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Healthcare Should Address Climate Change Emergency, Authors Say

Allison Inserro
It's time for doctors and healthcare systems to act on climate change, said a pair of articles in The New England Journal of Medicine, before public health consequences become too dire. 
A call to action published in The New England Journal of Medicine (NEJM) on Wednesday says it’s time for healthcare professionals and governments to act immediately to address climate change because of the growing consequences to public health.

A brief review article recaps the overwhelming evidence that unless governments act cohesively and urgently, warming temperatures by the year 2100 (81 years from now) will cause increases in illness and death stemming from heat-related illnesses, bad air quality, poor nutrition from reduced food quality and security, an increase in vectorborne diseases, and economic impacts from reduced worker productivity.1

The article was released on the same day that 2 former surgeon generals, one appointed by a Democrat and one appointed by Republican, wrote an opinion piece about the issue, saying climate change is already affecting human health, including the mental health of communities in the aftermath of repeated disasters like hurricanes and wildfires.  

In an interview with The American Journal of Managed Care® (AJMC®), Andy Haines, MD, said the intent of the NEJM article is to bring healthcare professionals up-to-date on the issue and urge them to be proactive in interactions with patients.

“In terms of greenhouse emissions, we’re on an emission pathway which would take us to about 3 degrees [Celsius] warmer by the end of the century, 3 degrees [higher] compared with preindustrial times," said Haines, the lead author.

Haines added that warming will happen without implementing the agreements made in the Paris climate change accord, which called for nations to act to keep global temperature from rising more than 2 degrees Celsius, or 3.6 degrees Fahrenheit, above preindustrial levels, and ideally not more than 1.5 degrees Celsius.

“We’re already headed above where we need to be,” said Haines, a professor of environmental change in public health at the London School of Hygiene and Tropical medicine. “We need to build on the Paris agreement, recognizing that some nations are more committed than others.”

President Donald Trump announced last year that he would pull the United States out of the Paris pact, although The Washington Post recently noted that the withdrawal is a long process, and one that would not take affect until a day after the 2020 election, which sets up climate change as a major campaign issue next year.  The administration also rolled back the Clean Power Plan, which set limits on coal-fired power plants.

Democrats, pushed by newly elected Congresswoman Alexandria Ocasio-Cortez, D-New York, are starting to join a call for a “Green New Deal,” which calls for, among other things, transitioning to completely renewable energy. The focus on the environment became prominent after the October 2018 Intergovernmental Panel on Climate Change report from the United Nations, which the environment affects of climate change are accelerating and 

While Haines said he did not know the specifics of her plan, he said, “I think moving rapidly towards a zero-carbon economy is a good way to go. That means investing more in renewable energy,” he said, as well as moving toward lower-emission or zero-emission vehicles. Those steps should be taken “as fast as is practical to do so,” said Haines. 

Currently, ambient air pollution and household air pollution are estimated to be responsible for about 6.5 million premature deaths a year, but the number could be even higher. Action on climate change could reduce the number of premature deaths by 1.3 million in 2050.

In the accompanying NEJM Perspective piece, 2 American physicians called the issue “a health emergency.” 2

“Working to rapidly curtail greenhouse gas emissions is now essential to our healing mission,” wrote Caren G. Solomon, MD, MPH and Regina C. LaRocque, MD, MPH. It’s time, they wrote, for physicians to start educating their patients about the health risks of climate change as well as becoming advocates, whether writing legislators were meeting with them in person.

Haines said he hopes the healthcare industry “takes notice” of the request. “We do see, around the world, a growing number of professional organizations very concerned about the effects of climate change on health and becoming increasingly committed to doing something about it.”

Commitment to action is taking place both within the healthcare system itself, in terms of trying to reduce “the environmental footprint” of institutions, as well as by personal example, which in turn, can help improve individual health. Where it is appropriate to do so, he said, physicians can advise patients to walk, bike, take public transportation, and eat more fruits and vegetables instead of red meat, in order to improve their health, as well as their individual carbon footprints.

However, socioeconomic disparities affect how much this can be accomplished, even when trying to guide someone who is at risk for diabetes or is obese. Haines noted that telling someone to eat more fresh fruits and vegetables is not practical if they live in a food desert where none are available at an affordable price. “We need more policies that will make the healthy option the affordable option,” he said.

“Healthcare providers have very high credibility with the public, so can be key voices when there are questions on the health risks of climate change,” said his coauthor, Kristie Ebi, MPH, PhD, in an email to AJMC®. Healthcare makes up about 10% of the emissions produced in the United States, and some systems are already moving to change this, including Kaiser Permanent, Partners HealthCare, Boston Medical Center, as well as Gundersen Health System, which now produces more energy than it consumes.  

In addition, healthcare providers can increase their own awareness in order to be better prepared for emerging health threats, as tick and mosquito-borne borne diseases (such as Lyme or dengue fever) move northward to new locations, the authors said.

References

1. Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med. 2019;380:263-73. doi: 10.1056/NEJMra1807873.

2. Solomon CG, LaRocque RC. Climate change — a health emergency. N Engl J Med. 2019;380:209-211. doi: 10.1056/NEJMp1817067

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