Climate Change Health Impacts: A Role for the Family Physician
Am Fam Physician. 2019 Nov 15;100(10):602-603.
Related editorial: Climate Change: What the Science Tells Us
The American Academy of Family Physicians (AAFP) recently joined more than 100 health care organizations in declaring climate change a public health emergency.1 Why is climate change a matter of such importance to us as health care professionals, and why must we act? An article in this issue of American Family Physician reviews the well-established health influences of higher temperatures on heat-related illnesses, the expansion of infectious disease vectors, and the role of fossil fuel emissions in potentiating the respiratory and cardiovascular effects of air pollution.2 Climate change affects our regional environments, altering the way we live as floods, droughts, wildfires, and other catastrophic events occur. There is mounting evidence that climate change also affects mental health, not only in the setting of direct climate disasters, but manifesting as an increase in depression and anxiety.3 Morbidity and mortality are challenging to estimate because health impacts range from direct thermal effects4 and air pollution5 to displacement of populations due to natural disasters and rising sea levels.6 What is clear, however, is that vulnerable populations such as children, older adults, and people living in resource-poor regions will be disproportionately affected, at least in the foreseeable future.
What, then, can family physicians do to address the health impacts of climate change? Our role is multiple: We must act as citizens, clinicians, advocates, and healers.
As citizens, we can reduce the carbon impact of our behaviors and encourage others, including our patients, to do the same, particularly by choosing active transport and a plant-based diet. More importantly, through phone and email contact, attendance at town hall meetings, and our votes, we can support our official representatives' commitment to a cleaner, safer environment.
As clinicians, we must recognize the impact of climate change on our patients' health. We need to keep abreast of climate science to address patients' questions about the effects of climate change.7 The illnesses with which patients present will be familiar to us—respiratory, allergic, infectious, and cardiovascular—but are increasing in prevalence. To best serve our patients, it is essential that we consult reliable, health-related research and policy sources, such as The Lancet, PLOS One, JAMA, and our medical societies, as well as international health organizations. It is important for physicians in all specialties to be aware of the health sector's contributions to greenhouse gas emissions, which are estimated at 10% of total U.S. emissions.8 Health care–related emissions and associated costs are due largely to energy use, procurement of goods and services, and travel.9 So while attention may gravitate to high-cost operating room waste, cost-effective interventions to improve sustainability should include everything from energy-conservation campaigns to sourcing plant-based local food for patients and staff 10 and reducing drug wastage.11 Most guides on green health care facilities recommend studying the specific health care setting9,12 and tailoring interventions accordingly. For example, in one report, the authors found that 6% of the 4.6 million regionally used disposable gloves were wasted by falling to the floor.13 Even small interventions targeting better packaging of gloves may make a difference. Family physicians can reduce health care emissions by prioritizing preventive care and utilizing resources judiciously (e.g., using effective online communication and telemedicine tools9 to reduce patient automobile travel).14 Practice Greenhealth's website provides detailed guides focused on sustainability solutions for hospital and health systems, whereas My Green Doctor provides advice on climate-smart practices in physicians' offices (https://www.mygreendoctor.org). Climate communication skills can contribute to messaging efficacy, which is important in addressing patients' concerns,7 speaking on behalf of specialty organizations, and addressing legislators. Communication experts recommend emphasizing positive approaches that highlight healthy habits and community prosperity while minimizing personal or collective blame for behaviors that contribute to greenhouse gas emissions.15
As advocates, we can form collaborations between colleagues and hospital administrators to strengthen efforts to reduce energy use and medical waste while decreasing costs.16 Detailed information on actions and institutional support is available through organizations such as Practice Greenhealth and Health Care Without Harm (see Table 4 in related article). Family physicians have many other opportunities to get involved on the advocacy level. We can join the AAFP's Climate Change and Environmental Health Member Interest Group or participate in state academy lobby days as general registrants, by proposing action on specific bills, or by working with colleagues and lawmakers to write novel legislation. We can seek out information, networking opportunities, and action items by consulting the Medical Society Consortium on Climate and Health, which is headed by a family physician; we can support the bipartisan efforts of Citizens' Climate Lobby; or we can familiarize ourselves with additional policy interventions as members of Physicians for Social Responsibility.
Finally, as healers, we must make ourselves available to provide solace to patients as they become increasingly aware of the dangers of climate change.17 Family physicians have an ethical obligation to address the health effects of climate change to safeguard the health and well-being of disenfranchised people, our children and grandchildren, and future generations.18
Editor's Note: Dr. Wellbery is associate deputy editor of American Family Physician.
Referencesshow all references
1. U.S. call to action on climate, health, and equity: a policy action agenda. 2019. Accessed July 22, 2019. https://climatehealthaction.org/cta/climate-health-equity-policy...
2. Parker CL, Wellbery CE, Mueller M. The changing climate: managing health impacts. Am Fam Physician. 2019;100(10):618–626. Accessed November 15, 2019. https://www.aafp.org/afp/1115/p618.html
3. Temte JL, Holzhauer JR, Kushner KP. Correlation between climate change and dysphoria in primary care. WMJ. 2019;118(2):71–74.
4. Gasparrini A, Guo Y, Sera F, et al. Projections of temperature-related excess mortality under climate change scenarios. Lancet Planet Health. 2017;1(9):e360–e367.
5. Balbus JM, Tart KG, Dilworth CH, et al. Changing the climate of respiratory clinical practice. Insights from the 2016 Climate and Health Assessment of the U.S. Global Change Research Program. Ann Am Thorac Soc. 2016;13(8):1202–1204.
6. Abubakar I, Aldridge RW, Devakumar D, et al. The UCL– Lancet Commission on Migration and Health: the health of a world on the move. Lancet. 2018;392(10164):2606–2654.
7. Temte JL, McCall JC. Patient attitudes toward issues of environmental health. Wilderness Environ Med. 2001;12(2):86–92.
8. Eckelman MJ, Sherman JD. Estimated global disease burden from US health care sector greenhouse gas emissions. Am J Public Health. 2018;108(S2):S120–S122.
9. Tomson C. Reducing the carbon footprint of hospital-based care. Future Hosp J. 2015;2(1):57–62.
10. Storz MA. A practical guide for physicians and health care workers to reduce their carbon footprint in daily clinical work. Perm J. 2018;22:17–145.
11. National Health Service Sustainable Development Unit. Update: NHS carbon reduction strategy. Updated January 2010. Accessed July 31, 2019. https://www.sduhealth.org.uk/policy-strategy/engagement-resources/nhs-carbon-reduction-strategy-2009.aspx
12. Health Care Without Harm. Simple steps to reducing carbon emissions from healthcare. March 2016. Accessed July 31, 2019. https://noharm-uscanada.org/sites/default/files/documents-files/3840/2016-03-22%20CLIRE%20Project%20Simple%20Steps%20Guide%20Infographic.pdf
13. Health Care Without Harm. CLIRE report shows how healthcare can reduce its climate footprint. March 22, 2016. Accessed July 31, 2019. https://noharm-global.org/articles/news/europe/clire-report-shows-how-healthcare-can-reduce-its-climate-footprint
14. Centre for Sustainable Healthcare. We work in healthcare — of course we care about carbon! Accessed July 22, 2019. https://sustainablehealthcare.org.uk/blog/we-work-healthcare-%E2%80%93-course-we-care-about-carbon
15. EcoAmerica; Climate for Health. Let's talk health and climate: communication guidance for health professionals. 2016. Accessed July 22, 2019. https://ecoamerica.org/wp-content/uploads/2017/03/3_letstalk_health_and_climate.pdf
16. Intermountain Healthcare. Air qualit y and health resources. Accessed October 21, 2019. https://intermountainhealthcare.org/about/transforming-healthcare/sustainability-environmental-health/air-quality-health
17. Knight V. ‘Climate grief’: fears about the planet's future weigh on Americans' mental health. Kaiser Health News. July 18, 2019. Accessed July 22, 2019. https://khn.org/news/climate-grief-fears-about-the-planets-future-weigh-on-americans-mental-health
18. Sorondo MMS, Frumkin H, Ramanathan V. Health, faith, and science on a warming planet. JAMA. 2018;319(16):1651–1652.
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