your message? I know you said the importance of boards being activated around it. But do you have thoughts on how best to start to engage in that conversation, you just start with education and level setting and then get into what ought to be prioritized. But how do you advise on how do you advise boards to lead on climate action?

Neal Hogan 25:23
That’s a great question. First, let me say I’ve been working with board since 1996, in my first board retreat, where I led a board retreat for board then, and I’ve done hundreds of those sets, and I love to work with boards. And I’m on the board of Integris health in Oklahoma. And on that board for six years now, I think, I tell people, it’s the best professional experience of my lifetime, because the people on that board are so dedicated to the mission, spend so much time working to make sure our finances are secure, that we have excellent quality, and so on. And it’s just an honor to be on that board with those folks. And we have a great leader in Tim person, our CEO. And so I feel for boards because I’ve worked with the board for about 30 years and there’s always a crisis in health care. And right now, we have a really severe crisis. So our recruitment, retention issues are through the roof, which means we have very high demands for salary increases, which means our margins are generally slimmer, under incredible pressure. Not to mention, Everyone is exhausted from a couple of years of dealing with a pandemic. So I think there’s just an enormous amount of pressure, and I feel a little bad being the guy who’s out there saying, Yeah, but we really have to work on emissions reduction and work on climate change, because there’s a whole business approach to this, that we can do this in a way that’s good for us. So the first thing I think we’re gonna do is getting into the idea of getting educated about this and learning about this, I worry a little bit that we are still in the hangover of this being a political issue. And I’ve worry a little bit that if I’m the CEO of a health system, is this something I want to bring up? I think it’s gonna get easier and easier for CEOs to bring them up. As you know, investors drive this issue for bonds. You mentioned Fitch and I mentioned standard versus Moody’s coming down the road, I think as it becomes more of a bond issue and a bond rating issue that will help I think, if CMS pushes that will help. But I also worry that if we wait for all that to happen, we are getting way too far behind. As I said, it takes a few years to even gear up and ramp up. So I am hoping that my work, the book will make people feel less threatened about it. It’s focused specifically on health systems, I focused explicitly on the business case while you do this, and I’m hoping that our educational programs we can do, and I’m hoping things like this, I’ve told everybody what are the scary parts of climate change is we actually after we get done stopping emissions, we’re gonna have to take about a trillion tons of carbon out of the atmosphere to get that temperature back down. And so I tell everybody, we’re all on to trillion tons. And, Renee, I’ve just inducted you with the team tons on this. Any organization that’s working on this, I want to work with them. And I want to help them get to that next level.

Renee DeSilva 28:12
Yeah, I think it’s a great conversation to have. It comes up in some of our so as you now at the Academy, where we’re pulling together executives quite regularly. And I think people want to have the conversation, it comes up in some of our content calls, we’ve not always really had the maybe framework or right way to have it. But I’m glad that you and I are having this conversation because no good no good deed will go unpunished. Hopefully, you’ll come and share this message with our group’s live at some point in the next couple of months because I do thinks it’s an appetite.

Neal Hogan 28:40
I’ve been so lucky working with the Academy because I’ve actually presented to the academy over the years and for the last six years integrity as a member we’ve gone to the trustee regains and they are a great opportunity for education. And for boards in particular, the opportunity to interact with other boards, you just boards, unlike executives are not going out. I mean, I’m going out like you do every day to lots of different programs. And I’m thinking about healthcare all the time, not learning about healthcare all the time. But Mike fellow incredibly smart, mission-driven, capable ordain members are running their own businesses. And so they, when they get an opportunity to go to academy program, they get a chance to talk to board members of other health systems. And it’s very powerful, they come back and talk about it. And after every meeting, we were talking to the guys at Scott and White or we were talking to the guys at Providence. And we’ve learned this and it’s a very powerful way and so having the academy evolved to be part of a few trillion tonnes I think it’s a big forward movement for the effort.

Renee DeSilva 29:45
So let me take us a little bit of a different direction, more of a curiosity for me: Is this the first book that you’ve written?

Neal Hogan 29:51
No, I wrote a book coming out of graduate school on the history of medical malpractice and I strongly urge no one to read It has a wonderful impact in that no one had written a history of medical malpractice in the 20th century before. And so wonderfully, I have to be cited by any really good historian who’s writing a quality book about law and medicine interacting. But it was an early book and the Advisory Board, having spent 15 years thinking about how to get message across the people on the fat in that book and realize, man, I did not get that message out. And then it Britain a lot of white papers. In fact, you had told Leon recently, and Tom Lee, the first white paper I wrote, for BBC advisors, I ran into Tom Lee, who I didn’t know at the time, actually. And he pulled me aside and gave me this very nice compliment about the white paper. And when he left, and I just thought this again, when I was listening to your podcast, I just thought that guy was so nice to even remember that he read my piece, and then to comment to me about it. And in the years since knowing Tom Lee better and better over the years, everyone I talked to tells me a similar story. And I’m still engaged with him. And he’s just been such a great guy.

Renee DeSilva 31:14
He is. My question for you on the book side of things would be if you had a single piece of advice for folks listening, who may think they have a book in them, how does one even start the process of getting their own story drafted?

Neal Hogan 31:27
Wow, interesting question. I started reading a quarter of articles and information. So I have a giant file of digital information that I have multiple files within and so I can figure it out. It’s so as I started to think about my book, I started to look at that information that I had, and look through it, and think through the possibility and then I literally just sat down and wrote out what did I think the seven chapters should be, or eight chapters, you guys need seven chapters. And I just thought, I gotta explain it’s a health crisis, I’m gonna have to give people information about the climate, like understand some climate science, because if they don’t totally buy into this, I want them to just literally and it’s a very easy scientific issue to understand. Then I want to talk about how other businesses are being pressured to do this. And the whole thing we were talking about, about the FCC and the ESG investing, and then I wanted them to talk about how they take climate action. And then I moved into a roadmap for health systems to take climate action. So was a pretty easy way to lay it out. And then I took all the articles I had completed into there. And then I thought through what’s the argument I want to make? And that concept is pretty basic for writing a book or writing a white paper. The trick is then sitting down and actually doing it to doing it. Yeah. Yeah, the first person that I acknowledge in the book is my wonderful wife who I, in the acknowledgments, I promise that I will not talk about climate change until after she’s had her first cup of coffee. Because she had to suffer through getting up in the morning, higher, you’ve been up writing and then becoming down. And now it’s, that’s terrible things happening. And so you just have to kind of grind it out. And that is not fun. Be grinding out a book. It’s not fun. It’s sort of a torturous work.

Renee DeSilva 33:19
Yeah. Well, deep respect for people who can organize themselves and then just commit to getting up and running every day, so kudos to you on that. All right. Here’s my final question for you. And it’s a take on one that I ask all of my guests, which is, if you could invite two people to continue this conversation today that you’d get insirpation from that you think has a good perspective on this. What two people would you invite and why?

Neal Hogan 33:45
Yeah. So my first answer that question I’m gonna give you two answers is I invite those two people to my table every night, which is my wife and my daughter who are fantastic at bouncing thoughts about this off of and again, it’s so weak, they’re tortured by having to talk about my topic. So I kudos to them for having done it. They’ve given me so much. Great, great thinking that I’ve incorporated my stuff. But I think what would be interesting would be there are two kinds of leaders in thinking about climate change right now. One is Bill McKibben, who is a writer for The New Yorker, if you have a chance to read any of his work, I highly recommend in fact, the New Yorker has a anthology of their climate writing called the fragile Earth, which has quite a bit of his stuff in it. And he wrote for years about climate change, and then decided that that wasn’t going to be enough. He was going to have to start an organization and he started three And he is just a leader in the fight to try to get us to reduce emissions and figure this out. And I’ve huge respect for Bill. And then the other person would actually be Bill Gates, who wrote a book two or three years ago about climate change. And the reason I like to have both of them on is they both agree we absolutely have to get to zero by 2050. But they have completely different viewpoints about How we shouldn’t do it. And I think it’d be really interesting to have that yet, Bill Gates is much more on the technology is going to solve our, all of our problems. And we’ll be entertaining until the carbon out lots of carbon out of the atmosphere. And we’ll be able to do these different things. And Bill McKibben is more on the we don’t need to wait for the technology, we already have solar winds, we just need the political will to make it happen. And I’m not sure that they’re too far apart. But it’d be great conversation. They both are very deep on climate change and the business approach to solving the problem. I’d love to talk to him about it.

Renee DeSilva 35:33
Fantastic Well, thank you, Neal. I feel much more educated than I was at the beginning of this conversation. And I applaud the conversation that you’re driving and look forward to continuing it with you over time. So thank you so much for joining us today.

Neal Hogan 35:47
Well, thanks so much, Renee. It’s really an honor when I look at the folks that you had on especially this season, obviously. I listened to a couple of podcasts last week. I just feel very honored to be part of that group. And thank you so much for having me join you at this table.

Renee DeSilva 36:00
Thank you. Talk to you soon.

Thanks again for joining me at the table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website,, or by subscribing on the podcast platform of your choice, and if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.