Connecting climate change to patient care

We’re featuring this great piece from 2019 again today for Earth Day 2024.

Lee sat across from me in the exam room, catching his breath from walking to clinic, his hat drenched in sweat. Over the summer, he’d been working outside on construction sites in Baltimore, putting up fencing and cleaning up debris. Even during a particularly brutal two-week long heat wave in the area, he continued working. He has mild asthma and usually doesn’t need to use his albuterol rescue inhaler, but asked for a refill. I refilled his inhaler and because of the heat, counseled him on what he should do to prevent heat exhaustion.

Lee wasn’t alone in struggling with the heat. One patient with heart disease told me that the “thick air” made it hard to breath, and several other patients made similar observations. I didn’t talk with my patients about climate change making heat waves more likely, but after hearing a National Public Radio story about doctors talking to patients about climate change, I wondered if I should have.

The World Health Organization describes climate change as “the greatest health challenge of the 21^st century.” Heat waves, which are occurring more frequently, intensify the urban heat island effect in many cities. In a recent study by NPR and the University of Maryland, the hottest areas in Baltimore tend to be the poorest neighborhoods, and that association is seen in large cities throughout America. The heat can increase air pollution, which can exacerbate pulmonary conditions. The other health effects of climate change are wide-ranging and include injuries, kidney disease, spread of infectious disease, and mental health impacts.

We need to be leaders in addressing climate change in order to protect the health of our community and especially the most vulnerable in our communities. Many changes to mitigate climate change will require policy and public health interventions. Here are three steps that all of us can take:

1. Read about the health effects of climate change in your community.

Climate change needs to be framed as a health issue, so we need to be well versed in the health effects of climate change. Unfortunately, most medical schools do not include any courses on environmental health or climate change, so many of us need to start from scratch.

Your specialty organization may have information on climate change and health, and is a good place to start. For example, the American College of Physicians has a Climate Change Toolkit that provides background information and descriptions of regional effects of climate change. Talk about what you learn with your colleagues. If you teach or precept medical students or residents, teach them about climate change and health.

2. Talk about the health effects of climate change with patients.

Since climate change may affect each patient differently, tailor the discussion based on the patient in front of you. If your patient has asthma or COPD and lives in an urban area, it will be important to discuss heat waves and air pollution during the summer. It can be difficult to fit more information into a 15-20 minute visit, so it may make sense for you to broach the topic with your patient and ask another team member in your clinic to spend more time discussing resources like cooling centers.

3. Advocate within your organization for changes to reduce greenhouse gas emissions.

The U.S. healthcare sector accounts for 10% of our country’s greenhouse gas emissions. Health systems, hospitals, and clinics can take action that will reduce their impact on climate change, which will improve the health of our communities. For example, Boston Medical Center has undertaken a significant campus redesign with the goal of becoming carbon neutral by 2020. If every hospital and clinic across the U.S. did that, it would have a substantial health impact.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.