Talking About Climate Change With Patients

A beach never seems short on sand. Yet the beach by my childhood home is slowly shrinking, as rising seas reclaim bits of the shore. During storm surges, the tide froths brown like powdered hot chocolate, and the waterline almost reaches the road. The morning after a recent storm, I went down to examine the damage and let my dog roll around the seaweed. As I absentmindedly counted plastic bottles and cigarette butts, a couple of bulldozers rumbled in. I wondered what they were doing there, on an otherwise quiet morning, when the first one dumped out a big pile of sand. Burning gas to save the beach seemed to me like an aging actor getting a facelift: a fraught and costly attempt to oppose nature. Then again, I am from Los Angeles. 

The tide may be higher than ever, and the storm surges more frequent, but the disappearing beach is the least of my concerns about climate change. It merely grounds me in a world where people are losing their homes and lives to the climate at scales that are hard to grasp. Chances are, if you’re a CLOSLER reader and a healthcare professional, you believe me when I say that the climate crisis is the defining challenge of my generation. In fact, clinicians who have written for us before recognize the urgency with which we must act on this global emergency.  

Climate change isn’t always thought of as a major health issue by the public. When polled, Americans are mostly concerned about the current COVID-19 pandemic, the cost and access to healthcare, and diseases like cancer. Yet the health effects of the climate crisis are real, and won’t be limited to obvious weather-related disasters like heat waves and hurricanes causing injury and premature death. Vector-borne tick and mosquito diseases will infect increasing numbers of people. Rates of anxiety, depression, and insomnia will rise. The water we drink will have more diarrheal pathogens, the air we breathe will have more inflammatory allergens and pollutants, and the food we eat will be scarcer.  

We must acknowledge that not everyone will be affected equally. Despite occupying far less of a carbon footprint, the impoverished will not have the wealth or mobility to adapt to this changing world, and will suffer the most. In Miami, for example, it costs several thousand dollars to install central air conditioning in a home. It costs even more to move to a city that won’t be underwater by 2050.  

While there’s increasing awareness of these issues, it can be challenging for a clinician to discuss the climate crisis with a patient. Climate change has become a highly politicized topic, hindering efforts to discuss its impacts with objectivity, and potentially straining the patient-clinician relationship over differing political views. Additionally, the existential fear that climate change invokes can seem overwhelming to both patient and clinician. It may be difficult to relate a problem as huge and complex as climate change to the health of an individual patient, much less offer tangible solutions in their care plan.  

Still, it’s important to acknowledge the root cause of the diseases that climate change will bring, rather than only treating their symptoms. Clinicians are in a unique position to educate patients about climate change and advocate for solutions. There are a few strategies you can employ when speaking to patients about climate-related health issues:  

1. Meet the patient where they are.  

Skepticism about climate change has a lot of overlap with skepticism about the safety and efficacy of vaccines. Thus, many of the same strategies for combating vaccine skepticism apply to discussions about climate change: listen to your patient nonjudgmentally, answer questions honestly, and be prepared not to change someone’s mind overnight. Specifically for climate skeptics, referring more generally to the effects of the environment on health, rather than climate change specifically, can be a good strategy.  

2. Make climate change personally actionable. 

Beneficial lifestyle choices for patient health go hand-in-hand with the health of our planet. Encouraging patients to walk, bike, and use public transit when possible, means less greenhouse gas emissions and more exercise. A diet higher in produce and lower in animal products is more environmentally sustainable, and linked to positive health outcomes. And choosing renewable energy sources like wind and solar won’t produce as many atmospheric pollutants over their operational lifetimes as coal or gas. Making climate change a matter of personal choices makes it easier for patients to understand how they can help. That being said . . . 

3. Advocate.

Real solutions to climate change will require systematic responses from all levels of society. This includes the medical profession, which may be responsible for 4.4-4.6% of greenhouse gas emissions worldwide. Advocate for your organizations to invest in renewable energy sources and reduce waste. In addition, you can educate receptive patients on the seriousness of the health consequences of climate change, so they can help shift the culture surrounding the climate in their own communities. 

Change, like the disappearance of a beach, happens slowly. Although we can’t solve the climate crisis in a single office visit, we can have conversations that can change minds and empower others to act.