Curbside Consultation
Climate Change and the Local Environment: Communicating with Your Patients about Health Impacts
Am Fam Physician. 2021 Nov ;104(5):526-530.
Case Scenario
I have a patient, K.B., with a three-year history of asthma. The patient's parent is concerned because K.B. wakes every night coughing. The family just moved to an apartment that does not have air conditioning and has received several code violations for a leaking roof and windows. The apartment is located next to two major interstate highways and is 10 miles from a cement factory. Air quality has reached the orange zone several times this month, and pollen levels have been consistently high for several months. I have provided the parent with an Asthma Action Plan and updated K.B.'s medications according to current guidelines. I believe that the environmental factors exacerbate or even cause my patient's condition, so how do I talk with the family about these issues over which they have little or no control? How do I talk with a patient about issues such as air pollution or climate change and their impacts on health?
Commentary
This case provides an example of how the environment can have significant impacts on the health of our patients. It also illustrates the complex interaction of local, regional, and global environmental harms. The wide scope of environmental threats to human health presents challenges in managing patients who are increasingly affected by climate-related changes, including severe weather events, extreme heat, worsening air quality, increasing allergens, changes in vector ecology, water quality, food and water supply, and environmental degradation.1
The effects of climate change on individual and entire population health are well established.2,3 Many of these effects, especially those related to disruption of infrastructure, heat, and air pollution, are regional.4 Health harms disproportionately affect children, pregnant people, older adults, and those with limited resources and/or populations who are marginalized who have been disproportionately exposed to unhealthy environments due to a history of discriminatory policies. When wondering whether and how these health impacts should be discussed with a patient, physicians should be knowledgeable about the daily life and circumstances of the patient and trust that patients recognize their family physicians as credible sources of information and support.
GENERAL CONSIDERATIONS BEFORE INITIATING DISCUSSIONS
Although only limited evidence is available to guide clinicians on broaching discussions about climate change with patients, it can be helpful to remember that health care professionals, including physicians and nurses, have powerful voices and are among the most trusted individuals according to populations surveyed in the United States.5,6 Physicians also have an ethical obligation to discuss climate concerns with their patients7 because climate change has been determined as a health emergency and is identified as the greatest public health threat of our century.8,9 Finally, physicians hesitant to provide advice about environment and health should take solace from data showing that more than three-fourths of the U.S. adult population would support climate solutions if they benefited personal or public health.10,11 A patient-centered approach to such discussions addresses patients' specific health concerns while exploring their receptivity to a larger, climate-informed treatment plan. Table 1 suggests approaches to common physician concerns about conducting climate change conversations in the office setting.1,3,12–17
Concerns and Considerations about Climate Counseling with Patients
| Practical concerns | Counseling considerations |
|---|---|
How does climate change impact the health of my patients? | The health effects of climate change are well documented on the Centers for Disease Control and Prevention and World Health Organization websites1,12; in a report created by the Medical Society Consortium on Climate and Health13; and by summary reports published in The Lancet, Annals of Internal Medicine, and Pediatrics.3,14,15 |
Do I have enough time to incorporate one more topic into my visits? | Physicians should prioritize which patient counseling topics to address and how to address them effectively and efficiently for each patient. Physicians should seek resources and determine the best ways to incorporate priority topic(s) into well-visit and problem-visit workflows. Consistent, simple, clear, and tailored messaging is recommended.16 Counseling generally should be brief (less than one minute) to improve patient receptivity. |
Reimbursement and federal standards | Although no International Classification of Diseases-10 (ICD-10) codes currently reimburse for environmental justice–related activities, experts are currently working with federal leaders to incorporate the topic into the Centers for Medicare and Medicaid Services standards. This may ultimately influence reimbursement by other payors, quality assurance standards, and health systems |
References
show all references1. Centers for Disease Control and Prevention. Climate effects on health. Updated March 2, 2021. Accessed September 26, 2021. https://www.cdc.gov/climateandhealth/effects/default.htm...
2. Frumkin H, Haines A. Global environmental change and noncommunicable disease risks. Annu Rev Public Health. 2019;40:261–282.
3. Watts N, Amann M, Arnell N, et al. The 2020 report of The Lancet Countdown on health and climate change [published correction appears in Lancet. 2021;397(10269):98]. Lancet. 2021;397(10269):129–170.
4. Centers for Disease Control and Prevention. Preparing for the regional health impacts of climate change in the United States; July 2020. Accessed April 8, 2021. https://www.cdc.gov/climateandhealth/docs/Health_Impacts_Climate_Change-508_final.pdf
5. Funk C, Gramlich J. Amid coronavirus threat, Americans generally have a high level of trust in medical doctors; March 13, 2020. Accessed April 8, 2021. https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-level-of-trust-in-medical-doctors
6. Boland TM, Temte JL. Family medicine patient and physician attitudes toward climate change and health in Wisconsin. Wilderness Environ Med. 2019;30(4):386–393.
7. Alame D, Truog RD. How should clinicians weigh the benefits and harms of discussing politicized topics that influence their individual patients' health? AMA J Ethics. 2017;19(12):1174–1182.
8. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet. 2015;386(10006):1861–1914.
9. Atwoli L, Baqui AH, Benfield T. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health [editorial]. Med J Aust. 2021;215(5):210–212.
10. Hill N. American climate perspectives survey 2021, Vol. II. Health surpasses jobs in climate action support. March 2, 2021. Accessed September 27, 2021. https://ecoamerica.org/american-climate-perspectives-survey-2021-vol-ii/
11. Reinhart RJ. Nurses continue to rate highest in honesty, ethics. January 6, 2020. Accessed September 27, 2021. https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx
12. World Health Organization. Climate change. Accessed September 26, 2021. https://www.who.int/health-topics/climate-change#tab=tab_1
13. Sarfaty M, Gould RJ, Maibach EW; Burness. Medical alert! Climate change is harming our health. Updated August 15, 2017. Accessed September 26, 2021. https://medsocietiesforclimatehealth.org/wp-content/uploads/2017/03/gmu_medical_alert_updated_082417.pdf
14. Crowley RA; Health and Public Policy Committee of the American College of Physicians. Climate change and health: a position paper of the American College of Physicians. Ann Intern Med. 2016;164(9):608–610.
15. Council on Environmental Health. Global climate change and children's health. Pediatrics. 2015;136(5):992–997.
16. Maibach EM. Increasing public awareness and facilitating behavior change: two guiding heuristics. In: Lovejoy TE, Hannah LJ, eds. Biodiversity and Climate Change: Transforming the Biosphere. Yale University Press; 2019: 336–346.
17. U.S. call to action on climate, health, and equity: a policy action agenda; 2019. Accessed September 27, 2021. https://climatehealthaction.org/cta/climate-health-equity-policy
18. Krygsman K, Speiser M. Let's talk health & climate: communication guidance for health professionals. Accessed June 26, 2021. https://ecoamerica.org/wp-content/uploads/2017/03/3_letstalk_health_and_climate.pdf
19. Bebinger M. Has your doctor asked you about climate change? July 19, 2019. Accessed June 26, 2021. https://khn.org/news/has-your-doctor-asked-you-about-climate-change
20. Powell A. Heatwave = heat stroke = ER visit; February 10, 2020. Accessed August 3, 2021. https://news.harvard.edu/gazette/story/2020/02/connecting-the-dots-between-climate-change-and-health-care
21. Lewandowski AA, Sheffield PE, Ahdoot S, et al. Patients value climate change counseling provided by their pediatrician: the experience in one Wisconsin pediatric clinic. J Clim Change Health. 2021;4:100053.
22. Westaway K, Frank O, Husband A, et al. Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather. J Clin Pharm Ther. 2015;40(4):363–367.
23. National Institute for Health and Care Excellence. NICE encourages use of greener asthma inhalers; April 8, 2019. Accessed August 3, 2021. https://www.nice.org.uk/news/article/nice-encourages-use-of-greener-asthma-inhalers
24. Lancet Countdown on Health and Climate Change: policy brief for the United States of America; December 2020. Accessed September 27, 2021. https://www.lancetcountdownus.org/2020-lancet-countdown-u-s-brief
25. Tessum CW, Apte JS, Goodkind AL, et al. Inequity in consumption of goods and services adds to racial–ethnic disparities in air pollution exposure. Proc Natl Acad Sci U S A. 2019;116(13):6001–6006.
26. Tessum CW, Paolella DA, Chambliss SE, et al. PM2.5 polluters disproportionately and systemically affect people of color in the United States. Sci Adv. 2021;7(18):eabf4491.
27. Bullard R, Gardezi M, Chenault C, et al. Climate change and environmental justice: a conversation with Dr. Robert Bullard; 2016. Accessed August 3, 2021. https://www.iastatedigitalpress.com/jctp/article/566/galley/446/view
28. Macpherson CC, Wynia M. Should health professionals speak up to reduce the health risks of climate change? AMA J Ethics. 2017;19(12):1202–1210.
29. Epperley T, Bechtel C, Sweeney R, et al. The shared principles of primary care: a multistakeholder initiative to find a common voice. Fam Med. 2019;51(2):179–184.
Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Materials are edited to retain confidentiality.
This series is coordinated by Caroline Wellbery, MD, associate deputy editor.
A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.
Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.
Copyright © 2021 by the American Academy of Family Physicians.
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