UN Summit

The Paris climate change agreement was a day late and a dollar short

How the Paris accord lost its way between preamble and operative text.

Under grey-blue skies in Paris, a day after the United Nations Climate Change Conference, or COP21, was initially scheduled to end, the intense two-week negotiations ended in backslapping and hugs and much self-congratulation. Nearly 200 countries adopted an agreement that could ostensibly save the world from disastrous climate change.


Whether it will succeed, how it will succeed, and who exactly will have to pay for this ambition hides under the veneer of nice-sounding words and crafty side-steps. Somewhere in there, science, history, equity, and decisions based on hard reality seem to have gone completely missing.

Here’s how the operative part of the final, much-lauded text shakes down:
“…Holding the increase in the global average temperature to well below 2 °C above pre-industrial levels and to pursue efforts to limit the temperature increase to 1.5 °C above pre-industrial levels, recognising that this would significantly reduce the risks and impacts of climate change;…”

What does this really mean? A temperature target must necessarily correspond to a carbon budget. That is, how much carbon headroom do we have before the average temperature increase hits 1.5 degrees Celsius? And who will use how much of that headroom? By when?

The developed countries have used up their budget, even overdrawn on it. But there is no mention of correcting or balancing this historical inequity in favour of developing countries.

Moreover, the current plans of nations – the Intended Nationally Determined Contributions – puts the world on course to warming well above 3 degrees Celsius. A telling infographic by carbonbrief.org  shows us how many years of current levels of emissions will use up this carbon budget. The final text, however, does not seem to base itself on this science.


Source: carbonbrief.org


Onus on developing countries

To contain warming to 1.5 degrees Celsius will take an inordinate amount of investment by developing countries. Here’s how the text proposes to offer finance to developing countries:
“This Agreement will be implemented to reflect equity and the principle of common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.”

The Centre for Science and Environment, located in India, points out that this differentiation becomes weak when left to “capabilities” and with no reference to “historic responsibilities.”

The developed countries were to make available $100 billion per year to enable developing countries to mitigate and adapt to the disastrous effects of climate change. In the final agreement, however, this number figures only in the preamble but not in the operative, legally binding section.

Under this agreement, small island states and coastal areas already suffering severe losses because of rising sea levels and extreme weather, not to mention farmers and fishermen facing the brunt of droughts and floods, cannot claim anything from the developed world for liability and compensation. In other words, the big historical polluters essentially walked away from Paris having washed their hands of any responsibility for the damage they have already caused.

That the small island states who were so vocal in the run-up to these talks capitulated and signed on to this agreement gives one an idea of what went on behind closed doors. For an idea of how the spirit of the text changed over the second week, here is a telling example: The draft that was presented by the Platform for Enhanced Action to COP21 had these words in the important Article 2, the “purpose”:
[This Agreement shall be implemented on the basis of equity and science, and in accordance with the principle of equity and common but differentiated responsibilities and respective capabilities, in the light of different national circumstances, and on the basis of respect for human rights and the promotion of gender equality and the right of peoples under occupation]

All of it was bracketed, which meant that it was under review and discussion. (The run up to the final day of any COP is all about what “is bracketed” and what is “now out of brackets” or “completely gone.”)

Here’s the bit that made the final text:
“This Agreement will be implemented to reflect equity and the principle of common but differentiated responsibilities and respective capabilities, in the light of different national circumstances.”

In other words, “equity,” “science,” “human rights,” “gender equality” and the “rights of peoples under occupation” were all sacrificed in the Purpose.

Traditional knowledge

There were indigenous people from around the world at the conference fighting to get their rights heard, to have those key clauses “put back” into Article 2, but to no avail.

In passionate press conferences – a refreshing change from the clinical insipid conferences held by non-governmental organisations and government lackeys – the indigenous people spoke of protecting freshwater ecosystems, the land, wild fruit, medicinal plants, food security, and land integrity. They spoke of the violation of collective land rights, and of the “double discrimination” their women face from being, firstly, women and then indigenous to boot.

Indigenous women are at the short end of the stick when it comes to climate change. They are the ones that build houses, find fuel to cook and energy to run their homes, they fetch the water, they produce the food.

Speaking at the women’s caucus one early morning at COP21, Edna Kaptoyo, a Pokot woman from Kenya, said, “We had a culture where we preserved wild fruits for when we didn’t have enough food and grains. My mother did this for our family. But today, these fruits have disappeared. Our rivers are rain-fed. But now, they are drying out – something that has never happened before.”

Coming from the Arctic north, Mataali Okalik, an Inuit Youth Council leader dressed in a sealskin skirt and reeling from jet lag, said, “We have been seeing the impacts of climate change for many years. Our elders have been saying for decades that these impacts are detrimental to not only our people but for the rest of the world. But traditional knowledge is not deemed important. If it had been, we would have been steps ahead.”

These indigenous people expected COP21 to recognise their rights, and to respect their traditional knowledge as sustainable and valid. Frank Ettawageshik, representing the International Indigenous Peoples Forum on Climate Change, said in his address to the Closing Plenary on December 12:
“It is essential that the rights of indigenous peoples be recognised, protected and respected within a broad human rights framework. We sought such assurance in the operative section of the Agreement. We are keenly disappointed that the Parties did not see fit to accommodate this request in which we joined with a broad constituency.

“We … came seeking recognition, respect for, and use of our traditional knowledge, with our free, prior, and informed consent.  We appreciate that a provision appears in the operative section under adaptation, but it should apply everywhere in the Agreement and Decision without the qualification “where appropriate”.”

How nations negotiate their Intended Nationally Determined Contributions and what, if anything, will balance equity and rights in this new, but-not-really-new, regime remains to be seen.

The preamble of the Paris Agreement seems to have its heart in the right place. The operative text, however, seems to have sold its soul to the highest bidder. Some insist it is a start, that there is now something on the table – but to hail it as the saviour the world was waiting for is anything but the truth. This is no "get out of jail free” card.

But wait. It is exactly that for some.

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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 Scroll.in marketing team and not by the Scroll.in editorial staff.