By Robyn Alie, manager, MMS Health Policy and Public Health
In the scientific and medical communities there is little doubt about the causes and consequences of climate change. Its influence on human health and health care delivery is being felt today in communities from Bangladesh to Boston. Climate change is “the biggest global health threat of the 21st century,” the Lancet Commission on Climate Change concluded in 2009. “We need to act now to mitigate against the health effects,” says Nitin S. Damle, MD, MS, MACP, clinical associate professor of medicine at Brown University’s Alpert Medical School and a past president of the American College of Physicians.
Global Warming, Local Effects
While climate change is profoundly affecting lower-income countries, more affluent countries are in no way immune. The US Global Change Research Program calls climate change “a significant threat to the health of the American people.” The program cites current and future threats from higher temperatures; increased storm intensity, rainfall rates, and storm surge; temperature-related illness and death; air quality impacts; natural disasters; and vector-borne disease.
Massachusetts is feeling the heat, too. “The simple truth of the matter is we have 351 cities and towns in Massachusetts, and they all need a vulnerability plan, and they all need a hazard mitigation plan,” Governor Charlie Baker said in March, announcing a Climate Resiliency Initiative. In 2015, for example, a Climate Change Vulnerability Assessment in Cambridge found that heat exposure has a direct impact on total daily deaths, and higher temperatures may affect birth outcomes, such as an increase in preterm births. Cambridge is among the many urban communities that are vulnerable to the “heat island” effect, intensified by older housing stock, minimal protection from trees, air pollutants related to high energy consumption, and other factors.
Effects on Physician Practices
Climate change shapes the everyday practice of physicians in Massachusetts, says Aaron Bernstein, MD, MPH, co-associate director of the Center for Climate, Health, and the Global Environment at Harvard T. H. Chan School of Public Health. “This is a medical care issue. It affects the ability of doctors to practice medicine, and it affects our ability to provide the care we need.”
Distant weather events can have long-term effects on the medical supply chain. The ongoing shortage of IV fluids in Massachusetts health care centers, for example, has everything to do with the hurricane in Puerto Rico last year that disrupted production at a single, small volume IV fluid bag plant, Dr. Bernstein points out.
The regional health care system is also challenged by influxes of people displaced from disaster zones to Massachusetts and other areas, as well as by local weather events. “We’re starting to uncover these vulnerabilities for which we’re not prepared,” says Dr. Bernstein. “New England has experienced the greatest intensification of the water cycle. Heavy snows and rains are a risk to power supplies — we can’t refrigerate our medicines — and create risks to access to care. People can’t get to clinics, including the people who work there.”
Effects on Patient Health
Climate change is directly influencing human health in the US. “We’re not talking about polar bears, we’re talking about kids,” says Mona Sarfaty, MD, MPH, FAAFP, a family physician based in Washington, DC, and executive director of The Medical Society Consortium on Climate and Health, established in 2017 to help physicians address the health risks of climate change.
Some demographics and communities are particularly susceptible to air pollution and heat exposure (see “What Are Your Patients Breathing? The Rising Harms of Air Pollution”). “Kids spend more time outside and are more likely to suffer heat illness; pregnant women are more vulnerable to heat and poor air quality,” says Dr. Sarfaty. Thousands of student athletes are treated for heat illnesses each year, and people of limited socioeconomic means are often unable to evacuate areas affected by wildfire smoke or storms, she says.
The elderly and chronically ill are also at relatively high risk, says Dr. Damle, who is an internist in Rhode Island. “We have seen an increase in heatwaves leading to more emergency room and office visits and higher death rates in our vulnerable populations: the elderly, people with chronic heart and lung conditions, and the poor who lack access to air conditioning and other measures.”
The northeast US is also experiencing increasing risk from tick-borne disease (see “Scientists Look to Gene Editing to Combat Lyme Disease in Massachusetts”), Dr. Damle says. “We are seeing more cases of tick-borne illness — primarily Lyme disease, Anaplasma, and Babesia infection — and a longer season for susceptibility, extending from March to November of each year. The impact of climate change is real and now.”
Physicians as Advocates
The good thing is, says Dr. Bernstein, that recommendations we routinely make for our patients, such as eating less red meat, and walking, biking, and using public transit instead of driving, also promote carbon reductions.
On a broader scale, physicians can play an important role in advocating for evidence-based environmental policies that will protect health. “The voice of the health profession is essential” to mitigating the effects of climate change, said the Lancet Countdown on Health and Climate Change (previously the Lancet Commission on Climate Change) in 2017, noting that the delayed response to climate change over the past 25 years has jeopardized human life. The American College of Physicians warned in a 2016 position paper that climate change could have a devastating effect on human and environmental health and emphasizes physicians’ roles in addressing and mitigating the health effects of climate change (see “Green Your Practice While Cutting Costs: Why and How to Get Started”).
“Policy should be based in science and evidence and not be censored,” Dr. Damle says. “Our actions should be based on the scientific evidence, the bedrock of an advanced society.” In surveys, the Medical Consortium for Climate and Health found that physicians knew climate change was occurring, that it was substantially caused by humans, and that it was directly relevant to the practice of medicine.
Physicians’ Voice
The media offers physicians and other health professionals an opportunity to be heard. Since 2007, newspaper coverage of climate change has increased 78 percent, the Lancet Countdown noted. Stories on federal actions — such as the US withdrawal from the Paris Agreement, rollbacks of clean air regulations, and the increased role of industry in EPA policymaking — reveal climate change to be a highly charged issue politically. “[People] want to know what doctors are thinking. Not everyone knows a climate scientist, but they know a physician,” says Dr. Sarfaty.
“This is where the voice of thoughtful physicians can be really valuable,” says Matthew J. Bivens, MD, an emergency physician at St. Luke’s and BIDMC who chairs the Greater Boston chapter of Physicians for Social Responsibility. Dr. Bivens had a long career as a reporter before he became an emergency physician. “One of the dirty secrets of journalism is that there are no good rules about deciding who to interview as an ‘expert.’ Many people or institutions that interact with reporters about climate change have a narrow agenda. As a group, physicians have no business or political interest. But we do have a medical interest in our patients and fellow citizens and a scientific interest in identifying and documenting risks to public health.”
On an individual level, says Dr. Bernstein, “we can make sure we know the record of our elected officials on voting related to energy policy, and vote. This is a medical care issue. It affects the ability of doctors to practice medicine and provide the care we need; it affects access to medications, and the integrity of our facilities.”
