The Changing Climate: Managing Health Impacts


Am Fam Physician. 2019 Nov 15;100(10):618-626.

Related editorial: Climate Change Health Impacts: A Role for the Family Physician

Related editorial: Climate Change: What the Science Tells Us

Related Curbside Consultation: Effective Advocacy for Patients and Communities

Author disclosure: No relevant financial affiliations.

Concentrations of greenhouse gases continue to accumulate in the atmosphere at increasing rates, heating the Earth's surface and destabilizing climate. Health impacts from climate change may include increased morbidity and mortality from worsening cardiopulmonary health, worsening allergies, and greater risk of infectious disease and mental illness, including anxiety, depression, and posttraumatic stress disorder from extreme weather events. Family physicians should advise patients to minimize exposure to air pollution, which is potentiated by rising temperatures. Use of self-monitoring devices, tracking local weather information, and awareness of events such as wildfires can alert patients to poor ambient air quality. Vulnerable individuals should avoid intense outdoor exercise and stay indoors or wear protective N95 masks when air quality is in the harmful range. Physicians can teach patients to recognize early symptoms of heat illness and advise adequate hydration and cooling on hot days. Physicians should become aware of the signs and symptoms of vectorborne illnesses to ensure early treatment and limit spread. Physicians should be aware of the climate and health benefits of active transport and plant-based diets when counseling their patients. Physicians can have a positive impact on climate change awareness and policy by incorporating counseling, public health precepts, and advocacy into their practice.

Concentrations of greenhouse gases continue to accumulate in the atmosphere at increasing rates, pushing Earth's climate further from the stability that has persisted since humans developed civilizations.1 The health consequences of a rapidly changing, less predictable climate are expected to be substantial.


Eighteen of the past 19 years have been the warmest on record.

The five-year average melting in west Antarctica from 2012 to 2017 was three times faster than from 1992 to 1997, putting coastal cities at increasing risk of flooding, enduring inundation, and saltwater contamination of freshwater sources.

As temperate and colder regions experience shorter, warmer winters, insect vectors can expand into new regions. The Centers for Disease Control and Prevention reported a doubling of vectorborne diseases reported from 2004 to 2016.

Air pollution is associated with increased risks of coronary heart disease, myocardial infarction, and stroke, and is associated with increased emergency department visits, chronic obstructive pulmonary disease and asthma exacerbations, and development of respiratory disease.

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Clinical recommendationEvidence ratingComments

Physicians should counsel patients about prevention of heat injuries, including moving to public cooling centers during heat waves, recognizing early symptoms, and taking appropriate actions.8


Recommendation based on a meta-analysis of case-control or cohort studies

Physicians should encourage the use of self-monitoring devices and N95 protective masks, and should counsel patients to stay indoors and avoid intense outdoor exercise in response to air quality alerts.7


Recommendation based on expert opinion

Physicians should encourage walking, jogging, and cycling where safe as means of transportation to improve cardiopulmonary health and reduce stress while reducing air pollution.50


Recommendation based on public health epidemiologic data

Physicians should encourage a plant-based diet to improve health while reducing agricultural pollution and waste.52


Recommendation based on multiple methods of assessment, including prospective trials, epidemiologic research, and modeling studies

Providing climate-smart health care has the potential to save lives by reducing energy, resource use, and associated emissions.5557


Recommendation based on multiple methods of assessment, including prospective trials, epidemiologic research, and modeling studies

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to

The Authors

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CINDY L. PARKER, MD, MPH, is codirector of the Program on Global Sustainability and Health at John Hopkins Bloomberg School of Public Health, Baltimore, Md....

CAROLINE E. WELLBERY, MD, PhD, is a professor in the Department of Family Medicine at Georgetown University School of Medicine, Washington, D.C.

MATTHEW MUELLER, DO, MPH, is an emergency medicine resident at Henry Ford Wyandotte (Mich.) Hospital.

Address correspondence to Cindy L. Parker, MD, MPH, at Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


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1. Pachauri RK, Meyer LA; Groupe d'Experts Intergouvernemental sur l'Evolution du Climat. Climate change 2014: synthesis report: contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Intergovernmental Panel on Climate Change; 2015....

2. Anderegg WR, Prall JW, Harold J, et al. Expert credibility in climate change. Proc Natl Acad Sci U S A. 2010;107(27):12107–12109.

3. IMBIE team. Mass balance of the Antarctic Ice Sheet from 1992 to 2017. Nature. 2018;558(7709):219–222.

4. Reidmiller DR, Avery CW, Easterling DR, et al., eds.; U.S. Global Change Research Program. Impacts, risks, and adaptation in the United States: fourth national climate assessment. November 2018. Accessed May 7, 2019.

5. Di Q, Dai L, Wang Y, et al. Association of short-term exposure to air pollution with mortality in older adults. JAMA. 2017;318(24):2446–2456.

6. Brook RD, Rajagopalan S, Pope CA III, et al.; American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121(21):2331–2378.

7. Huang YC. Outdoor air pollution: a global perspective. J Occup Environ Med. 2014;56(suppl 10):S3–S7.

8. Bouchama A, Dehbi M, Mohamed G, et al. Prognostic factors in heat wave related deaths: a meta-analysis. Arch Intern Med. 2007;167(20):2170–2176.

9. Smith KR, Woodward A, Campbell-Lendrum D, et al.; Intergovernmental Panel on Climate Change. Human health: impacts, adaptation, and co-benefits. In: Climate change 2014: impacts, adaptation, and vulnerability. Cambridge University Press; 2014:709–754.

10. Walsh J, Wuebbles D, Hayhoe K, et al. Appendix 3: climate science supplement. In: Melillo JM, Richmond TC, Yohe GW, eds. Climate change impacts in the United States: the Third National Climate Assessment. U.S. Global Change Research Program; 2014:735–789.

11. Ghiani A, Aina R, Asero R, et al. Ragweed pollen collected along high-traffic roads shows a higher allergenicity than pollen sampled in vegetated areas. Allergy. 2012;67(7):887–894.

12. El Kelish A, Zhao F, Heller W, et al. Ragweed (Ambrosia artemisiifolia) pollen allergenicity: SuperSAGE transcriptomic analysis upon elevated CO2 and drought stress. BMC Plant Biol. 2014;14:176.

13. Rogers CA, Wayne PM, Macklin EA, et al. Interaction of the onset of spring and elevated atmospheric CO2 on ragweed (Ambrosia artemisiifolia L.) pollen production. Environ Health Perspect. 2006;114(6):865–869.

14. Darrow LA, Hess J, Rogers CA, et al. Ambient pollen concentrations and emergency department visits for asthma and wheeze. J Allergy Clin Immunol. 2012;130(3):630–638.e4.

15. American Psychological Association; Climate for Health; ecoAmerica. Mental Health and Our Changing Climate: Impacts, Implications, and Guidance. ecoAmerica; 2017.

16. Schwartz RM, Gillezeau CN, Liu B, et al. Longitudinal impact of Hurricane Sandy exposure on mental health symptoms. Int J Environ Res Public Health. 2017;14(9):957–969.

17. Verplanken B, Roy D. “My worries are rational, climate change is not”: habitual ecological worrying is an adaptive response. PLoS One. 2013;8(9):e74708.

18. Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–649.

19. Strosnider H, Kennedy C, Monti M, et al. Rural and urban differences in air quality, 2008–2012, and community drinking water quality, 2010–2015 – United States. MMWR Surveill Summ. 2017;66(13):1–10.

20. Stocker TF, Qin D, Plattner GK, et al.; Intergovernmental Panel on Climate Change. Climate change 2013: the physical science basis. Accessed February 17, 2019.

21. Kaufman JD, Adar SD, Barr RG, et al. Association between air pollution and coronary artery calcification within six metropolitan areas in the USA (the Multi-Ethnic Study of Atherosclerosis and Air Pollution): a longitudinal cohort study [published correction appears in Lancet. 2016; 388(10045):660]. Lancet. 2016;388(10045):696–704.

22. Mustafić H, Jabre P, Caussin C, et al. Main air pollutants and myocardial infarction. JAMA. 2012;307(7):713–721.

23. Lee KK, Miller MR, Shah AS. Air pollution and stroke. J Stroke. 2018;20(1):2–11.

24. Bayram H, Bauer AK, Abdalati W, et al. Environment, global climate change, and cardiopulmonary health. Am J Respir Crit Care Med. 2017;195(6):718–724.

25. Hutchinson JA, Vargo J, Milet M, et al. The San Diego 2007 wildfires and Medi-Cal emergency department presentations, inpatient hospitalizations, and outpatient visits: an observational study of smoke exposure periods and a bidirectional case-crossover analysis. PLoS Med. 2018;15(7):e1002601.

26. Perera FP. Multiple threats to child health from fossil fuel combustion: impacts of air pollution and climate change. Environ Health Perspect. 2017;125(2):141–148.

27. Medical Society Consortium on Climate and Health. Mission and consensus statement. Accessed October 26, 2018.

28. Centers for Disease Control and Prevention. Climate and health: CDC policy. Accessed October 20, 2018.

29. Centers for Disease Control and Prevention. Protect yourself from wildfire smoke. Accessed October 20, 2018.

30. Environmental Protection Agency. Wildfire smoke factsheet: protect your lungs from wildfire smoke or ash. Accessed October 20, 2018.

31. NASA Global Climate Change. Vital signs of the planet: global temperature. Accessed March 11, 2019.

32. Knowlton K, Rotkin-Ellman M, King G, et al. The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect. 2009;117(1):61–67.

33. Lam HC, Chan JC, Luk AO, et al. Short-term association between ambient temperature and acute myocardial infarction hospitalizations for diabetes mellitus patients: a time series study. PLoS Med. 2018;15(7):e1002612.

34. Flynn A, McGreevy C, Mulkerrin EC. Why do older patients die in a heat-wave? QJM. 2005;98(3):227–229.

35. Cedeño Laurent JG, Williams A, Oulhote Y, et al. Reduced cognitive function during a heat wave among residents of non-air-conditioned buildings: an observational study of young adults in the summer of 2016. PLoS Med. 2018;15(7):e1002605.

36. Thompson R, Hornigold R, Page L, et al. Associations between high ambient temperatures and heat waves with mental health outcomes: a systematic review. Public Health. 2018;161:171–191.

37. World Health Organization. Public health advice on preventing health effects of heat: new and updated information for different audiences. Accessed October 31, 2018.

38. Gupta S, Carmichael C, Simpson C, et al. Electric fans for reducing adverse health impacts in heatwaves. Cochrane Database Syst Rev. 2012;(7):CD009888.

39. Osborne NJ, Alcock I, Wheeler BW, et al. Pollen exposure and hospitalization due to asthma exacerbations: daily time series in a European city. Int J Biometeorol. 2017;61(10):1837–1848.

40. Zhang F, Krafft T, Zhang D, et al. The association between daily out-patient visits for allergic rhinitis and pollen levels in Beijing. Sci Total Environ. 2012;417–418:39–44.

41. Spengler JD, Adgate JL, Busalacchi AJ Jr, et al. Dampness, moisture, and flooding. In: Climate Change, the Indoor Environment, and Health. National Academies Press; 2011:133–154.

42. Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases — United States and territories, 2004–2016. MMWR Morb Mortal Wkly Rep. 2018;67(17):496–501.

43. Centers for Disease Control and Prevention. Ticks: on people. Accessed October 25, 2018.

44. Centers for Disease Control and Prevention. Prevent mosquito bites. Accessed October 25, 2018.

45. Gillies D, Maiocchi L, Bhandari AP, et al. Psychological therapies for children and adolescents exposed to trauma. Cochrane Database Syst Rev. 2016;(10):CD012371.

46. Hayes K, Blashki G, Wiseman J, et al. Climate change and mental health: risks, impacts and priority actions. Int J Ment Health Syst. 2018;12:28.

47. Husk K, Lovell R, Cooper C, et al. Participation in environmental enhancement and conservation activities for health and well-being in adults: a review of quantitative and qualitative evidence. Cochrane Database Syst Rev. 2016;(5):CD010351.

48. Allen M, Babiker M, Chen Y, et al.; Intergovernmental Panel on Climate Change. Special report: global warming of 1.5°C: summary for policymakers. Accessed October 20, 2018.

49. Barrett B, Charles JW, Temte JL. Climate change, human health, and epidemiological transition. Prev Med. 2015;70:69–75.

50. Maizlish N, Woodcock J, Co S, et al. Health cobenefits and transportation-related reductions in greenhouse gas emissions in the San Francisco Bay area. Am J Public Health. 2013;103(4):703–709.

51. Zeraatkar D, Han MA, Guyatt GH, et al. Red and processed meat consumption and risk for all-cause mortality and cardiometabolic outcomes: a systematic review and meta-analysis of cohort studies [published online October 1, 2019]. Ann Intern Med. Accessed October 18, 2019.

52. Estruch R, Ros E, Salas-Salvadó J, et al.; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34.

53. Springmann M, Godfray HC, Rayner M, et al. Analysis and valuation of the health and climate change cobenefits of dietary change. Proc Natl Acad Sci U S A. 2016;113(15):4146–4151.

54. Barrett B, Grabow M, Middlecamp C, et al. Mindful climate action: health and environmental co-benefits from mindfulness-based behavioral training. Sustainability. 2016;8(10):1040.

55. Eckelman MJ, Sherman J. Environmental impacts of the U.S. health care system and effects on public health. PLoS One. 2016;11(6):e0157014.

56. Frumkin H, Coussens C; Institute of Medicine. Green Healthcare Institutions: Health, Environment, and Economics. National Academies Press; 2007.

57. Joy EA, Horne BD, Bergstrom S. Addressing air quality and health as a strategy to combat climate change. Ann Intern Med. 2016;164(9):626–627.

58. American Academy of Family Physicians. Environmental health and climate change. Accessed October 22, 2019.

59. Carameli KA, Eisenman DP, Blevins J, et al. Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers. Disaster Med Public Health Prep. 2013;7(3):257–265.

60. Centers for Disease Control and Prevention. Natural disasters and severe weather: chronic conditions. Accessed October 31, 2018.

61. Tomio J, Sato H. Emergency and disaster preparedness for chronically ill patients: a review of recommendations. Open Access Emerg Med. 2014;6:69–79.

62. Ryan B, Franklin RC, Burkle FM Jr, et al. Identifying and describing the impact of cyclone, storm and flood related disasters on treatment management, care and exacerbations of non-communicable diseases and the implications for public health. PLoS Curr. 2015;7.

63. Arrieta MI, Foreman RD, Crook ED, et al. Providing continuity of care for chronic diseases in the aftermath of Katrina: from field experience to policy recommendations. Disaster Med Public Health Prep. 2009;3(3):174–182.

64. Haq C, Stiles M, Rothenberg D, et al. Effective advocacy for patients and communities. Am Fam Physician. 2019;99(1):44–46. Accessed September 12, 2019.

65. Parker CL. Slowing global warming: benefits for patients and the planet. Am Fam Physician. 2011;84(3):271–278. Accessed September 12, 2019.



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