The Changing Climate: Managing Health Impacts

Cindy L. Parker; Caroline Wellbery; Matthew Mueller

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Nov 15, 2019 Issue

The Changing Climate: Managing Health Impacts

CINDY L. PARKER, MD, MPH, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

CAROLINE E. WELLBERY, MD, PhD, Georgetown University School of Medicine, Washington, District of Columbia

MATTHEW MUELLER, DO, MPH, Henry Ford Wyandotte Hospital, Wyandotte, Michigan

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

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.

WHAT'S NEW ON THIS TOPIC

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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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	Comments
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	C	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	C	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	C	Recommendation based on public health epidemiologic data
Physicians should encourage a plant-based diet to improve health while reducing agricultural pollution and waste.⁵²	C	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.^55–57	C	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 https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation	Evidence rating	Comments
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	C	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	C	Recommendation based on expert opinion
Physicians should encourage walking, jogging, and cycling where safe as means of transportation

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 cindyparker@jhu.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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