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Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

The United States electricity sector is engaged in a long-term experiment regarding the proper role of market competition. Many states that transitioned to competitive electricity markets in the early 2000s are again reconsidering the relationship between market competition and public policy goals. Low natural gas prices, falling costs of renewable energy and energy storage, and improvements in efficiency are causing early retirements of coal and nuclear power plants and thus affecting environmental policy goals and economic interests. States that continue to rely on monopoly utilities for electricity are also reconsidering the role of competition, but from a different angle. Rather than focusing on mitigating the downsides of competition, some traditionally regulated states are creating new opportunities for third parties to compete with monopoly utilities. The implications for electricity sectors in restructured and traditionally regulated states extend far beyond the particular facilities that stand to gain from new subsidies or the monopoly utilities subject to new forms of competition. Post hoc changes to market rules risk wasting resources that will be necessary to aggressively reduce greenhouse gas emissions, ensure long-term affordability, and mitigate the employment impacts of a transitioning sector. This Article explores the factors causing policymakers to reconsider the role of competition in the pursuit of energy goals. It identifies lessons for realizing the benefits of electricity sector competition while managing the downsides that occur during periods of unanticipated change. In restructured markets, the lessons center on strategies to address job losses and achieve state environmental goals. In traditionally regulated states, the lessons focus on opportunities to harness competition to deliver additional societal benefits without undermining the traditional rate-setting model for monopoly utilities. [ABSTRACT FROM AUTHOR]

To combat climate change, many leading states have adopted the aim of creating a "participatory" grid. In this new model, electricity is priced based on time of consumption and carbon content, and consumers are encouraged to adjust their behavior and adopt new technologies to maintain affordable electricity. Although a more participatory grid is an important component of lowering greenhouse gas emissions, it also raises a new problem of clean energy justice: utilities and consumer advocates claim that such policies unjustly benefit the rich at the expense of the poor, given the type of consumer best able to participate in the grid. These arguments pitting clean energy against equity often prove persuasive to energy regulators considering whether to adopt or maintain clean energy policies. But these arguments fail to seriously engage the question of how energy law's historical equity norms should be interpreted and applied in the era of climate change. This Article concludes that there are legitimate and underappreciated equity concerns with the participatory grid, given that participation in the grid is likely to stratify along income lines. However, these equity concerns do not justify slowing progress on climate change, given the extreme inequities raised by that problem itself. Fortunately, however, there is a longstanding tradition of attention to equity concerns within electricity law that paves a way forward. Throughout the twentieth-century project. of electrification, electricity law focused on expanding the range of Americans able to access affordable electricity. Twentyfirst century regulators, in contrast, plan to require consumers to participate in the grid in order to maintain affordable power. This new vision requires a new instantiation of electricity law's long-standing equity commitment: a project of "clean electrification," which seeks to expand participation in emerging clean energy marketplaces to all Americans. [ABSTRACT FROM AUTHOR]

A considerable amount is known about the factors that influence policy adoption and implementation across different issue areas. Less is known, however, about the factors that influence governments to abandon programs or policies prior to reaching their stated objectives or originally specified end-points. This article applies termination theory to local climate protection initiatives and examines cities' withdrawal from the dominant sustainability organization facilitating these efforts. In the face of national government inaction, large numbers of U.S. municipalities voluntarily committed to reduce their greenhouse gas (GHG) emissions and joined the ICLEI's Climate Protection program. After steady membership increases for nearly a decade, ICLEI attained its largest size in 2010 with 565 city members. Over the next 2 years, this number plummeted by 20 percent. Positioned in the literature on policy change, we empirically test three hypotheses for why a substantial portion of cities ended their affiliation with this organization and terminated the explicit climate protection objectives associated with it: (1) political ideology and interest group pressure, (2) fiscal constraints, and (3) perceived program ineffectiveness. Analytical results support the first and third hypotheses. We identify factors that influence the termination of local GHG reduction initiatives and discuss theoretical implications of these findings. [ABSTRACT FROM AUTHOR]

We assess the static and dynamic implications of alternative market-based policies limiting greenhouse gas emissions in the US cement industry. Our results highlight two countervailing market distortions. First, emissions regulation exacerbates distortions associated with the exercise of market power in the domestic cement market. Second, emissions "leakage" in trade-exposed markets offsets domestic emissions reductions. Taken together, these forces can result in social welfare losses under policy regimes that fully internalize the emissions externality. Market-based policies that incorporate design features to mitigate the exercise of market power and emissions leakage deliver welfare gains when damages from carbon emissions are high. [ABSTRACT FROM AUTHOR]