Climate Change Must Be a Central Concern of All Health Professionals

Mona Sarfaty

Abstract

The reality is that the past decade has delivered mounting evidence of the centrality of health to climate change. The climate directly affects human health with impacts--and costs--that are substantial and growing. Increasingly, U.S. residents are aware of this and express support for solutions. Equity concerns also drive engagement because communities of color, especially those that experienced environmental injustice in the past, are getting hurt first and worst. Health systems and health professionals must act responsibly if they are to be resilient in the face of the growing climate-induced health harms and continue to provide care to their patients and communities. Our will to make a difference is reinforced by seeing our efforts create positive change. The Medical Society Consortium on Climate and Health and its state-based affiliates, Health Care Without Harm, and the Alliance of Nurses for Healthy Environments provide opportunities for engagement. With so much at stake, knowing we can make a difference makes it imperative that we try.

Article

More than a decade ago, my husband and I were discussing what we thought were the greatest threats to public health. As an infectious disease specialist with a research career, his concern was a pandemic. He anticipated an epidemic of a deadly infectious agent that could spread easily from person to person, and for which there was no cure. His concern was both prescient and expected. After all, how could a health professional, particularly one specializing in infectious disease, not be concerned about a pandemic?

My greatest public health concern, climate change, seemed just as clear to me as a public health physician credentialed in family medicine. But at the time the idea that health professionals might see the health threat of global warming to be as central to their professional identities as the threat of a global pandemic raised eyebrows, some quizzical and some skeptical. My husband’s number one public health concern burst onto the world stage first and has caused the death of over a million people in the U.S. and many millions around the world.

I’m not surprised to report that my greatest public health insight -- that climate change must be a central concern of all health professionals -- has gained widespread traction. There are few raised eyebrows today. Over the last 5 years, the growing climate activism of health professionals, at organizational and individual levels, has been spurred by health professionals’ three R’s of climate engagement: reality, responsibility, and reinforcement.

Reality

The past decade, especially the last five years, has delivered mounting evidence of the centrality of health to climate change. The dire predictions of the world’s scientific experts are coming true. Weather patterns are increasingly extreme. Winds have higher velocities; torrential rains have greater volumes in shorter time frames.¹ Raging floods wash away villages; droughts are so severe that millions of square miles of forests are lost to fire and become ash and particle rich smoke.^2,3 Sea levels are rising, and flooding at high tide occurs along many stretches of the east coast of the U.S.⁴

These forces directly affect human health, with impacts--and costs--that are measurable and growing. Heat deaths, premature births, deterioration of lung and heart conditions, drownings, spread of tick and mosquito borne diseases, and the mental health unraveling that accompanies the destruction of homes--with displacement and loss--are some of the obvious consequences. The impact on communities of color in the U.S. and across the globe that are hurt first and worst, though they have been contributing least to carbon pollution generated by the overuse and waste of fossil fuels, is clear and undeniable. U.S. communities of color at greatest risk are typically those already victimized by environmental injustice. Prejudices caused by race, class, immigration status, or lack of wealth and political influence, have required people to make accommodations in places that are unhealthy and more exposed. Exposure may be caused by proximity to the fence line of fossil fuel drilling, mining, storage, dumping, or industrial use. Of course, the principal exposure in many localities is to vehicle exhaust, including diesel exhaust. The dollar cost of the related health harms is high. Recent estimates are in the billions of dollars per year.⁵ Much of the cost arises from the impact on cardiac and pulmonary conditions of air pollution traced back to burning fossil fuels.⁶

However, the flip side of the reality of climate change as a health hazard is also driving engagement: the growing evidence that acting on climate change will not only mitigate those harms but also deliver enormous health benefits, especially those accrued from reducing fossil fuel pollution and exposure. Burning fossil fuels has powered our lives but produced pollution. Pollution has caused health harms, and costs lives and dollars. Savings can result from addressing this causal loop.

Reducing air pollution through the Environmental Protection Agency and the Clean Air Act it administers has already saved lives and money. Systematic analysis has demonstrated that every dollar spent on the Act saved 31 dollars.⁷ Further reducing pollution will lead to more reductions in morbidity, mortality, and health costs.⁸ Healthful environments can also save lives and money because our surroundings are powerful social determinants of health. In sum, health professionals are increasingly recognizing that our climate and our health have a common enemy in heat-trapping fossil fuel pollution.

Responsibility

Health professionals are also more aware that they are practicing in health systems that must act responsibly if they are to be resilient in the face of growing climate health harms. Responsibility is the second driver of engagement. Many hospitals, for example, are in flood zones.⁹ Our health infrastructure must be there when we need it and national standards are necessary to guarantee its resilience.^10,11

Our health systems must also take responsibility for reducing their contribution to the problem. As a major sector of the American economy, health contributes significantly to carbon pollution. Hospitals are energy intensive; the contribution of the health sector has been calculated at 8.5% of all U.S. greenhouse gases. This carbon footprint is now the focus of efforts by the U.S. Department of Health and Human Services (HHS) and the National Academy of Medicine. Together they share the goal of decarbonizing the health system. The group Health Care Without Harm (HCWH), representing hospitals and health systems, has been pushing for this national goal for nearly three decades.¹² The new support from the Office of Climate Change and Health Equity within HHS makes it likely that new standards will be released to bring on these changes.

Reinforcement

The will to make a difference is reinforced by seeing our efforts create positive change. With so much at stake, knowing we can make a difference makes it imperative to try. At the organizational level, our movement is gaining strength and momentum. The Medical Society Consortium on Climate and Health (Consortium), which we founded with eight medical societies in 2017, now boasts 39 national societies representing 70% of all U.S. doctors and includes a network of 18 state affiliates for climate action that take a similar approach. The Consortium engages all its members and affiliates in policy advocacy. A parallel group of nurses is called the Alliance of Nurses for Healthy Environments. Physicians, nurses, and public health professionals and their societies are currently engaged in raising awareness of the public and policymakers about the threat to our health from the climate crisis--and the benefits to us that come from effective and equitable climate solutions. In 2019, organizations representing these professionals came together in support of a widely endorsed agenda presenting equitable solutions: “A Call to Action on Climate, Health, and Equity: A Policy Action Agenda.”¹³ The agenda has 188 endorsements from societies and schools of medicine, nursing, and public health, and a group representing over 500 hospitals.

At the individual level, we know that physicians, nurses, and other health professionals have real influence with the public and policymakers. Multiple polls over many years show that doctors, nurses, and pharmacists are some of the most respected professionals in the nation.^14,15 Their level of respect and position of direct relationship with the public provides unparalleled access with the potential to inform and persuade. The necessity of addressing personal health issues is tangible for people because many of these conditions are affected by heat, allergens, and poor air quality generated by climate change. We can give individuals the information they need to protect themselves. We can let policymakers know what we are seeing and how climate solutions could make people healthier and reduce health costs in the process.

Whatever the pace of our engagement with reality, we must accelerate it. The window for effective action on climate is closing fast.¹⁶ We are at a unique juncture in the history of our species, and we have a unique opportunity to help change the course of that history and avoid a dire fate. We can create a future with clean renewable energy to power our homes and buildings, with low and no carbon transportation to move us about, and with regenerative agriculture to enrich our soils and provide us with plant-forward diets. We can work more responsibly in decarbonized health care systems. We can reinforce our efforts by ensuring that better health through climate action is shared by everyone. Thousands of us are already working toward this vision of healthy people living in healthy places on a healthy planet.¹⁷ You are welcome to join us!

About the Author

Mona Sarfaty, MD MPH (H-R’71) is the Founder and Executive Director of the Medical Society Consortium on Climate and Health based within the Center for Climate Change Communication at George Mason University in Virginia. The Consortium is a coalition of medical societies, affiliated public health organizations, and individual advocates with the mission of raising awareness of the health harms of climate change and mobilizing advocates across the country for policy changes that protect health. She is a Harvard graduate, a family physician with public health training, and the grandmother of six.

References

Climate change 2021: The Physical Science Basis [Internet]. IPCC Intergovernmental Panel on Climate Change. [cited 2022May8]. Available from: https://www.ipcc.ch/report/ar6/wg1/
Gile M. Flooded German town trying to find place to bury victims after cemetery washed away [Internet]. Newsweek. Newsweek; 2021 [cited 2022May4]. Available from: https://www.newsweek.com/flooded-german-town-trying-find-place-bury-victims-after-cemetery-washed-away-1611594
Hoover K, Hanson L. Wildfire Statistics [Internet]. Congressional Research Service reports. 2022 [cited 2022May4]. Available from: https://sgp.fas.org/crs/
US Department of Commerce NOAA. What is high tide flooding? [Internet]. NOAA's National Ocean Service. 2021 [cited 2022May4]. Available from: https://oceanservice.noaa.gov/facts/high-tide-flooding.html
De Alwis D, Limaye VS. The Costs of Inaction: The Economic Burden of Fossil Fuels and Climate Change on Health in the United States [Internet]. The Medical Society Consortium on Climate and Health (MSCCH). 2021 [cited 2022May8]. Available from: https://medsocietiesforclimatehealth.org/
Schraufnagel DE, Balmes JR, De Matteis S, Hoffman B, Kim WJ, Perez-Padilla R, et al. Health benefits of Air Pollution Reduction. Annals of the American Thoracic Society. 2019;16(12):1478–87.
Benefits and Costs of the Clean Air Act 1990-2020, the Second Prospective Study [Internet]. EPA. Environmental Protection Agency; 2011 [cited 2022Apr22]. Available from: https://www.epa.gov/clean-air-act-overview/benefits-and-costs-clean-air-act-1990-2020-second-prospective-study
Schindell D. Testimony to the House Committee on Oversight and Reform Hearing on “The Devastating Impacts of Climate Change on Health,” [Internet]. 2020 [cited 2022May9]. Available from: https://oversight.house.gov/sites/democrats.oversight.house.gov/files/Testimony%20Shindell.pdf
Martin E. Record flooding poses rising threat to health facilities [Internet]. Health Facilities Management. 2019 [cited 2022May4]. Available from: https://www.hfmmagazine.com/articles/3666-record-flooding-poses-rising-threat-to-health-facilities
Zhong S, Clark M, Hou X-Y, Zang Y, FitzGerald G. Validation of a Framework for Measuring Hospital Disaster Resilience using factor analysis. International Journal of Environmental Research and Public Health. 2014Jun18;11(6):6335–53.
Kizer KW, Nadeau KC. Confronting health care’s climate crisis conundrum. JAMA. 2022Jan31;327(8):715–6.
Our history [Internet]. Practice Greenhealth. [cited 2022Apr28]. Available from: https://practicegreenhealth.org/our-history
U.S. Call to Action on Climate, Health, and Equity: A Policy Action Agenda [Internet]. Climatehealthaction.org. 2019 [cited 2022May8]. Available from: https://climatehealthaction.org/
Saad L. Military brass, judges among professions at New Image Lows [Internet]. Gallup.com. Gallup; 2022 [cited 2022May4]. Available from: https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx
Hill N. New American Climate Perspectives Survey [Internet]. ecoAmerica. ecoAmerica; 2021 [cited 2022May4]. Available from: https://ecoamerica.org/american-climate-perspectives-survey-2021-vol-ii/
Climate Change 2022: Impacts, Adaptation and Vulnerability [Internet]. IPCC Intergovernmental Panel on Climate Change. [cited 2022May4]. Available from: https://www.ipcc.ch/report/ar6/wg2/
About [Internet]. The Medical Society Consortium on Climate and Health (MSCCH). [cited 2022May4]. Available from: https://medsocietiesforclimatehealth.org/about/