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Am Fam Physician. 2019;100(10):602-603

Related editorial: Climate Change: What the Science Tells Us

Author disclosure: No relevant financial affiliations.

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.

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