An orange glow glazes the horizon as I drive north on Interstate 405 on my way to work. The beginning of a sunrise, I think briefly, before noticing that it is set in the wrong direction. My eyes water when I step out of the car, and my throat starts to itch as I take a deep breath of the crisp morning air. Fires, I realize, catching a whiff of smoke lingering in the dense fog. I hold my breath as I walk toward the hospital, exhaling only after I reach its polished interior. Once inside, I feel as though I am in a fortress, temporarily sheltered from the natural disasters that surround me. But when I reach the physician workroom, I understand that the burning in my eyes and throat, as well as the burning of the land mere miles from where I live and work, will not easily go away.
During my formal medical training, I never explicitly learned about the impact of climate change on human health and well-being. It was not denied, but rather presented as a phenomenon happening beyond the scope of our work, and perhaps even in spite of it. While my medical school and residency curricula have made ample space for discussion about the social determinants of health — that is, the conditions in the places where people live, learn, work and play that affect a wide range of health and quality of life risks and outcomes — climate change rarely emerges as an independent factor to be studied or a target for intervention. Rather, it often becomes relevant only by proxy, such as when it leads to homelessness or food insecurity or poor air quality.
Climate change, however, independently influences human health in innumerable ways. Extreme weather events — such as fires, floods, and earthquakes — lead to injuries and premature deaths, changes in the geographical distribution and prevalence of infectious diseases, and disturbances in mental health, among various other direct effects. According to the WHO, between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress. And not everyone is equally at risk: Climate change disproportionately afflicts already vulnerable populations, including the elderly, impoverished, and historically marginalized communities. This is not to deny the magnitude of health-related effects caused by other social determinants. Rather, it is a recognition that climate change in and of itself leads to profound morbidity and mortality that will continue to escalate until we begin to address the root causes — not only as global citizens but also as physicians.
A major new scientific report was recently released by the Intergovernmental Panel on Climate Change, which comprises experts convened by the United Nations. The report provides a comprehensive and up-to-date evaluation of the threats posed by global climate change. It found that “the extent and magnitude of climate change impacts are larger than estimated in previous assessments … causing severe and widespread disruption in nature and society … thus affecting people’s health and well-being and damaging livelihoods.” The report notes that humans and nature can reduce the risks and effects of climate change if we adapt to the changing conditions, but that successful adaptation requires urgent action. According to the report, “any further delay in concerted anticipatory global action will miss a brief and rapidly closing window of opportunity to secure a livable and sustainable future for all.”
Participating in concerted anticipatory global action may seem like a tall order for physicians and nonphysicians alike. However, the first step to implementing solutions is to recognize that climate change is not merely happening around us but rather a result of our everyday actions — or lack thereof. Though this is by no means an exhaustive list, there are many initiatives physicians can take:
- Recognize the health-related effects of climate change, such as respiratory and heat-related illnesses, food and water insecurity, malnutrition, and behavioral health problems. Ask patients about these effects on a routine basis.
- Encourage patients to take steps toward reducing their carbon footprint that also improve health, such as adopting a plant-based diet, eating locally produced food, and walking or biking instead of driving, where applicable.
- Integrate climate change education into medical training at all levels and participate in the development of curricula, such as one recently published for residents by physicians at multiple institutions.
- Utilize and contribute to the development of physician resources, such as the American College of Physicians’ toolkit for climate change and the American Lung Association’s report on air pollution.
- Join physician advocacy groups around climate change, such as the Medical Society Consortium on Climate and Health, Health Care Without Harm, and Physicians for Social Responsibility.
- Speak with hospital administrators about ways to reduce waste and improve energy efficiency at your facility, such as implementing a mechanism for composting, reducing consumption of plastic, and increasing use of renewable energy.
- Speak with local and state representatives about the impact of climate change on health and well-being, and encourage lawmakers to incorporate solutions into bills and budget proposals.
Once inside the hospital, we are not impervious to the global havoc wrought by our warming planet. Rather, we are an integral part of our tormented environment and the process of change. The time is ripe to make our voices heard for the sake of our patients’ and planet’s future. For if we do not act now, it may soon be too late.
What aspects of health care are most affected by changes to the environment? Share your thoughts in the comment section.
Rebecca Tsevat, MD, is a fourth-year resident in internal medicine and pediatrics at UCLA. She attended medical school at Columbia University Vagelos College of Physicians and Surgeons and obtained a master's degree in narrative medicine from Columbia University. Her interests include primary care, narrative medicine, medical education, and health services research, and can be found on Twitter @rktsevat.
Illustration by Jennifer Bogartz
