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Why the US-China climate deal has pushed India into a corner

New Delhi will have to cement its domestic climate strategy and recalibrate its tack at future global summits.

In a landmark deal, China and the United States, the world’s largest economies and polluters, have agreed to new and ambitious targets for cuts in their nations’ carbon emissions. The agreement, announced on Wednesday, is certain to impel a change in the positions of many participants in next year’s United Nations climate change talks in Paris. India, in particular, will have to review its strategy of been tag-teaming with China at global climate summits.

Under the US-China deal, President Barack Obama has agreed that by the year 2025, the United States will emit 26% to 28% less carbon than it did in 2005. To achieve this, it will have to double the pace of cutting emissions it achieved from 2005-2020. In return, President Xi Jinping has agreed that China’s emissions will peak around 2030, after which a drop can be expected.

“This is smart politics,” said Navroz Dubash, a senior fellow at the Centre for Policy Research in Delhi. "The US target and the Chinese peaking year will certainly require some effort, but they are probably not stretch targets. It allows both to claim leadership in breathing life into climate talks.”

For India, the deal means that it can no longer hide behind the reluctance – which China shared previously – to commit to emission caps that would limit GDP growth. Nor can it now secure Beijing’s support when bargaining in future multilateral meetings. The deal also means that a lot may depend on Delhi’s bilateral ties with Washington before the Paris discussions in December 2015.

Sharp departure

This is a sharp departure from the past. After the 2009 climate talks in Copenhagen failed – because of lack of consensus on how to reduce global warming by 2 degrees Celsius by the end of the century – India and China had allied to increase their bargaining power in other multilateral fora, such the ones discussing relaxation in intellectual property laws that both could benefit from.

Of course, the US-China deal is not without criticism. Its terms – more than its targets – could short-change India when the country is at the bargaining table in Paris.

The 26%-28% cut below 2005 levels promised by Washington is about 8% of the levels of carbon the US produced in 1990. Even under the 1997 Kyoto Protocol, an international treaty that required countries to commit to reducing greenhouse gas emissions, the United States was supposed to reduce its emissions by 5%-7% from 1990 levels.

“The year 2005 is an easy target for the United States because its shale gas usage slashed emissions during this period,” said Arun Mohan Sukumar, senior fellow at the Centre for Communication Governance in Delhi. At the time, the US had imposed regulations on its coal-based power plants that led to increased reliance on shale gas, whose processing and use emits less methane, a greenhouse gas. At Copenhagen, India committed to a 20%-25% reduction from the 2005 levels by the year 2025. These are the lowest common denominators for countries to sign up to.

China too gets some leeway in the new agreement. Pavan Srinath, head of policy research at the Takshashila Institution, Bengaluru, pointed out that the “size of China’s emissions peak remains unknown and that gives it a lot of wiggle room”. While the deal is itself legally binding, “there is no tangible enforcement mechanism presented, nor does one seem feasible”.

Goalpost shifting 

The United States-China bilateral deal reduces the negotiating power of the already fractured BASIC (Brazil, South Africa, India and China) and G77 groups by robbing them of China’s bargaining power. Irrespective of what its emissions peak to, China has been confident enough to announce that in order to meet its targets, it will expand its share of consumption of renewable energy to 20% by 2030.

As US senator John Kerry pointed out in an op-ed in The New York Times, this means that it will have to deploy at least 800 gigawatts of renewable energy generation, such as more solar and wind power generators and nuclear power plants.

Without China in the picture as an ally, “the chances of India and other developing countries getting a better deal on technology transfer and funding, which require extensive negotiations, are slim”, said Sukumar. “India can commit to a similar target in Paris next year, but what is the point of signing a treaty that neither gives you benefits nor tackles climate change?”

As the chart above shows, India’s per capita carbon dioxide emissions are lower than China’s and United States’. But global talks on climate change are starting to focus on goals for the post-2020 period, when countries like India and China will be even more growth-focused and thus may have to transition from emission limits normalised to their population to limits normalised to their GDP.

Srinath noted that India now runs the risk of becoming painted into a corner in spite of significant efforts at home to promote renewable energy. With China having decided to play its own game, the ball is squarely in India’s court to chart out its domestic climate strategy. As Dubash put it, “The only way for India to square this circle is to create conditions to deliver more emission restrictions than countries actually promise and push for tighter limits.”

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.