Stepping Up to Climate Change

The disruption of the global climate system—due to unsustainable exploitation of Earth’s natural systems and the burning of fossil fuel—is recognized by many scientific organizations and multinational institutions to be a global emergency and an existential threat to humankind.

The scale and complexity of the climate crisis can be difficult to comprehend, and for a practicing clinician, it can be hard to consider the impact of climate change in one’s daily practice. If we look closely, however, it is clear that the threats of climate change on health are not simply theoretical; they are happening now and affecting the healthcare system in dramatic and far-reaching ways.

For most people, the health consequences of climate change are easiest to appreciate when there is a clear cause and effect. A heat wave resulting in increased hospital admissions for heatstroke and cardiopulmonary ailments, for instance. Or changes in precipitation and temperature potentiating suitable areas for the transmission of vector borne disease.

When I think about the ways climate change impacts human health, I remember a patient I cared for my intern year. He was a young man from El Salvador who came to our emergency department with insidious symptoms of fatigue and leg swelling. He was twenty-two years old, married with an infant son, and worked in construction. On evaluation, his healthy appearance contrasted starkly to the results of his blood tests, which revealed profound kidney damage. He was started on dialysis, and after a thorough work up, he was diagnosed with chronic kidney disease of unknown origin, a disease of which I was previously unaware.

Chronic kidney disease of unknown origin (CKDu) is now considered to a quintessential climate sensitive disease. It was identified in the 1990s, when otherwise healthy agricultural workers in El Salvador started dying of kidney disease. Though still not fully understood, it is thought to be caused by repeated episodes of acute kidney injury occurring due to dehydration, potentially exacerbated by exposure to agricultural chemicals. Heat and humidity directly affect the pathogenesis of CKDu, so it is not surprising that it been increasing in prevalence as the Earth warms. In an article in the New England Journal of Medicine, Dr. Cecilia Sorensen and Dr. Ramon Garcia-Trabino outline the ways that CKDu demonstrates unique features of climate-sensitive disease. Chief among these is the critical intersection between social and economic vulnerability and the burden of climate change related illness: those subject to the greatest risk are impoverished, marginalized, or migrating populations, as well as children and the elderly.

Less obvious ramifications of climate change are still profound and startling. For example, climate change is associated with increased frequency and severity of extreme weather events, and these events, in addition to their direct trauma to communities, can affect healthcare supply chains. When Hurricane Maria hit Puerto Rico on September 2017, it damaged the Puerto Rican based manufacturing plants of Baxter International, which in turn contributed to a widespread intravenous saline shortage that affected the care of patients across the United States. There are also examples that at first glance appear truly baffling. In Bangladesh, rising sea levels has been implicated in increased rates of pre-eclampsia in pregnant women, thought to be due to increased groundwater salinity that increases the salt content of drinking water. And this is to say nothing of the potential for mass human displacement, disruption of food security, and other globally destabilizing phenomena that would also affect healthcare.

The climate crisis is already having a recognizable impact on human health and healthcare systems. These repercussions are expected to increase unless we are able to dramatically limit carbon emissions and actively prepare for the consequences of climate change.

Here are 3 things we can do as clinicians:

1.Recognize that the climate crisis is directly relevant to our work within healthcare, regardless of specialty. We can all educate ourselves about how the health of our patients is affected by climate change.

Consider subscribing to the monthly newsletter of the Planetary Health Alliance.

Sign up for environmental newsletters from major new organizations.

Read curated articles from medical journals about the climate crisis. I especially recommend an interactive perspective in the New England Journal of Medicine that illustrates the impact of climate change on human health and healthcare delivery.

2.Understand that issues of climate change are issues of social justice and health equity. We can consider vulnerability to environmental stressors when counseling patients and recommending treatments.

3.Get involved.

This can mean talking to our colleagues and patients about climate change, engaging with policy makers, and advocating within our institutions about environmentally sustainable practices. Consider joining Clinicians for Planetary Health. We can all make environmental policy and climate change an important part of our evaluation of elected officials.