Fifteen million Californians and half of the state’s children depend on Medi-Cal, but our health care system is in crisis. Hospitals are closing, emergency rooms are overcrowded and patients wait months to see a doctor.
That’s why the California Medical Association is joining Planned Parenthood, community health centers and hospitals, and hundreds of organizations to support #Yeson35. Prop 35 will support Medi-Cal and provide dedicated resources to improve patient care – without raising taxes.
Yes on 35 to protect Medi-Cal, California families and children, and access to health care.
In this issue
SCCMA is a professional association representing over 4,500 physicians in all specialties, practice types, and stages of their careers. We support physicians like you through a variety of practice management resources, coding and reimbursement help, training, and up to the minute news that could affect your practice. The Bulletin is our quarterly publication.
Santa Clara County Medical Association
SCCMA OFFICERS
President | Gloria Wu, MD
President-elect | Fahd Rahman Khan, MD
Secretary | Randal Pham, MD
Treasurer | Shahram Gholami, MD
Immediate Past President | Anlin XU, MD
VP-Community Health | Santosh Pandipati, MD
VP-External Affairs | Christine Doyle, MD
VP-Member Services | Sam Wald, MD
VP-Professional Conduct | Lewis Osofsky, MD
SCCMA STAFF
CEO/Executive Director | Marc E. Chow, MS
Director of Membership & Programs | Angelica Cereno
Governance & Advocacy Associate | Emily Coren
Facilities & IT Manager | Andie Campanilla
Executive Assistant | Rashida Mirza
SCCMA COUNCILORS
El Camino Hospital of Los Gatos | Jaideep Iyengar, MD
El Camino Hospital – Mountain View | Carol A. Somersille, MD
Good Samaritan Hospital | CK Park, MD
Kaiser Foundation Hospital - San Jose | Veena Vanchinathan, MD
Kaiser Permanente Hospital - Santa Clara | OPEN
O’Connor Hospital | OPEN
Regional Medical Center | Raj Gupta, MD
Saint Louise Regional Hospital | Kevin Stuart, MD
Santa Clara Valley Medical Center | Patricia Salmon, MD
Stanford Health Care/Children’s Health | Karen Kim, MD
Managing Editor | Emily Coren
Production Editor | prime42 – Design | Market | Host
Opinions expressed by authors are their own, and not necessarily those of The Bulletin or SCCMA. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA of products or services advertised. The Bulletin and SCCMA reserve the right to reject any advertising.
Address all editorial communication, reprint requests, and advertising to:
Emily Coren, Managing Editor
700 Empey Way
San Jose, CA 95128
408/998-8850
Fax: 408/289-1064
A Message from the President
Gloria Wu, MD SCCMA President
Where once the responsibility to manage patient health was centered on individual behavior, we now clearly see that places we live and the social and ecological determinants shape population health. They are the intertwined arms of health equity. As we strive to build healthier and more equitable communities, it’s imperative that we build stronger safeguards for the environmental impacts that influence our own health and the health of our patients.
Environmental health challenges today are interconnected and complex. Key environmental health issues include climate change, air pollution, water quality, chemical exposures, biodiversity loss, food safety and occupational hazards. The climate crisis is a public health and equity crisis. It compounds the impacts of air quality, water resources, food security, and the spread of diseases. Health impacts include more frequent and severe natural disasters such as heat waves and floods. Insect borne illnesses are increasing and compounding resource scarcity worsen historical health disparities. Outdoor and indoor air pollution continue to be major public health concerns, as noted in the World Health Organization article Empowering health professionals for clean air and better health. Contamination of water sources with pollutants such as heavy metals, chemicals, and pathogens poses serious risks to human health, such as the high mercury concentration in the fish in the San Francisco Bay. Widespread use of chemicals in industry, agriculture, and households has led to increased exposure to harmful substances such as persistent organic pollutants and endocrine disruptors. These toxic chemicals have long-term effects on human health, including cancer, reproductive issues, and developmental disorders.
Disadvantaged communities often bear a disproportionate burden of environmental hazards. Health equity closely ties together policies that impact vulnerable populations, who often suffer disproportionately from environmental hazards. This includes supporting environmental justice initiatives that gradually improve communities access to clean air, water, and safe living conditions. Advocacy in environmental social justice requires coordinated global efforts, including policy changes, technological innovations, public awareness, and sustainable practices across all sectors, and benefits highly from the trusted voices of us,
as physician leaders.
Physician advocacy can play a crucial role in improving environmental health policies by leveraging the medical community’s expertise, credibility, and influence to shape public policy and public opinion. Physician advocacy can support and enhance environmental health policies.
Public outreach and education - As trusted sources of information, physicians can educate their patients, communities, and the broader public about the links between environmental factors and health outcomes. By highlighting the health impacts of pollution, climate change, and other environmental issues, they can contribute to building public support for stronger environmental policies.
Media Engagement - Physicians can write opeds, participate in interviews, and use social media to raise awareness about environmental health issues, bringing these topics to the forefront of public discourse.
Legislative Advocacy - Physicians can provide expert testimony in legislative hearings and informal meetings with policymakers offering evidence-based perspectives on how environmental factors impact public health.
Guiding the policy of professional organizations - Medical associations, such as the American Medical Association (AMA) and California Medical Association (CMA) issue policy statements such as the Major Issue Report produced by CMA in 2023 on Climate Change. Participating in these groups leads the direction and pace of environmental policies in the healthcare industry.
Physician Training - Leading Physicians can advocate for their professional organizations to prioritize environmental health in medical education, ensuring that upcoming generations of physicians are equipped to engage in this area.
We invite you, here in Santa Clara County, into the ongoing advocacy work to improve air quality, reduce artificial turf, expand greenspace and decrease the direct carbon emissions of the healthcare industry as we work together to build a safer, more equitable Santa Clara.
Environmental Health Committee
Are you a doctor in Santa Clara County who wants to advocate for healthier environment? We are now advocating for:
Climate Change
Clean Air
Clean Water
Reduced Environmental Toxins
CINDY RUSSELL, MD Co-Chair SCCMA Environmental Health Committee
The ancient Greeks believed that four classical elements, Earth, Water, Air, and Fire, made up all matter, living and non-living, in the universe. This was the cornerstone of philosophy, science, and medicine for about two thousand years and nearly all early civilizations adopted a variation of this world view. Humans lived close to nature and conceived that they were part of it, along with the astounding diversity of creatures on earth, water and in the air. Many indigenous cultures, without the benefit of modern science, observed, respected and protected the relationships between these elements in order for future generations to survive. The Earth was their Mother.
Science has given us an understanding of the world, deep into the molecular level and far into the atmosphere, creating many conveniences and advances for the benefit of humans, however, it appears we have disconnected, and turned our backs on the source of our survival, a healthy biodiverse planet, our Mother Earth. We are at a critical time in our existence to adopt a broader and more connected view of our relationship with the Earth, understanding and changing our monolithic impact on these classical elements of Earth, Water, Air, and Climate (Fire).
One Planet
This is the only planet we know of that sustains life. The Earth’s biosphere functions are at risk as we hit planetary boundaries that will shift us out of the warm interglacial Holocene period, which allowed humans to flourish and “civilize”. These nine processes, critical for maintaining the stability and resilience of Earth’s systems within a Planetary Boundaries Framework, were developed by 28 scientists in 2009 (Richardson 2023). Earth is already beyond 6 of them.
Nine Planetary Boundaries
• Climate change
• Change in biosphere integrity (biodiversity loss and species extinction)
• Stratospheric ozone depletion
• Ocean acidification
• Biogeochemical flows (phosphorus and nitrogen cycles)
• Land-system change (for example deforestation)
• Freshwater use
• Atmospheric aerosol loading (microscopic particles in the atmosphere that affect climate and living organisms)
• Introduction of novel entities
Since human evolution, we have been very fortunate to live in this particular 10,000-year period of post ice age Earth warming, with CO2 levels cycling between a comfortable 200-300 ppm. Things are getting a little too hot right now as CO2 emissions continue to rise, however, and in 1990 we overshot the 350 ppm CO2 goal that renowned climatologist James Hansen said is “the level on which civilization developed and to which
life on Earth is adapted.” At the current level of 420 ppm CO2 we have already seen 1.1 degrees C (2 degrees F) of warming above pre-industrial levels. In 2016, the Intergovernmental Panel on Climate Change (IPCC) said that a CO2 level of 430 ppm would push the world past its target for avoiding dangerous climate change. We are fast approaching that number in the next few short years, which continue to be filled with politics and preoccupation, instead of a focus on the prize, our planet. We need to get back down to Earth and back down to 1990 levels pretty fast.
Surprisingly (or not), the Institute for European Environmental Policy notes that, more than half of all CO2 emissions poured into the atmosphere since 1751 were emitted in the last 30 years. We just kept on with business as usual, despite knowing the risks. In fact, it is well documented that oil executives learned in 1959, from their own scientists, that burning fossil fuels would contribute to anthropogenic climate change. A Georgetown University publication, Defense, Denial, and Disinformation: Uncovering the Oil Industry’s Early Knowledge of Climate Change, spells the history very succinctly. The oil industry claimed decades ago that they, “will combat climate change by continuing to produce oil and gas in order to fuel economic growth and foster technological innovation.” (Taylor 2023)
Pre-Industrial Planetary Boundaries OK for 9,000 years
Planetary boundaries are directly related to deforestation, consumption, population and modernization. Pre-industrial humans did increase the carbon in the atmosphere by about 20 ppm by cutting forests for agriculture, but they lived simply (Wood 2018). Modern man has taken it to a whole new level, adding a whopping 120 ppm CO2 in less than 200 hundred years, going from 300 ppm to 420 ppm CO2 today. These levels are the highest recorded atmospheric CO2 levels in 14 million years, and due primarily from fossil fuel combustion and industrial processes, with the highest growth from fluorinated gases used in many cooling products. (Sovacool 2021) Being very intelligent creatures, humans innovate, create and build systems, and that is a good thing. We however, seem to lack in deliberation of the consequences of our actions, or taking thoughtful precautions with our “advances” in technology.
We seem drawn to the shiny new thing that will make our lives easier and better for us and the economy, without considering the full repercussions of production, use and waste on other humans and the environment. As a result, humans have unleashed of a number of convenient technologies that we are now forced to rethink, and which are causing us to live beyond Earth’s means. Voluntary simplicity may be the new norm cast upon us. It will be by design or by crisis. We may have to consider changing our habits and our economic principles to create a “safe operating space for humanity”. That is the challenge
ahead. Paraphrasing, “Ask not what our planet can do for you, but what can you do for your planet.”
Hope for the Future: Physicians Leading the Way
There is hope, many physician groups (and many others) are, indeed, diligently working on this effort. Medical organizations include:
The Medical Society Consortium on Climate Change and Health; Climate Health Now; Health Care Without Harm; Practice Green Health; Clean Med; Physicians for Social Responsibility; UCSF Center for Climate Health and Equity; Center for Climate Change and Health, and also the California Medical Association, that discussed and created policy on climate change as a major issue at the 2023 CMA House of Delegates, driven by their physician members and medical students.
It is both inspiring and encouraging that physicians, younger and older and in all types of practices, are educating themselves and others about this issue, in order to bring about positive change for our patients, communities and the planet. All on hands on deck for climate change. Anything and everything we do makes a difference.
“Human activities, principally through emissions of greenhouse gases, have unequivocally caused global warming, with global surface temperature reaching 1.1°C above 1850-1900 in 2011-2020. Global greenhouse gas emissions have continued to increase, with unequal historical and ongoing contributions arising from unsustainable energy use, land use and land-use change, lifestyles and patterns of consumption and production across regions, between and within countries, and among individuals (high confidence).” IPCC 2023
The European Union is Already Reducing CO2
Greenhouse gas emissions need to be sharply and rapidly curbed, specifically carbon dioxide, methane and the growing use of fluorinated gases (super pollutants) for refrigeration and air conditioning. The goal of the Paris Agreement of 2015 is to limit the temperature increase before it reaches1.5 degrees Celsius. This means that “greenhouse gas emissions must peak before 2025 at the latest and decline 43% by 2030.” (IPCC). In addition, the best-case scenario for the planet is to reach Net Zero carbon emissions by 2050. Net Zero means that the amount of carbon emitted is equal to that absorbed in natural, and if feasible manmade, carbon sinks.
The European Union took robust action against climate change, resulting in a more than 31% drop in EU emissions in 2022 compared with 1990. This was largely due to switching to renewables and using less fossil fuel. Capturing wasted methane from natural gas production was also successful.
High Tech and Low Tech Solutions
The technological answers to reduce carbon emissions are not always straightforward, as these systems are costly, energy-intensive and can release substantial carbon and GHG in a life–cycle analysis. Energy efficiency with ‘integrative design’ is at the core of this movement, as it is less costly and less extractive (Lovins RMI, 2018). A holistic and honest cost accounting of the net carbon output is necessary, so we do not substitute one regrettable energy source with another that uses more resources and carbon, thus delaying truly effective solutions that will be measured directly by lower CO2 in the atmosphere and not just a piece of paper, trading promises (WRI 2023).
Non-technologic strategies, that are cost effective, that we can adopt immediately are - halting deforestation, using land sustainably, restoring nature by rewilding, soil regeneration with organic agriculture, using low tech transportation, flying less and consuming less. Conserving energy is the cornerstone of mitigation for us all. Reduce, reuse, recycle, refuse, repair, restore, rethink, redesign, repurpose.
Source Locally…Buy Locally Grow locally…Eat Locally It is all important.
In This Issue
This special publication of the Bulletin will again focus on climate change and related environmental issues, focusing on solutions. Authors will discuss health care decarbonization, artificial turf, electrification, energy use of technology, public health and climate change, California native plants and more. We hope you enjoy it.
You’re Invited! Environment and Health Webinar Series 2024
The SCCMA Environmental Health Committee is pleased to present their second Environment and Health Webinar series and you are invited to join the conversation. More voices, more viewpoints, better decisions and more action.
To register go to the SCCMA.org website and the information will be on the front page under Upcoming Events. Videos will later be posted on the SCCMA website under Resources then Webinars-SCCMA. The webinars are listed below.
Note: The SCCMA Environmental Health Committee is working on all aspects of protecting Earth, Water, Air and Climate. So far, we have adopted policy recommendations for Safe Technology in Schools and Artificial Turf. You can access these via the SCCMA website under Programs then Environmental Health.
• Oct 1 - Artificial Turf on Sports Fields: Promise or Peril?
• Oct 15 - Environmental Toxins- Environmental Illness: Root Causes and Prevention
References
• Earth beyond six of nine planetary boundaries. Richardson K et al. SCIENCE ADVANCES 13 Sep 2023, Vol 9, Issue 37. https://www.science.org/doi/10.1126/sciadv.adh2458
• A safe operating space for humanity Rockström J et al. Nature 461, 472–475 (2009). https://pubmed.ncbi.nlm. nih.gov/19779433/
• Planetary boundaries: Guiding human development on a changing planet. Steffen W et al.
• We would need at least three planets if everyone lived and consumed like the average European today. https://sustainabilityguide.eu/sustainability/planetary-boundaries/
• How many Earths do we need? BBC. June 16, 2015. Charlotte McDonald https://www.bbc.com/news/magazine-33133712
• World Energy Use Over Time. https://yearbook.enerda-
• Energy in the United States: Overview and key statistics. The Journalist Resource. April 19, 2012. https:// journalistsresource.org/environment/u-s-energy-overview-key-statistics-2012/
• Energy Production and Consumption. Our World Data. https://ourworldindata.org/energy-production-consumption
• China: Energy Country Profile. Access to Electricity Our World Data. https://ourworldindata.org/energy/country/ china
• Ancient humans may have shaped the planet with fire and rice. July 20, 2018. Sicence Line. Charlie Wood. https://scienceline.org/2018/07/ancient-humans-may-haveshaped-the-planet-with-fire-and-rice/
• More than half of all CO2 emissions since 1751 emitted in the last 30 years. Institute for European Environmental Policy. April 29, 2020. https://ieep.eu/news/ more-than-half-of-all-co2-emissions-since-1751-emitted-inthe-last-30-years/
• Defense, Denial, and Disinformation: Uncovering the Oil Industry’s Early Knowledge of Climate Change. Oct 25, 2023. Charlotte Taylor. https://commonhome.georgetown.edu/topics/climateenergy/defense-denial-and-disinformation-uncovering-the-oil-industrys-early-knowledge-of-climate-change/
• Early oil industry disinformation on global warming. Benjamine Franta. Environmental Politics. Jan 5, 2021. https://www.tandfonline.com/doi/full/10.1080/09644016.20 20.1863703
• The Medical Society Consortium on Climate and Health https://medsocietiesforclimatehealth.org/
• Climate Health Now. https://climatehealthnow.org/
• Health Care Without Harm. https://noharm.org/
• Physicians for Social Responsibility. https://psr.org/
• Clean Med. https://cleanmed.org/
• UCSF Center for Climate health and Equity. https:// climatehealth.ucsf.edu
• Center for Climate Change and Health. https://climatehealthconnect.org
• Practice Green Health. https://practicegreenhealth.org
• Health Professionals for a Healthy Climate. https:// hpforhc.org/our-work/collaborators/
• Our World Data. CO2 Emissions. https://ourworldindata.org/co2-emissions
• Carbon dioxide concentrations in the atmosphere. https://ourworldindata.org/grapher/co2-long-term-concentration
• Major issues reports posted for CMA’s 2023 House of Delegates. 2023. https://www.cmadocs.org/newsroom/ news/view/ArticleId/50295/Major-issues-reports-posted-forCMA-s-2023-House-of-Delegates
• Why 350?“If humanity wishes to preserve a planet similar to that on which civilization developed and to which life on Earth is adapted, paleoclimate evidence and ongoing climate change suggest that CO2 will need to be reduced from [current levels] to at most 350 ppm.” -- Dr. James Hansen. https://mn350.org/understanding350/
• A New 66 Million-Year History of Carbon Dioxide Offers Little Comfort for Today. Dec 7, 2023. Columbia Climate School. Climate Earth and Society. https://news. climate.columbia.edu/2023/12/07/a-new-66-million-year-
• What is the ideal level of carbon dioxide in the atmosphere for human life? May 18, 2021. Ask MIT Climate. Climate Portal. https://climate.mit.edu/ask-mit/ what-ideal-level-carbon-dioxide-atmosphere-human-life
• The Intergovernmental Panel on Climate Change. MIT Climate Portal. April 21, 2023 https://climate.mit.edu/ explainers/intergovernmental-panel-climate-change
• What are F-gases and why are they harmful? European Environmental Agency. Aug 19, 2024. https://www.eea. europa.eu/en/about/contact-us/faqs/what-are-f-gases-andwhy-are-they-harmful
• European Environmental Agency. EU Greenhouse Gases in Numbers. https://www.eea.europa.eu/en/topics/ in-depth/climate-change-mitigation-reducing-emissions
• Climate change and industrial F-gases: A critical and systematic review of developments, sociotechnical systems and policy options for reducing synthetic greenhouse gas emissions. Sovacool BK et al. Renewable and Sustainable Energy Reviews. Vol 141, May 2021, 110759 https://www.sciencedirect.com/science/article/abs/ pii/S136403212100054X
• Energy Consumption. Our World Data. https://ourworldindata.org/energy-production-consumption
• What Does “Net-Zero Emissions” Mean? 8 Common Questions, Answered. https://www.wri.org/insights/netzero-ghg-emissions-questions-answered
• 6 Ways to Remove Carbon Pollution from the Atmosphere. March 17, 2023. World Resources Institute. https:// www.wri.org/insights/6-ways-remove-carbon-pollution-sky
• European Environmental Agency. Restoring Lands. https://www.eea.europa.eu/en/topics/in-depth/nature-protection-and-restoration
• Earth Day 1990. EPA. History. Think Globally…Act Locally. https://nepis.epa.gov/Exe/ZyNET. exe/9101CVYD.TXT?ZyActionD=ZyDocument&Client=EPA&Index=1986+Thru+1990&Docs=&Query=&Time=&EndTime=&SearchMethod=1&TocRestrict=n&Toc=&TocEntry=&QField=&QFieldYear=&QFieldMonth=&QFieldDay=&IntQFieldOp=0&ExtQFieldOp=0&XmlQuery=&File=D%3A%5Czyfiles%5CIndex%20 Data%5C86thru90%5CTxt%5C00000029%5C9101CVYD. txt&User=ANONYMOUS&Password=anonymous&SortMethod=h%7C-&MaximumDocuments=1&FuzzyDegree=0&ImageQuality=r75g8/r75g8/x150y150g16/ i425&Display=hpfr&DefSeekPage=x&SearchBack=ZyActionL&Back=ZyActionS&BackDesc=Results%20page&MaximumPages=1&ZyEntry=1&SeekPage=x&ZyPURL
• How Big Is The Energy Efficiency Resource? REPORT | 2018. Amory Lovins. https://rmi.org/insight/ how-big-is-the-energy-efficiency-resource/
• R-Strategies for a Circular Economy. https://www. circularise.com/blogs/r-strategies-for-a-circular-economy
• On Buying Locally, Sourcing Locally, and Consuming Critically. Aug 35, 2021. Green Network. https://greennetwork.asia/brief/on-buying-locally-sourcing-locally-and-consuming-critically/
MEMBERSHIP
CMA makes important peer review updates to Model Medical Staff Bylaws
The California Medical Association (CMA) Model Medical Staff Bylaws provide hospital medical staffs with a professional and legal structure that best supports effective medical staff operations. This year’s bylaws include significant updates reflecting new laws, court precedents and best practices.
The model bylaws are fully annotated to provide background information on critical provisions, including explanation of relevant state and federal laws, hospital accreditation standards, and other explanatory information.
Please visit https://www.cmadocs.org/newsroom/news for more information.
CMA backs DEA’s proposal to further research medical benefits and limitations of cannabis
CMA and the Medical Cannabis Research Advocacy Alliance (MCRAA) submitted comments to the U.S. Department of Justice (DOJ) and U.S. Drug Enforcement Agency (DEA) supporting the DEA’s proposal to re-classify cannabis from a Schedule I to Schedule III under the Controlled Substances Act (CSA) Schedule. The letter noted the U.S. Department of Health and Human Services (HHS), which is considered the agency best equipped to evaluate the medical use of cannabis, concluded “the risks to the public health posed by marijuana are low compared to other drugs of abuse,” and that “no safety concerns were identified in our review that would indicate that the medical use of marijuana poses unacceptably high safety risks for the indications where there is some credible scientific evidence supporting its therapeutic use.”
CMA calls for the passage and signing of Assembly Bill 2164 which will further protect physician’s right to mental health support
After urging to revise licensure application to prioritize physicians seeking mental health care, CMA issued the following statement on the Medical Board of California’s decision to revise its licensure application to reduce the stigma around mental health for physicians.
“Physicians face unique stressors and challenges in their work that often lead to burnout, depression and even suicide,” said CMA President Tanya W. Spirtos, M.D. “This decision by the medical board is a critical step to ensuring physicians can access critical mental health care without worrying about jeopardizing their careers.”
CMA is currently sponsoring Assembly Bill 2164 by Assemblymember Marc Berman, which would prohibit the Medical Board of California and the Osteopathic Medical Board of California from asking invasive questions that stigmatize care on licensure applications. The bill advanced off the Senate floor yesterday and will next head to the Governor’s office for signature.
Interest in Joining a Committee?
Are you interested in joining a committee and making a meaningful impact within the medical community? SCCMA offers a range of committees that focus on important issues such as Legislative Advocacy, Environmental Health, Bioethics, Physician Wellness, and Membership Engagement. These committees play a crucial role in shaping the work of the Association by addressing specific areas of concern. To learn more about how you can get involved and contribute to these efforts, please contact the SCCMA Office at (408) 998 – 8850. We would be happy to help you find the right fit for your skills and passions!
Remember to Vote!
No matter who or what you are voting for, we would like to remind you you’re your voice matters! Voting is a climate, health and equity solution. Yet estimates are that 8 million health professionals did not vote in 2020. Civic engagement in healthcare settings- helping our patients to become informed voters for health can help too. Check out this hot off the presses article Increasing Voter Participation Through Health Care–Based Voter Registration that shows that healthcare settings can be especially effective at improving civic engagement for the most marginalized, and often sickest, patients.
As trusted messengers, we can use health professional civic engagement to advance policies that will protect our collective health. Non-partisan advocacy is now mainstream; supported by both the AMA 2022 Resolution that Voting is a Social Determinant of Health, and by Healthy People 2030 which includes voting participation as a key metric.
Voter registration can be found at: https://registertovote.ca.gov/
CMA urges Aetna to rescind new policy that delays lifesaving care
CMA is urging Aetna to immediately rescind a recent update to its Claim and Code Review Program for emergency services that may violate state and federal laws, increase costs for physicians and cause delays for patients in need of life-saving emergency care.
Under the new policy – which took effect July 8, 2024, and applies to both fully insured and self-funded plans – Aetna has indicated it will be reviewing physician and hospital emergency department claims that include Level 4 or 5 evaluation and management (E/M) codes and following that review “may adjust your payment if the claim details don’t support the level of service billed.”
Prop 35 will address our most urgent health care priorities; here’s how you can help
CMA is a proud supporter of Proposition 35, which will secure dedicated funding to keep hospitals, clinics and doctors’ offices open.
Prop 35 will:
• Provide long-overdue rate increases for Medi-Cal providers and stabilize rates, to protect and expand access to care
• Secure ongoing funding – without raising taxes on individuals – to ensure that our health care system has the resources it needs
• Ensure health care funds aren’t redirected for nonhealth care purposes
• Fund more graduate medical education (GME) residency programs to address the physician shortage
• Fund loan repayments for physicians and allied health professionals
• Expand access to preventative health care to alleviate the burden on ERs
• Reduce wait times in emergency rooms and urgent care facilities
• Help hire more first responders and paramedics to reduce emergency response times
Bottom line: Prop 35 will improve health outcomes for millions of Californians.
For more information, please visit: https://www.cmadocs.org/prop35
Promote COVID vaccination in patient encounters
In late August 2024, the federal government approved updated COVID vaccines, which provide the best protection against the types of COVID circulating now. Everyone aged 6 months and older is recommended to get an updated COVID vaccine, and a seasonal flu shot. Even if your own practice does not immunize, your endorsement could have a significant impact on your patients’ intentions to seek vaccination. Please consider discussing vaccination with your patients and their families and recommending they stay up to date, including on the COVID vaccine. A recent survey conducted in Santa Clara County found that 44% of people reported that their doctor had not spoken to them about the COVID vaccine in the last year, a missed opportunity. As of early August 2024, only 24% of people in Santa Clara County were fully up to date on their COVID vaccination, having gotten all of the doses of the 2023 version of the vaccine for which they were eligible. As you know, a strong recommendation from a physician can make a real difference. Promote COVID vaccination in patient encounters to best protect the health of your patients.
The physicians in Santa Clara County go above and beyond the role of their jobs to make the community a healthier and happier place to live. Here we are honoring just a few of the outstanding physician leaders that have made exceptional contributions to our community.
Michael M. Jadali, MD
Medical Director, Center for Pain & Rehabilitation Medicine, Diplomate, American Board of Physical Medicine & Rehabilitation, Fellow, American Academy of PM&R, Fellow, American Academy of Anti-aging Medicine, Fellow, Association for Advancement in Restorative Medicine, Registered Pharmacist
I am deeply honored by my colleagues’ nomination as a physician superhero, but this title truly belongs to all healthcare providers. Like in all fields of medicine, navigating government regulations and insurance pressures can be even more challenging for PM&R and pain specialists. However, my patients’ daily gratitude and the ability to enhance their lives by improving their pain, fatigue, sleep, and mood make my job rewarding.
Originally from Iran, I moved to France early in life, where I studied prosthetic dentistry and later attended dental school. Finding the physical demands of dentistry too great, I joined my family in the USA, arriving at Dulles Airport in Northern Virginia. While in France, I enjoyed automobile rally racing and playing soccer in European Division 3 leagues.
After relocating to the USA, I completed pharmacy school, earning my degree earlier than scheduled and becoming a registered pharmacist. I then pursued medical school and residency. A few years into my practice, I realized I was unsatisfied and felt like a mere technician. It was at this point that I made a pivotal decision to pursue multiple fellowships in functional medicine, a choice that provided a new perspective on treating patients’ pain, fatigue, sleep, and mood and positively affecting their family dynamics. Now, I focus on addressing the root causes of my patients’ medical issues, which means spending a lot of time with each one. For this reason, I am deeply grateful for the opportunity to be a physician serving my community and beyond!
Karen Kim, MD
Clinical Assistant Professor, Department of Medicine/Division of Gastroenterology, Stanford School of Medicine
Like many other specialties, Gastroenterology has been impacted with huge demand and limited access. Wait times for new patients to access a GI consultation can be months-long, across many different health care systems, not just Stanford. About 15-20% of patients who undergo immunotherapy to treat their cancer will have a GI complication from the cancer treatment, and quick and timely access to a GI consultation is essential. Recognizing this care gap, Dr. Kim has stepped in to lead the GI immunotoxicity care efforts at Stanford Health Care, and has been working hard to get these patients in quickly to help prevent interruptions in their cancer care. This has involved looking at informal and operational ways to get patients in for office consultations, as well as procedures, as quickly as possible. She has also worked to help coordinate efforts for access to subspecialty care for immunotoxicity patients using Stanford’s e-Consult platform.
Valerie Kwai Ben, MD
The Permanente Medical Group
Randal Pham, MD
Dr. Valerie Kwai Ben has been working for The Permanente Medical Group since 1991. Her specialty is General Cardiology, with special interest in Echocardiography, Transesophageal Echocardiography and skilled in Invasive Cardiology. Currently, she is the Director of the Echocardiography Department at Kaiser Permanente San Jose Medical Center, Assistant Director of the Kaiser School of Allied Health Sciences Cardiac Sonography Program and Assistant Professor of the Boston University Medical School. She is Co-Chair of the Physician Health and Wellness Council at Kaiser San Jose.
She was former Chief of Cardiology and Chief of Pharmacy and Therapeutics at Kaiser San Jose for over a decade. She has been involved in the community as the President of the Bay Area Society of Echocardiography since 1997 and was former Board President of the American Heart Association Silicon Valley Branch.
She believes that delivery of care should be what is medically necessary, and patients should be allowed to actively participate in the decision-making of their medical illness evaluation and treatment strategies. She believes that delivery of patient care should equate to what and how you would treat your own family member or how you would want to be treated by the medical system. The key to understanding your medical issues is education.
She also avidly believes in work and life balance and enjoys adventure travels, triathlons, marathons, biking and swimming. Her extreme marathons have included the North Pole/ Polar Circle, Great Wall of China, Patagonia, Iceland, Switzerland. She also enjoys organizing international biking events for her staff and colleagues.
Dr. Pham arrived in the U.S. in 1975 as a refugee from Vietnam. Despite these challenges, he attended UC Berkeley and graduated from UCSF School of Medicine, completing residency in ophthalmology and fellowship training in oculofacial plastic surgery. Early in his career, he became passionate about preventing blindness from periocular deformities caused by diseases like trachoma, shaping his future contributions to medicine.
Dr. Pham’s innovative spirit earned him the Stanford Provost Award for laser treatments around the eye and the UCSF Inaugural Innovator Award for advancements in combining laser treatments with diagnostic technologies. In 2018, he was named Castle Connolly’s Surgeon of America and became the first Vietnamese-origin surgeon inducted into the American Society of Ophthalmic Plastic and Reconstructive Surgery.
His most significant contribution came during the early days of the COVID-19 pandemic. After hearing from fellow ophthalmologist Li Wenliang about the virus in Wuhan, Dr. Pham warned his community on KSJX public radio on January 23, 2020, the eve of Lunar New Year, defying cultural taboos. He also alerted the Santa Clara County Medical Association, leading to critical response planning. On March 16, 2020, Santa Clara County issued the nation’s first COVID-19 lockdown. Dr. Pham credits the true heroes as those who continue to protect lives during the pandemic.
Confronting Climate Change: Carbon Storage, Reduction and Natural Regeneration
Artificial Turf on Sports Fields: Promise or Peril?
Environmental ToxinsEnvironmental Illness: Root Causes and Prevention WEBINAR 3
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n e x t g e n e r a t i o n w h o a r e a f f e c t e d b y o u r d e c i s i o n s . W e i n v i t e
p a r t i c i p a t i o n a n d d i s c u s s i o n a m o n g p h y s i c i a n s , w h o a r e t r u s t e d
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2
Artificial Turf on Sports Fields:
Promise or Peril?
Date: Tuesday, October 1, 2024
Time: 6:30 PM - 7:30 PM with Q&A to follow Location: Zoom
The Santa Clara County Medical Association’s Environmental Health Committee presents the 2024 Fall Environment and Health three part webinar series! In this series we look at some ways to reduce the burden of climate change and illness, understanding that our health is inextricably related to a cleaner environment and a stable climate. This second session is on artificial turf on sports fields. We invite you to be part of the conversation and part of the change.
Speakers:
Sarah F. Evans, PhD, MPH - Artificial Turf and Children's Health
Rachel Massey, ScD - Safer Athletic Fields: Reducing Toxic Chemical Use
Scan QR Code For More Information or visit www.sccma.org
Scan QR Code
3
Environmental Toxins
Environmental Illness: Root Causes and Prevention
Date: Tuesday, October 15, 2024
Time: 6:30 PM - 7:30 PM with Q&A to follow
Location: Zoom
The Santa Clara County Medical Association’s Environmental Health Committee presents the 2024 Fall Environment and Health three part webinar series! In this series we look at some ways to reduce the burden of climate change and illness, understanding that our health is inextricably related to a cleaner environment and a stable climate. This third session is on Environmental Toxins - Environmental Illness. We invite you to be part of the conversation and part of the change.
Speakers:
Christopher D'Adamo, PhD - Total Load: the synergistic effects of modifiable lifestyle factors and environmental exposures on human heath
Pete Myers, PhD - The Impact of Plastic Additives on the Health of Future Generations
Ray Dorsey, MD, MBA - The Root Cause of Parkinson's Disease
Scan QR Code
2024 Physician Wellness Retreat
The Santa Clara County Medical Association offered a Physician Wellness Retreat for the second year to members. The all-inclusive Wellness Retreat is a three-day, two-night program at 1440 Multiversity, a 75-acre campus at Santa Cruz Mountains. Attendees were immersed in a beautiful backdrop of nature as they unplug over the course of the weekend and participate in sessions aimed at delivering healing and supportive care. All guests are served fresh, organic, plant-based food that is geared towards a healthy integrated lifestyle with a “food as medicine” approach to nutrition.
Over the retreat, the a total of four sessions were conducted:
• Session 1 – Ice Break with John Chuck, MD
• Session 2 – Befriending Your Nervous System with Christophe Gimmler and Teja Patil
• Session 3 – Moral Injury Recognition and Care with Kristine Burkman
• Session 4 – Hope, Journey to Joy, and Growth with John Chuck, MD
Other activities on the retreat included creative journaling, qigong, stick tai chi, sound healing, meditation, and forest bathing in between sessions.
The retreat brought relaxation and rejuvenation for the attend-
ees. One attendee said, “I hope other physicians rotate in and that this can be offered more than just once a year. I plan to return in the future if possible! The retreat felt like a hidden gem, but wellness shouldn’t be hard to find.” SCCMA began offering wellness retreats in 2023 to help relieve physician burnout in an environment that enhances the experience of the wellness program. SCCMA will continue to organize wellness programs for all SCCMA members. Please stay updated with our events at www.sccma.org/news-events/upcoming-events.aspx.
Empowering health professionals for clean air and better health
Air pollution has become one of the most pressing public health issues of our time, contributing to approximately 7 million premature deaths annually worldwide. Despite its devastating health impacts, it remains a relatively under-discussed topic in medical education. In response to this gap, the World Health Organization (WHO) has launched several initiatives aimed at equipping health workers with the necessary tools to understand, manage, and communicate the health risks of air pollution.
The Global Health Impact of Air Pollution
Air pollution is linked to several non-communicable diseases, including heart disease, stroke, chronic obstructive pulmonary disease (COPD), lung cancer, and respiratory infections like pneumonia. It disproportionately affects children, older people, pregnant women, people living with diseases and individuals in low- and middle-income countries. These adverse health outcomes also place a substantial burden on global health costs, with air pollution-related illnesses costing 6.1% of the global GDP, or over $8.1 trillion USD in 2019.
Given the critical role that health professionals play in mitigating these risks, it is essential that they are equipped with comprehensive knowledge of air pollution’s effects and potential mitigation strategies.
The
WHO’s Air Pollution and Health Training Toolkit for health workers (APHT)
In an effort to bridge the gap in health education, the WHO has developed the Air Pollution and Health Training (APHT) toolkit, specifically tailored for health workers, which will be released by the end of 2024. This toolkit includes downloadable modules, guidelines, and a train-the-trainer manual that empowers health professionals to not only manage air pollution-related health conditions but also advocate for clean air policies within their communities.
The toolkit’s key modules focus on outdoor (ambient) air pollution, household air pollution, the main health effects of exposure and the role of health professionals. Its contents has been piloted with more than 100 health workers in Ghana and Rwanda. By understanding the underlying causes and effects of air pollution, health professionals are better positioned to guide
communities on how to reduce exposure as well as to advocate for clean air.
The OpenWHO Online Course: A Pioneering Effort
To support the broader dissemination of air pollution knowledge, the WHO has launched an online OpenWHO course in September 2023, coinciding with the International Day of Clean Air for Blue Skies. This free online course is structured to provide a comprehensive learning experience, integrating expert knowledge and practical tools to help health workers address air pollution-related health issues.
Health professionals, including doctors, nurses, community health workers, and medical students, can access the course, which is designed with a focus on both clinical practice and public health policy.
Health Professionals as Advocates for Clean Air
The health sector is uniquely positioned to drive policy change and community action on air pollution.
By integrating the training offered by WHO into healthcare practices, health professionals can become powerful advocates for clean air, using their clinical experiences and evidence-based knowledge to push for systemic change in policies that protect both people and the environment.
A Call to Action for Health Professionals
As air pollution continues to contribute to millions of preventable deaths and undermine global health, the role of health professionals in addressing this issue cannot be overstated.
By participating in these training opportunities, health professionals can develop the skills to effectively manage the health impacts of air pollution, communicate risks to the public, and advocate for policies that ensure cleaner air and a healthier future for all. This is not just a medical issue but a societal one, where health workers can take the lead in creating sustainable
solutions to air pollution. For a healthier planet and healthier people.
Please see these additional resources:
• Air pollution and health: an introduction for health workers | OpenWHO online course for health professionals (see also article here: WHO launches groundbreaking air pollution training for health workers on International Day of Clean Air) – this may be very relevant for health professionals
• BreatheLife | Trello including resources from BreatheLife
• International Day of Clean Air for blue skies 2024 | Trello from UN clean air day
• WHO to host second global conference on air pollution and health – Colombia 2025
• Air quality, energy and health (who.int) this the
website of the webinar series “Clean air and energy for health” (recordings available and new ones coming soon)
• Air pollution and health video series mosaic (who. int) video series of short interviews with experts
• Monthly Newsletter of the Health and Energy Platform of Action (HEPA) Get the latest Health & Energy news (confirmsubscription.com)
• WHO trains health workers in Ghana on air pollution and health - BreatheLife2030
• WHO trains health workers in Ghana on air pollution and health
• Taking the prescribed action: The healthcare providers who protect our children’s present are riding to protect their future
Healthcare System Decarbonization
SANTOSH PANDIPATI, MD
Maternal-Fetal Medicine
Chief Health Officer & Co-Founder, Lōvu Health
Human activities have fundamentally changed Earth’s ecosystems, directly impacting our health and wellbeing (1). Climate change is resulting in: sea level rise; ocean acidification and heating; intensification of droughts, flooding, and storms; more frequent hot and fewer cold extremes, resulting in increased frequency and intensity of heatwaves; more wildfires as well as extreme weather events; fossil fuel-related pollution; and ecosystem collapse and mass extinction (2). Harms to human health can be direct and indirect, and are mediated through extreme weather events, heat stress, poor air quality, poor water quality and quantity, impaired food supply and safety, changes in vector distribution and ecology, and social factors (2). To reduce climate change-related harm to their patients, clinicians will need to deeply understand climate change impacts to human health, which has been addressed in numerous articles and publications in recent years, including in Santa Clara County Medical Association’s Bulletin (3-5). International efforts are now under way to achieve net zero emissions by 2050 to avert the most catastrophic outcomes.
As energy is the currency for life, and as such we will need to think through everything we do in human civilization. To deeply cut emissions within the coming decades every sector of human activity will need to change its approach to energy, from sourcing through consumption. While focused on mitigation and adaptation of populations, the healthcare system cannot abdicate its responsibility and role in the climate crisis that is at
hand. Indeed, the healthcare industry is responsible for ~5% of emissions globally, and 8.5% of emissions in the United States (6). As healthcare professionals demand deep societal changes to address the climate crisis, attention must also be turned inward to clean our own house, following the Hippocratic principle of “first do no harm”.
As is true with other sectors of the U.S. economy, the American healthcare system contributes disproportionately to climate emissions, accounting for nearly 25% of global healthcare emissions, with the healthcare sectors of China and the European Union being the next largest emitters (7,8). The U.S. healthcare system has the highest per capita and absolute emissions of any nation: a staggering 57 times the per capita emissions of India (8).
From an emissions perspective, the healthcare industry contributes directly and indirectly, and as such are categorized into “scopes” (Figure): Scope 1 refers to direct emissions from healthcare facilities, Scope 2 to indirect emissions through purchased electricity, and Scope 3 to indirect emissions through supply chain production (6-9). Examples of Scope 3 related emissions pertain to food, pharmaceuticals and chemicals, medical devices and supplies, water and waste handling, information technologies, transportation, etc. Scope 1 accounts for 7% of U.S. healthcare emissions, but globally up to 17%; Scope 2 for 11% in the U.S. and 12% globally; and Scope 3 for 82% in the U.S. and 71% globally (7,8). Influencing all 3 scopes is the production and consumption of electricity, which accounts for 29% of all U.S. healthcare emissions and more than half of global emissions (7,8).
Hospitals and health systems can start attacking their direct and indirect emissions through examination of all operations from a climate lens. Examples include obtaining electricity from utilities that emphasize renewable sources such as solar and wind as well as having on site battery storage and solar production, switching their vehicles to EVs, reducing meat in favor of more plant-based foods in cafeterias and patient menus, reducing plastic and disposable waste, capturing and recycling anesthetic gases from operating rooms, etc. But since 80% of emissions related to healthcare emanate from the supply chain the healthcare industry will need to significantly influence vendors, starting with proper tracking and reporting of emissions by vendors, and applying pressure to vendors to change practices to those that result in fewer emissions.
Leading healthcare organizations are already working on efforts to decarbonize the industry. The National Academy of Medicine launched an Action Collaborative on Decarbonizing
the U.S. Health Sector (Climate Collaborative) in 2021 (9). The Action Collaborative has called for 50% reductions in healthcare emissions by 2030, and net-zero by 2050. To have maximal impact, Singh et al. have called upon healthcare organizations to approach decarbonization as a crucial part of quality improvement, with mandatory tracking and reporting of emissions as a starting point to reductions (6). However, much policy work is needed to establish standards for such tracking and reporting. As outlined by The Commonwealth Fund, government actions that can help spur a green transformation of the healthcare sector should include (10):
• “Development of standardized metrics of health system performance at the facility, state, and federal levels.
• Enactment of policies that remove barriers and create incentives for health systems to reduce their GHG emissions.
• Creation of roadmaps for health systems that show them what to do and how to do it.”
Specific examples for healthcare decarbonization are outlined in the Table.
Examples of Healthcare Sector Decarbonization (11)
Scope 1
Implement green building and retrofitting
Transition to zero carbon fuel sources (solar panels, local battery storage)
Switch to zero-emissions fleet vehicles
Manage anesthetic gas choices (e.g., eliminate desflurane), decommission central nitrous oxide piping
Scope 2
Purchase renewable energy (solar, wind, geothermal, etc.)
Conserve and optimize energy use
Scope 3
Lower carbon alternatives to metered dose inhalers
Adopt philosophy of reuse, reprocess, repair, repurpose, and recycle (reduce single use plastics)
Food procurement (emphasis on plant-based foods) and food waste prevention
Minimize employee commuting (telehealth and telework)
While healthcare organizations start work on reductions, physicians can do their part to encourage decarbonization of healthcare at a very granular and local level. Examples of physician action can include:
• Self-education on the sources of climate change and impacts to human health
• Educate patients on both the impacts of climate change to their health and what they can do to reduce direct harms to themselves and their families, as well as reduce indirect harm through better lifestyle choices
• Active participation in hospital and health system leadership activities to promote broader awareness of climate change impacts to human health, as well as to the magnitude of the healthcare sector in climate emissions
• Working with hospital and health system leadership to implement emissions tracking, reporting, and reductions mechanisms
• Working with public health experts, local medical societies (such as Santa Clara County Medical Association), policymakers and local, state, and Federal levels to support efforts to mandate and standardize tracking, reporting, and reducing emissions
The global climate crisis that is at hand will require concerted effort in all aspects of human activities to avert the worst outcomes. Healthcare professionals and the institutions and systems in which they practice are immune neither from causation nor from impact of the climate crisis. Healthcare decarbonization is but one spear in this multi-pronged effort to combat climate change, and is where physicians can take a crucial stand.
References
1. Pandipati S, Leong M, Basu R, Abel D, Hayer S, Conry J. Climate change: Overview of risks to pregnant persons and their offspring. Semin Perinatol. 2023 Dec;47(8):151836. doi: 10.1016/j.semperi.2023.151836. Epub 2023 Oct 11. PMID: 37863676.
2. Haines A, Ebi K. The Imperative for Climate Action to Protect Health. N Engl J Med. 2019 Jan 17;380(3):263-273. doi: 10.1056/NEJMra1807873. PMID: 30650330.
3. Romanello M, Napoli CD, Green C, Kennard H, Lampard P, Scamman D, et al., The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centered response in a world facing irreversible harms. Lancet. 2023 Dec 16;402(10419):2346-2394. doi: 10.1016/S01406736(23)01859-7. Epub 2023 Nov 14. PMID: 37977174.
4. Pandipati S. The earth has a fever: a maternal-fetal medicine physician’s perspective on climate change. The Bulletin 2020;26(4):16-21.
5. Yew K. Climate change, drought, and the lessons of Flint. The Bulletin 2022;29(2):14-17.
6. Singh H, Eckelman M, Berwick DM, Sherman JD. Mandatory Reporting of Emissions to Achieve Net-Zero Health Care. N Engl J Med. 2022 Dec 29;387(26):2469-2476. doi: 10.1056/NEJMsb2210022. Epub 2022 Dec 14. PMID: 36516087.
7. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The United States: An Update. Health Aff (Millwood). 2020 Dec;39(12):2071-2079. doi: 10.1377/hlthaff.2020.01247. PMID: 33284703.
8. J Karliner, S Slotterback, R Boyd, B Ashby, K Steele, J Wang, Health care’s climate footprint: the health sector contribution and opportunities for action, European Journal of Public Health, Volume 30, Issue Supplement_5, September 2020, ckaa165.843, https://doi.org/10.1093/eurpub/ckaa165.843
10. Shanoor Seervai, Lovisa Gustafsson, and Melinda K. Abrams, “How the U.S. Health Care System Contributes to Climate Change,” explainer, Commonwealth Fund, Apr. 2022. https:// doi.org/10.26099/m2nn-gh13
11. Lakatos K, Teherani A, Thottathil SE, Gandhi S, Weiser SD, Brindis CD. A race to net zero-early lessons from healthcare’s decarbonization marathon. Health Aff Sch. 2023 Jun 20;1(1):qxad006. doi: 10.1093/haschl/qxad006. PMID: 38770407; PMCID: PMC11103727.
The Positive Impact of NATIVE PLANTS on the Earth and Everyone
RADHIKA THEKKATH
California Native Plant Society, Santa Clara Valley Chapter
Ample scientific studies on native plants show their positive impact on the local ecosystem across the spectrum, from tiny soil microorganisms to insects, bees, butterflies, birds, the smallest and the largest mammals. What is less well-known, is the impact of native plants on people’s health and general well-being. This article explores this topic while also introducing some lesser-known facts and scientific understanding about California’s native plants.
Native plants are defined as those that have co-evolved with other living beings in a specific region before contact with cross-global travelers and introduced species from other parts of the world. What is not common knowledge is the uniqueness of California’s flora and ecology and that California is classified as a global biodiversity hotspot. The diversity is mind-blowing, including nearly 7000 species of plants, 1368 species of butterflies and moths, and 1600 species of native bees. Unfortunately, hotspot implies that this species diversity is disappearing from California at an alarming rate. So, it is up to us humans to come together and organize as a community to take California off the hotspot watch list. Otherwise, our grandchildren will never see some of the beautiful flowers, butterflies or birds that exist today.
(3) science-based environmental organization. Its mission is, “To protect California’s native plants and their natural habitats, today and into the future, through science, education, stewardship, gardening, and advocacy.” This statewide organization is headquartered in Sacramento with 36 chapters across the state. Our local Chapter is the Santa Clara Valley Chapter2.
The benefits of planting native plants in urban home gardens, public parks, streets, and commercial landscaping are
immense for both the environmental well-being as well as human health and well-being.
These benefits are summarized here:
tles, and other wildlife are healthier and in balance. As humans are part of a region’s ecosystem, this has a positive effect on our overall health. Our immune system benefits from healthier soil and surrounding vegetation3,4,5
• Planting natives is an invitation to lunch for the myriad insects, butterflies, bees, and birds in the area. Your native garden provides food that is far more delicious than the neighbor’s exotics. (Exotic garden plants were chosen because few things eat them). These lunch guests provide natural pest control while they feed their young. And you can stop using chemical pesticides and fertilizers, which cleans up the soil, air, and watershed, saving us all from continued exposure to chemical toxicity6,7,8.
• Replacing regular turf grass with native plants eliminates the weekly gas-powered mowing with its toxic fumes, which saves our lungs. A lawn grown with California native grasses, depending on the species, may only need to be mowed once a year 9
The California Native Plant Society (CNPS)1 is an almost 60-year-old 501(c)
• Native plants improve soil health, and consequently, insects, bee-
• Human stress levels can increase during a drought when we visually experience dead plants and brown lawns. During a drought, many native plants that have evolved to withstand drought will survive with minimal winter watering. Having greenery in your garden can help reduce your stress. Some plants may die in a prolonged drought, but the
Painted Lady butterfly on Manzanita flowers –photo by Charley Pow.
overall quality of life in the long run will be more resilient in the presence of native plants10
• We know that being outdoors in nature has a positive impact on our physical, cognitive, social, and emotional health. Choosing native plants in our home and public gardens brings wildlife into our daily lives. Living among butterflies and birds allows us to make a deeper connection to nature which has a long-term positive impact on all aspects of our mental health, for both adults and children11.
• There is something special about a plant that has been here for millennia. If one can pause to contemplate the plant, there is a sense of time and place that fills us with wonderment, transcending daily troubles, and enabling us to tolerate daily stresses with resilience12
With an understanding of these benefits from planting natives in our urban and suburban surroundings, we, at the CNPS Santa Clara Valley Chapter are volunteers who come from all walks of life, students, teachers, tech workers, and medical professionals. We work passionately for the cause of conserving, restoring, gardening, and educating people about native plants. We do this because we believe strongly that restoration of the natural ecosystem and creating habi-
tat with native plants heals the earth. This healing is the long-term solution to our climate crisis. Caring for the earth is synonymous with caring for its people.
The best way to engage with us and help this movement grow is to start planting natives in your own home gardens13, becoming a member of the statewide CNPS organization, and joining your local Chapter14. You can attend a talk or event2, or, if you are too busy to attend a live talk, you can watch pre-recorded videos on our YouTube channel15, or attend a weekend field trip16
So how do we go from understanding the benefits of native plants to the practicality of creating a pleasant garden? CNPS has a valuable tool called Calscape17 which describes native plants, and is a tool you can use to design a garden and locate nurseries to purchase your native plants. Admittedly, this can be intimidating for a novice gardener or someone who is unfamiliar with native
allow them to become drought-tolerant.
1. Dr. Hurd Manzanita (Arctostaphylos ‘Dr. Hurd’)19 is a well-known manzanita cultivar that is easy to grow in a garden and is a specimen plant known for its shiny reddish-brown bark and glossy evergreen foliage. The white flowers bloom early in the season, feeding hummingbirds and pollinators when not much else is blooming. Flowers are followed by clusters of berries in the fall, eagerly eaten by birds. There are many sizes and varieties of manzanitas available.
2. Toyon (Heteromeles arbutifolia)20 is an evergreen shrub or small tree that is easy to grow. It produces fragrant white flowers that develop into scarlet berries in the winter. The flowers attract butterflies and other pollinators. The berries are essential winter food for many birds, including Mockingbirds, American Robins, and Cedar Waxwings.
plants. One option is to hire a professional specializing in native plants18 for a full garden makeover, or, begin within a small area of the garden by incorporating just a few high-habitat-value plants. Adding a few plants each year is a strategy that can work for busy professionals. Like a quick start manual, five native plants are highlighted here for their habitat value and low water use. Use their Calscape link for details. Note that even drought-tolerant native plants need regular water for the first two years to become established. After two years their watering regimen can be eased off to
3. Black Sage (Salvia mellifera)21 is the most common sage in California and is an important food source for bees, butterflies, and hummingbirds. The flowers are not showy, but small and pale
Foothill Penstemon over a flagstone– photo by Radhika Thekkath
Matilija Poppy (Romneya coulteri)the largest poppy in the world, a CA native– photo from Calscape
Toyon Bluebird - photo by Paul Heiple
Ceanothus ’Centennial’
blue-lavender. Black sage seeds provide food for birds, including quail and towhees.
4. Foothill Penstemon (Penstemon heterophyllus)22 produces gorgeous tubular flowers in shades of blue or purple. Once established it has low water need and high habitat value, supporting birds, bees, and butterflies.
5. Ceanothus ‘Centennial’23 is an evergreen ground-cover, 1’ tall to 5’ wide. The beautiful deep blue flowers bloom from late spring to early summer, attracting bees. A tough, low maintenance groundcover, it thrives in dry shade like the understory of oak trees. There are many sizes and varieties of Ceanothus available in nurseries
to a home gardener. Happy gardening and please join us in our mission to keep the earth and humans healthy in this corner of California!
California Native Plant Society Santa Clara Valley Chapter Mariposa field trip.
Dr. Hurd Manzanita
The Time is Well…Now
Electrification can reduce energy bills, maintenance costs, and fossil fuels
BY CINDY RUSSELL, MD
Co-Chair SCCMA Environmental Health Committee
Everyone is talking about electrification these days. This global transition is a critical topic of conversation. By switching from gas to electric appliances, heat pumps and electric vehicles, we are continuing the important shift away from direct fossil fuel use to renewables in order to meet the clearly spelled out Paris Agreement climate goals. Even if you do not have solar power, the electricity coming into your home is increasing derived from renewable energy sources and most people can purchase renewable energy from their power company. Battery storage is improving along with efficiencies in design. The cost to go electric is lower and federal and regional tax incentives and rebates make this an affordable option even for those with lower incomes.
10 Year Tax Credits for Homeowners: The Bipartisan Inflation Reduction Act
Switching to electric couldn’t come at a better time. There are tax incentives built into the Inflation Reduction Act of 2022 that are in effect until 2032 and give tax credits for homeowners going solar, as well as other energy reducing efforts. Homeowners who have installed rooftop solar between the start of 2022 through the end of 2032 will be able to deduct 30% of the cost directly from their federal income taxes, and this includes permitting fees, labor to install solar and stand-alone batteries with more than 3-Kilowatt storage.
There is no cap on these investment tax credits for solar conversion. Home improvements that reduce energy such as heat pumps, insulation and window replacement also qualify but
with different tax credits. Renters can even use some of the tax incentives. The NRDC has a Consumer Guide to the Inflation Reduction Act which is quite useful. You can also look up IRS Home Energy Tax Credits.
Heat Pumps: Heat and Cool Your House… and Save Energy
External heat pumps seem like a magic trick to provide both heating and cooling. They work by collecting and concentrating energy from the ambient outdoor air, even in cold climates, and converting it into heat, blowing warm air into the home. In the summer, a heat pump does the opposite, thus it doubles as an air conditioner. These HVAC systems (heating, ventilation and air conditioning) have greatly improved efficiency over the years. Heat pumps use less than 1/3 the energy used by a gas furnace, keep you cool in the summer and no gas is required. Electrical panel upgrades are sometimes needed but local and state utility rebates make heat pumps very affordable.
You can buy energy efficient heat pump water heaters as well. About 60% of the methane gas used by homes is for heating water. It is important to get a qualified contractor who is familiar with installation.
Choose Electric Stoves: Cooking with Gas is Hazardous to Your Health
Cooking with gas stoves creates indoor air-pollutants that are a hazard for your lungs and the climate. Not only do gas stoves use climate warming natural gas, they also emit a number of harmful airborne compounds through leaks and incomplete combustion. These include methane, nitrogen dioxide, benzene, carbon monoxide, formaldehyde and ultrafine particles. Stanford scientists recently found that the climate and health impacts of natural gas stoves are greater than previously thought, with the levels of toxic emissions increased in homes that are smaller and with poor ventilation. (Lebel 2022)
We typically associate ultrafine particles with air pollution from traffic, however using gas dryers, furnaces, fireplaces and stoves in our homes, as well as motor vehicles also emit these harmful substances that increase our risk of disease and exacerbate asthma.
Which Stove: Electric or Induction?
Not so fast with induction stoves. There has been a mad rush to support induction stoves over conventional electric as they heat up faster, are very efficient and the cooktop stays cool, but both are comparable in reducing energy consumption. Studies show induction stovetops are only 10% more efficient than electric stoves and both are much more efficient than gas stoves. According to the Energy Information Administration only 1.4% of annual home electricity use is for cooking. Not the biggest use of electricity, so keep your existing electric stove if you have one.
Cost Considerations:
The price of an induction stove is significantly more than a conventional electric. In addition, only certain types of pans will work on an induction stoves so your old pans may not work. You may need to invest in a new set of compatible cookware. Cast iron will work and some stainless steel cookware can be used, however many stainless steel pots have a mix of metals including nickel which blocks the magnetic field. Aluminum, all-copper, or glass cookware do not work unless they have a magnetic base.
Induction Stoves: Health Considerations
There also may be a health risk with induction stoves. Induction cooking is very different from conventional gas or electric cooking. It works by creating a powerful alternating magnetic field between the pot and the magnetic coils beneath the cooking surface. The energy created with these high-powered pulsed electromagnetic fields (EMF) emit heat that warms the
pot. Alternating current in our homes uses 60 cycles per second but induction stoves use 20,000 or more pulses per second within a coil to induce the magnetic field, that radiates a short distance from the stove.
Pacemakers and Induction Stoves
If you have an implanted cardiac pacemaker you may be at risk for interference from an induction stove. Newer model pacemakers are safer and well insulated, but magnets are still used to control pacemakers and turn them off. Medtronics, the largest pacemaker manufacturer, says in its safety insert that, “Patients should avoid sources of magnetic and electromagnetic radiation to avoid possible under detection, inappropriate sensing and/ or therapy delivery, tissue damage, induction of an arrhythmia, device electrical reset or device damage.” Another Medtronic warning reads, “The following household and hobby items require special precautions: … Induction cook tops – An induction cook top uses an alternating magnetic field to generate heat. Keep a cardiac device at least 60 cm (24 inches) away from the heating zone when the induction cook top is turned on.”
Induction Stoves Can Leak High Magnetic Fields
Induction stoves induce voltages directly that are measured close to the burners, but there can be leaks if the pan is not the right size or is not directly centered on the burner. Irnich (2006) looked at potential danger if someone has a pacemaker implanted and found that the current passing through someone touching the metal pot was 8 times higher (at 800mv) if the pot was not centered on the burner but this could be reduced to safe levels if the distance is over 35cm (1.7 feet). Irnich (2006) concludes, “Patients are at risk if the implant is unipolar and left-sided, if they stand as close as possible to the induction cooktop, and if the pot is not concentric with the induction coil… Patients with unipolar pacemakers are at risk only if they are not pacemaker-dependent.”
A study by Christ (2012) looking at the magnetic fields around these cooktops revealed that, “While most measured cooktops comply with the public exposure limits at the distance specified by the International Electrotechnical Commission (standard IEC 62233), the majority exceeds them at closer distances, some of them even the occupational limits...The brain tissue of young children can be overexposed by 6 dB or a factor of 2. The exposure of the tissue of the central nervous system of the fetus can exceed the limits for the general public if the mother is exposed at occupational levels.” One study by Hirose (2005) showed that pacemaker pulses were inhibited by the induction oven, and a safe distance was 50 cm or 1.7 feet.
The Swiss Federal Office of Public Health has this advice on their site.
• Make sure you read the operating and safety instructions before use
• Use the right size cookware and do not put a small pan on a large zone. Use a pan that covers the entire zone completely
• Don’t use damaged pans
• If you are standing close to the stove while cooking, use the rear cooking zones
• Use the correct manufactured pans
• If you have a pacemaker talk to your cardiologist about using the induction stove
Electromagnetic Illness
There have been anecdotal reports of people who could not tolerate the high magnetic fields around induction stoves, as well as fields from solar inverters (“Zapped” Movie). They may suffer from electromagnetic sensitivity. Electromagnetic illness is an increasingly recognized condition involving an array of adverse symptoms that arise in some people in the presence of man-made electromagnetic fields from electrical, magnetic and/or radiofrequencies from wireless devices. Case reports
highlight sensitivity to microwave emissions from Wi Fi Routers, cell phones, DECT phones, smart meters, laptops and cell towers (Thoradit 2024). Symptoms are largely related to the central nervous system and include headaches, dizziness, nausea, fatigue, depression, insomnia, difficulty in concentrating and memory loss. Some also report heart palpitations. It makes sense, as these are electrically controlled organs.
Military Personnel Developed Electrosensitivity
This sensitivity to electromagnetic fields was first recorded in military personnel working on radar, and is well documented in reports first in the Soviet Union in the 1930’s followed by other branches of our military. The early surveys documented these subjective complaints for a wide range of frequencies (3300,000 MHz). The effects were non-thermal and usually reversible if the person was removed from the source of radiation. Research now has identified several mechanisms of toxicity, with the most robust being oxidative damage, a mechanism of toxicity similar to that from chemicals. The nervous system appears to be the most sensitive to electromagnetic fields (EMF), as one would expect, however broad effects on all organs, including the reproductive, immune and hematopoietic systems, have been published on oxidative stress from wireless radiation. Genetic, metabolic and environmental factors explain why not everyone is affected.
Building Biology
The field of building biology developed in the 1970’s to identify the environmental factors such as chemical and infectious agents causing sick building syndrome, and now includes electromagnetic illness among environmental toxicants. Many certified building biologists have specialized to incorporate the complex field of electromagnetics into their services. They use expensive fragile equipment and meters to carefully measure electric, magnetic and radiofrequency fields, as well as “dirty
electricity”, known as high-frequency voltage transients from wiring. They use shielding, wire insulation as well as electrical filters to help people if they experience symptoms. The Building Biology Institute provides useful information.
Physicians can take a careful occupational and environmental history, including documentation of the patient’s symptoms and the temporal relation to their work and home environment to help identify environmental causes for their patient’s illness.
Our Human Carbon Footprint: Reduce, Reuse, Refuse (to consume)
While electrifying our homes is a necessary step for us all to remove the broad harms to the planet and our health from using fossil fuels, conservation has to be incorporated as well. Amory Lovins, from the famed Rocky Mountain Institute in Colorado, points to a phenomenon called the “rebound effect” or Jevon’s Paradox, where, “one may get higher consumption of resources with improved efficiency if we lose track of aggregate consumption.” According to the European Environmental Policy Institute in 2022, “In the last 30 years, the amounts of CO2 emissions have increased at a rate faster than ever before in history.” We need to reverse that trend of consumption.
All efforts to reduce fossil fuel use and our carbon footprint will reduce the need for problematic deforestation, mining and extraction methods, in addition to setting an example and inspiring neighbors, friends and family to act.
Full references for this article available at:
for Clean Air and Climate Action
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WE WANT TO HEAR FROM YOU!
SCCMA WOULD LIKE TO HEAR YOUR INPUT ON CONTENT YOU WOULD LIKE TO SEE FEATURED IN THE BULLETIN. THE FIRST TEN PEOPLE TO RESPOND WILL GET A $10 GIFT CARD TO STARBUCKS. OFFER ENDS NOVEMBER 1, 2024
CINDY RUSSELL, MD
Co-Chair SCCMA Environmental Health Committee
THE PATH OF TECHNOLOGICAL PROGRESS HAS PRODUCED MANY HEAD-ON COLLISIONS. - REBECCA STOPOLI ON AI
The alarm bell on energy consumption in information technology rang many years ago with 5G and the Internet of Things (IoT), even before AI rushed to join the race. With the AI (artificial intelligence) revolution, it is full speed ahead in complex energy gobbling computations that can, in some cases, use 1000 times more energy, say for AI art. Bitcoin uses power on the scale of entire countries and, according to the Bitcoin Energy Consumption Index, nearly 10 U.S. households can be powered for one day by the electricity consumed for a single bitcoin transaction. Most of this energy comes from fossil fuels, despite industry promises and some gains in renewables. The explosion of data centers to accommodate the growth of AI is positioned to punch through climate change goals.
Recent projections from the International Energy Agency (IEA) indicate a doubling of 2022 energy consumption levels from data centers, AI, and cryptocurrency by 2026. Generative AI has been Open Source since November 2022, when OpenAI widely released its large language model–fueled generative AI chatbot, ChatGPT. AI is now incorporated within systems that are automatic, widespread and often hidden from us, such as search engines, AI virtual assistants, biometrics, social media and language translation tools…and that is only the beginning.
We use technology almost ubiquitously now, staring into our screens not only for entertainment but also for shopping, school, work, registering for events, airline travel, banking, and screens still seem to return to the dinner table. Data
REDUCING CARBON IS WHERE THE WORLD NEEDS TO GO, AND WE RECOGNIZE THAT IT’S WHAT OUR CUSTOMERS AND EMPLOYEES ARE ASKING US TO PURSUE. THIS IS A BOLD BET — A MOONSHOT — FOR MICROSOFT. AND IT WILL NEED TO BECOME A MOONSHOT FOR THE WORLD.
is the new gold. The sky is the limit to collecting, computing and storing every keyboard click, monitoring every move we make with facial and body recognition; replacing actors, writers, artists, laborers and our cash money system with AI energy intensive computations stored in thousands of servers across the world. “Cloud ” computing is not white and fluffy. It consists of giant warehouses where long rows of buzzing densely stacked computers sit plugged into a high-powered energy source. These “cloud” centers are causing a shock to power grids that are trying to keep up with demand.
More rural data centers, more infrastructure, more fracking, drilling and mining results in large amounts of fresh water used for cooling, as well as more energy consumption driving climate change. What can go wrong? While AI has remarkable capability in medicine, business and even war, is our addiction and increasing dependence on digital technology and now AI veering us towards a path to collide head-on with planetary boundaries, human rights,
privacy and security? Energy consumption is just one issue, but a critical one. We need to reduce, not expand, energy consumption in all sectors to reach fast approaching Paris Agreement goals.
Data Centers Alone Could Consume 9% of U.S. Energy by 2030
Billions of dollars of capital investment have been made recently by the big tech companies with most of that for data centers driven by AI. They are also getting tax breaks by cities to build their data centers. The push for all these companies to lead in AI technology appears to parallel their race for the highest energy consumption. It is widely reported that one data center uses about 1 Gigawatt of power, equivalent to one nuclear power plant powering roughly 750,000 homes. Some data center campuses are requesting several gigawatts of power. The Electric Power Research Institute (EPRI) 2024 report shows that data centers alone could represent up to 9% of energy consumption in the U.S. by 2030, doubling the current amount. That is over 3 times that of the aviation industry. (IEA)
What Happened to Big Tech’s Carbon Neutral Goals?
Pipelines for Tech
Google announced this year in its Environmental Report 2024 that its greenhouse gas (GHG) emissions have increased nearly 50% in the last 5 years, primarily due to data centers. The tech giant admits that while it strives “to build the world’s most energy-efficient computing infrastructure” it faces “significant challenges”, and the goal of being carbon neutral by 2030 remains “uncertain”, especially considering the rapid incorporation of AI, which uses a lot of power.
A 2024 Goldman Sachs report estimates
ENERGY USE AND TECHNOLOGY
IN 2020, WE UNVEILED WHAT WE CALLED OUR CARBON MOONSHOT. THAT WAS BEFORE THE EXPLOSION IN ARTIFICIAL INTELLIGENCE... IN MANY WAYS THE MOON IS FIVE TIMES AS FAR AWAY AS IT WAS IN 2020, IF YOU JUST THINK OF OUR OWN FORECAST FOR THE EXPANSION OF AI AND ITS ELECTRICAL NEEDS. -BRADSMITH,PRESIDENTMICROSOFT
that a single ChatGPT query requires 10 times more energy than a google search and more complex AI searches use significantly more energy. They note, “our analysts expect incremental data center power consumption in the US will drive around 3.3 billion cubic feet per day of new natural gas demand by 2030, which will require new pipeline capacity to be built.” That does not include other energy consuming aspects of their business.
Microsoft Using 30% More Energy
Microsoft has also now called into question its zero emissions goals while promoting its new AI platform, after a $13 billion-dollar deal with OpenAI. In 2020 the Microsoft Sustainability Report announced, “a bold commitment and detailed plan to be carbon negative by 2030 and to remove from the environment all the carbon the company emitted since its founding by 2050.” Microsoft says it has been carbon neutral since 2012 by investing “in offsets that paid others to not emit carbon, instead of removing
carbon dioxide.” Now they state they will source all their energy with renewables in 2025, tax businesses in its supply chain for GHG and invest in controversial carbon capture and storage methods to remove carbon from the atmosphere.
Microsoft, however, has also partnered with petrochemical group giants Schlumberger and Chevron, as noted in their SIS Global Forum in 2019, working to accelerate gas and oil development by analyzing, “data to generate new exploration opportunities and bring prospects to development more quickly.” According to the Microsoft press release, “Schlumberger is the world’s leading provider of technology for reservoir characterization, drilling, production, and processing to the oil and gas industry… Chevron Corporation is one of the world’s leading integrated energy companies. Through its subsidiaries that conduct business worldwide, the company is involved in virtually every facet of the energy industry.”
Their 2024 Sustainability Report reveals that Microsoft is using 30% more total GHG emissions than in 2020, according to a Bloomberg News report. Microsoft President Brad Smith said in a recent Bloomberg article, “In 2020, we unveiled what we called our carbon moonshot. That was before the explosion in artificial intelligence... in many ways the moon is five times as far away as it was in 2020, if you just think of our own forecast for the expansion of AI and its electrical needs.”
Apple Using OpenAI
Apple has recently partnered with OpenAI to develop its “personal intelligence system”, to accompany their digital assistant Siri, creating bedtime stories, recipes ideas and room decorations.
On Sept 11, 2024 the Apple Intelligence generative software was launched with the new iPhone 16. This “will enable transcription for phone calls, AI photo retouching and improvements in the natural conversation flow with Siri”, according to an NPR article. The new phones were built with special chips to accommodate the increased power needed for AI operations.
Meta to Use Geothermal Power
Meta has stated in their 2024 Sustainability Report “We have publicly committed to achieving net zero emissions across our value chain and becoming water positive in 2030.” In August 2024 META announced they are partnering with Sage Geothermal to power their data center to provide 150 MW of new geothermal power by 2027. In a press release Meta states that they have, “contracted more than 12,000 MW in renewable energy projects, making us one of the largest corporate buyers of renewable energy globally.” That is about 12 nuclear power plants worth of energy. Currently in the U.S. there are 54 nuclear power plants housing 94 nuclear power reactors in 28 states. (USEIA)
Cooling Computers Uses 30-
AI MODELS’ WATER FOOTPRINT CAN NO LONGER STAY UNDER THE RADAR- WATER FOOTPRINT MUST BE ADDRESSED AS A PRIORITY AS PART OF THE COLLECTIVE EFFORTS TO COMBAT GLOBAL WATER CHALLENGES.
- LI ET AL (2023)
40% of Data Center Energy
Computers will fail if they are overheated. Typically, energy-hungry fans and air-conditioning have been used to cool data centers.
Zhang (2023) reported that “The energy use per square foot in data centers can be 100 times that of typical office buildings.” And the amount of energy required to cool the servers is about 30-40% of the total energy consumption of data centers. A newer way to cool super computers in data centers is to use fresh water.
Data Centers are Thirsty Too: AI’s Secret Water Footprint
Water is a shared finite resource. Usable freshwater is less than 1% of all the water on the earth. Freshwater scarcity is an increasing challenge due to climate change and water pollution. As data centers focus on reducing electricity, they are using more fresh water circulated in pipes near the processors to cool their supercomputers. The water emerges very hot, thus most is either sprayed or sent to water towers, with 80% or more eventually evaporating.
Clean fresh water must be used to prevent pipes from clogging. It is reported that one data center uses 300,000500,000 gallons of freshwater a day for cooling. Choi (2024) in an IEEE Spectrum article reports that in 2022 Google “con-
THE DATA CENTER BOOM REQUIRES CLOSER COLLABORATION BETWEEN LARGE DATA CENTER OWNERS AND DEVELOPERS, UTILITIES, GOVERNMENT, AND OTHER STAKEHOLDERS TO ENSURE THAT WE CAN POWER THE NEEDS OF AI WHILE MAINTAINING RELIABLE, AFFORDABLE POWER TO ALL CUSTOMERS.
- ELECTRIC POWER RESEARCH INSTITUTE
sumed about 19 billion liters of freshwater for cooling.” According to a report from the University of Amsterdam (DeVries 2023) Bitcoin in 2023 used about 16,279 L (4,300 gallons) of water per transaction. The average U.S. home uses 300 gallons per day. That calculates to 14 households daily use of water per single Bitcoin transaction.
Li et al (2023) notes in assessing AI water use “We point out the need for increased transparency of AI models’ water footprint, and highlight the necessity of holistically addressing water footprint along with carbon footprint to enable truly sustainable AI.”
“IF WE CONTINUE TO DEVELOP OUR TECHNOLOGY WITHOUT WISDOM OR PRUDENCE, OUR SERVANT MAY PROVE TO BE OUR EXECUTIONER.” -OMARBRADLEY(GENERAL,USARMY)
Big Tech Moving to Renewable Energy
Corporations purchased more US Clean energy in 2022 than ever before, according to a report by the American Clean Power Association (ACP) and the tech industry leads the pack. By the end of 2023 corporations
contracted 77 GW clean energy, enough energy to power 18 million American homes. Most of that energy comes from Texas wind and solar farms. While the technology industry is helping to combat climate change by using clean renewable energy, that energy may be competing with communities across the nation who also want to use green energy to wean themselves off fossil fuels. Will the push to have clean and green energy for tech spill over to benefit neighborhoods, or will it siphon valuable funding and electricity from communities who will be left in the dark and with a water crisis, while continuing to fuel climate change?
About 70% of all data storage in the world is in the state of Virginia and it plans to build more. A proposed data center in southwestern Virginia boasts that it will use over one Gigawatt of power from Next Gen Geo-fracking and have access to nearly 10 billion gallons of cool underground water from an abandoned mine to cool their computers. Local residents have raised questions about the safety of the project. They wonder if the land for this massive building project is stable, and also what the consequences are of using the collected pools of “mine water” that recharge their aquifer? There are also other reasonable questions about blowouts, earthquakes and water pollution with Geo-fracking to be answered before we launch another massive Earth changing enterprise. (See Part 3)
Full references for this article available at:
CINDY RUSSELL, MD
Co-Chair SCCMA Environmental Health Committee
CARS WILL SOON HAVE THE INTERNET ON THE DASHBOARD. I WORRY THAT THIS WILL DISTRACT ME FROM MY TEXTING. - ANDY BOROWITZ
Researchers have warned that the explosive market for smart phones, instant streaming and ubiquitous connection can be a climate changer. As 5G emerges with cell towers on every block, Multiple-Input Multiple-Output (MIMO) antennas, cloud computing and connected Internet-of-Things (IoT) devices, energy use is already mushrooming, with exponential growth expected. According to an ABI Research report a 5G base station requires three times more energy to provide the same coverage as a 4G network. Another ABI Research paper states, “the 5G ecosystem will see a 160% increase in power requirements by 2030, reaching the expected equivalent of all the energy consumption of Sweden.” This does not even include 5G joining the space race.
Is 5G a Manufactured Need?
The International Telecommunications Union says 5G will deliver 1,000 times higher mobile data volume per area, 100 times the number of connected devices and 100 times higher user data rate and that means more energy consumption. Enticing ads show remote gaming, virtual reality and automated driving, along with singers imploring us to, “do it for the phone”. If you build it and addictively market it, people will use it. 5G appears to create a demand for energy use more for our convenience, recreation and speed, rather than necessity. What’s the rush? According to a 2019 report by the European Parliament, 5G Deployment State of Play in Europe, USA and Asia, “As 5G is driven by the telecoms supply industry, and its long tail of component manufacturers, a major campaign is under way to convince governments that the economy and jobs will be strongly stimulated by 5G deployment. However, we are yet to see significant “demand-pull” that could assure sales.”
5G Requires Massive
Densification of Cell Towers in
Communities
A Cellular Telecommunications and Internet Association (CITA) report noted that at the end of 2021, there were 418,887 operational cell sites across the nation. This did not account for 5G cell towers placed on preexisting 4G towers. How much power they use or put out is not monitored or tracked, unlike France where the French National Frequencies Agency (ANFR) has made its data on radio-electrical installations across the nation available for viewing online. (SofreCom 2020) Fiberoptic cable will be more energy efficient and safer than wireless, especially if this connects directly to the home, as they are doing in
ed—to make the long- term investments necessary to build the enduring and sustainable public broadband fiber information highway that the country needs. Corporations will invariably seek the cheapest, quickest, and most profitable path, which has led to the current emphasis on wireless.”
The report explores the energy and societal benefits for establishing a far safer, exceptionally reliable, better quality and more equitable internet connectivity through wired systems. Because fiberoptic cabling is more energy efficient than wireless systems (European Commission 2020), it is being deployed now in cities and even rural areas buried underground. But as we are laying the ground work for broadband connectivity, a space race has started with no rational end in sight for broadband, cell phones and mile high advertising in the skies.
WHEN YOU HAVE THE CUMULATIVE EFFECT OF MORE LAUNCHES, IT IS GOING TO GET INTERESTING - DIMITRIS DRIKAKIS
Virginia. Fiberoptic is already happening but 5G cell tower deployment continues unabated. Do we need massive 5G energy hogging grids blanketing our cities, or just a modest number of cell towers for critical communication?
Reinventing Wires for Energy Efficiency and Reliability
Fiberoptic systems transport data more efficiently and inherently use less energy than wireless. In a Report, Reinventing Wires: The Future of Landlines and Networks, author Timothy Schoechle, PhD notes, “The history of U.S. communication infrastructure increasingly supports the proposition that it is unrealistic to expect private monopolies, duopolies, or triopolies—regulated or unregulat-
5G in Space: The Race to Where and Why and at What Cost?
The high-tech space race is largely unregulated with plans to exploit the atmosphere for ubiquitous cell phone coverage, artistic endeavors and advertising with satellite space billboards in the sky that can be seen for weeks by billions of people. Space is now called the final frontier for advertising. U.S. based startup, Rocket Lab, launched a 3-foot-wide mirrored geodesic sphere called Humanity Star in 2018 and advised us all to look up in the sky to experience our shared humanity. Astronomers were grateful when it fell out of orbit 2 months later, removing another artificial bright spot in the night sky.
Miniature satellites called CubeSats, the size of a Rubik’s cube, are also being launched into lower orbit for research, scientific studies, and commercial purposes. There are plans for much more commercialism, with space tourism also taking off. What is the effect on Earth’s ionosphere with increasing numbers of rockets being launched, emitting large amounts of potent greenhouse gases? As
ENERGY USE AND TECHNOLOGY
Levitt (2021) notes, “There are reasonable concerns that satellites may be contributing to atmospheric perturbation, climate change, and weather instability.”
5G Satellites: Broadband in the Sky with Diamonds
In 1958 the first satellite was launched into space. In 1984, Reagan signed the Commercial Space Launch Act, which mandated NASA to encourage private spaceflight. There were 372 active satellites at that time. A slow steady increase in satellites followed, with 1,000 circling the Earth in 2010. NASA and others placed these for critical communications, weather forecasting and studying atmospheric gases and clouds. 2016 marked the cosmic gold rush with the beginning of exponential growth and commercialization of space flight. (Statistica). What changed?
In 2015 the U.S. Commercial Space Launch Competitiveness Act was signed. The law “was designed to encourage commercial spaceflight and innovation by: postponing significant regulatory oversight of private spaceflight companies until 2023; extending the period during which the government indemnifies com-
mercial spaceflight companies for third-party damages beyond the company’s required liability insurance; and granting private companies the right to own resources collected in space, such as materials from asteroid mining.” (Space Foundation)
According to Statista in 2023, there were an estimated 9,115 active satellites orbiting the Earth, which represented a 35 percent increase in satellites compared to the previous year. Many of these new satellites in low earth orbit are intended for use in 5G communications. Tens of thousands of satellites are planned for the future with a 10-fold increase in launches in the next 10-20 years. Starlink is proposing about 42,000 of them. After the 7,000th Starlink satellite was recently launched, Elon Musk’s company, SpaceX, can now claim to own two thirds of all the active satellites. (CelesTrak 2024). These low Earth orbiting satellites reflect the sun as they move, looking like a shining diamonds in the sky.
Celestial Cell Towers
ADDITIONALLY, MOBILE COMMUNICATION AGENCIES SHOULD BE INFORMED AND INSTALLATION OF BASE STATIONS FOR MOBILE COMMUNICATION TOWERS SHOULD BE PROHIBITED AT AGRICULTURAL LANDS. -UPADHYAYA(2022)
THERE ARE NO ENVIRONMENTAL POLICIES IN PLACE TO MITIGATE ENVIRONMENTAL DAMAGE FROM ROCKETS AND SPACE JUNK, NECESSITATING MODELLING STUDIES TO QUANTIFY AND PROJECT THE EFFECTS. -ELOISEMARAIS,PHD,PROFESSOROF ATMOSPHERIC CHEMISTRY
Other larger and even more intrusive satellites have already been sent into space such as BlueWalker 3 satellite, which is officially now one of the top 10 brightest objects in the sky, comparable to a planet or a star. The celestial cell tower has an antenna the size of a badminton court, reflecting sunlight as well manmade electromagnetic radiation (EMR) back and forth to Earth. This satellite was developed to support 5G communications in space by AST Space Mobile. It has already demonstrated 5G connectivity to smartphones from Maui to Spain and also transmitted 4G video.
The purported mission is to have what is called a “Single Network Future”, with universal
coverage of cell phones for emergencies around the world, “bringing broadband internet to the estimated 2.6 billion people who don’t have access to it.” FCC chair Jessica Rosenworcel said, “We can make mobile dead zones a thing of the past.” A few questions remain. Is there any limitation on the number of cell towers or transmission levels the Earth will experience? How will this increased EMF affect the stability of Earth’s atmosphere and the living planet below? Is anyone studying the biological effects of this mushrooming radiation beaming to Earth? Do we need this in every corner of our planet?
Loss of the Night Sky to Satellites
Romantic notions of space flights in the past have been replaced with a reality check. Space X and other low orbit satellites blasted into the skies have obscured the view for astronomers and romantics alike, who used to look to the sky for discovery and solace. They now see new tech bright spots rather than stars. Night sky watchers have reported UFO sightings that look like a necklace made of white boxcars in the sky, but are only an array of Starlink satellites reflect-
ed by the sun.
Starlink satellites reflect so much light that astronomers can no longer photograph the night sky due to blurred images. Students are befuddled and astronomers frustrated to the point they prepared to sue the FCC for allowing uncontrolled satellites launches, writing a scathing letter. They have also posted an Astronomers’ Appeal, currently with 2,107 signatures, to safeguard the astronomical sky from artificial satellite pollution. They state the rising satellite numbers represent, “a dramatic degradation of the scientific content for a huge set of astronomical observations… and… Astronomers are extremely concerned by the possibility that Earth may be blanketed by tens of thousands of satellites, which will greatly outnumber the approximately 9,000 stars that are visible to the unaided human eye.”
Rocketman: Altering Ozone, Stratospheric Temperatures and Atmospheric Circulation
Our atmospheric chemistry is very complicated and scientists are still working to understand it. There are 5 layers of Earth’s atmospheric cake, all with
unique properties and temperatures, and which have allowed evolution while protecting our living breathing planet. Adding a steady flow of rocket launches spewing chemicals and heat trapping black carbon directly into the upper atmosphere, spells planetary warming from this space revolution. Scientists in 1967 predicted that increasing CO2 would warm the lower atmosphere and cool the upper atmosphere. A 2023 publication examining satellite-measured trends in the thermal structure of the Earth’s atmosphere and human “fingerprints”, confirms that the predicted cooling in the upper atmosphere from CO2 is “incontrovertibly” manmade (Santer 2023).
Three recent scientific articles published by atmospheric researchers on rocket launches, highlight the environmental and climate changing aspects of propelling more satellites into the skies. Scientists found temperature changes, ozone depletion and changes in atmospheric circulation that are worrisome. Regulation of space travel, especially for tourism, is advised.
THERE HAVE BEEN NO ENVIRONMENTAL ASSESSMENTS (EAS) OR ENVIRONMENTAL IMPACT STATEMENTS (EISS) REVIEWED UNDER NEPA BY THE FCC, WHICH DETERMINED IN 1986 THAT SATELLITES WERE CATEGORICALLY EXCLUDED.
- LEVITT 2021
The Climate and Ozone Impacts of Black Carbon Emissions from Global Rocket Launches (Maloney et al 2022) notes that there is a global launch industry that is just getting started. Rockets use fuel that, “emit black carbon (BC) particles directly into the stratosphere where they accumulate, absorb solar radiation, and warm the surrounding air”. The authors calculated if there is a 10fold increase in rocket launches, which is the anticipated increase in space traffic, that black carbon emission increases stratospheric
THIS ENTIRE EXERCISE IN RESTRAINT WOULD TEACH US THE MOST VALUABLE LESSON OF ALL: THAT THE QUALITY OF OUR LIVES WILL BE ENRICHED IF WE MAKE FEWER DEMANDS ON OUR RESOURCES. “LESS IS MORE” IS A PARAMOUNT TENET OF ENVIRONMENTAL REFORM, AND IT IS TIME FOR US TO RECOGNIZE ITS SPECIFIC BENEFITS. -STEWARTUDALL,F ORMER INTERIOR SECRETARY
temperatures by as much as 1.5K [1.5 C], along with slowing of the subtropical jet wind speeds with “a 10%–20% weakening of the overturning circulation occurs in the northern hemisphere during multiple seasons.” They conclude, “We show that the rocket black carbon increases stratospheric temperatures and changes the global circulation, both of which cause a reduction in the total ozone column, mainly in the northern high latitudes.”
Impact of rocket launch and space debris air pollutant emissions on stratospheric ozone and global climate (Ryan et al 2022) looked at emissions data from modern space launches and the increase in reentry space debris. They noted that the three phases of pushing a rocket into space, involved emitting several greenhouse gases including, ni-
ENERGY USE AND TECHNOLOGY
trous oxide, black carbon, alumina particles, water vapor and chorine. Reentry of space debris increased nitrous oxide. Their team found that black carbon from rockets are 500 times more efficient at warming the atmosphere than all other soot combined.
The authors conclude that after a decade of space tourism, the emissions, especially black carbon would reverse and undermine gains in the 1987 Montreal Protocol to reduce the ozone hole in the upper atmosphere. The protocol, which was signed by every nation in the world, phased out ozone destroying chemicals such as chlorofluorocarbons (CFC’s) used as a coolant in refrigerators, and brominated halons used in fire extinguishers. The protective ozone layer in the upper atmosphere filters out harmful ultraviolet radiation, which is associated with increased skin cancer and cataracts, reduced agricultural productivity, and disruption of marine ecosystems. In 2016 hydrofluorocarbons (HFCs) which replaced CFC’s, have just been added to the Montreal Protocols list to be phased out.
Atmospheric pollution from rockets (Drikakis and Kokkinakis 2022) examined webcam footage of exhaust gases from Space X rocket launches and modeled the emissions from a typical rocket transporting people and payloads into Earth’s orbit. They found the pollution from rockets could have a significant cumulative effect on climate. The nitrogen oxides (NOx) emitted by the rocket by the time it reaches 10 Kilometers would have polluted over 2 cubic kilometers of atmospheric air with unhealthy nitrous oxide concentration. They were surprised to find that in the first stage of the rocket launch, about 116 tons of CO2 was emitted in 165 seconds.
The final thoughts of atmospheric researchers… “These uncertainties and the results we obtain support the need to develop international regulation to mitigate environmental harm caused by launch
IF INDUSTRIAL MAN CONTINUES TO MULTIPLY HIS NUMBERS AND EXPAND HIS OPERATIONS HE WILL SUCCEED IN HIS APPARENT INTENTION, TO STEAL HIMSELF OFF FROM THE NATURAL AND ISOLATE HIMSELF WITHIN A SYNTHETIC PRISON OF HIS OWN MAKING. HE WILL MAKE HIMSELF AN EXILE FROM THE EARTH AND THEN WILL
KNOW AT LAST, IF HE IS STILL CAPABLE OF FEELING ANYTHING, THE PAIN AND AGONY OF FINAL LOSS.
-EDWARDABBEY,AUTHORDESERT SOLITAIRE.
and re-entry emissions of a fast-growing industry.” (Ryan et al 2022)
Space Junk: What Goes Up Must Come Down
As space flight has become cheaper and now commercialized, money is the driver, not human kind. There is concern not only about the planetary heating effects of launching these satellites, with excessive fossil fuel use and black carbon emissions from the rockets, but also the large mushrooming amount of floating “Space Junk”.
The recent entry of discarded hardware from the International Space Station, which crashed into a house in Naples, Florida, reminds us that all objects
launched into space are heading back down to Earth at some point. NASA identified that the rock that hit the house was originally a 5,800 pound (2.9 ton) cargo pallet containing aging nickel hydride batteries, that was released in 2021. As it traveled through the atmosphere, most burned up leaving a small yet powerful potato like mass, weighing not quite 2 pounds, that left a hole in the ceiling and floor of the house.
Scientists worry that the thousands of inactive satellites and degrading objects large and small in orbit around the Earth could prove catastrophic. The Kessler effect suggests that when a certain level of space debris enters the low orbit atmosphere it will trigger a colliding cascade effect, resulting in permanent risk to other satellites and spacecraft. International regulation of the sky has been suggested to protect space from unnecessary projects that pose more risk than benefits to humans.
Planetary Electromagnetic Fields from Space: Birds, Bees and frogs
Living organisms evolved within the low levels of the Earths’ natural electromagnetic fields (EMFs). We know that many species use these magnetic fields to navigate, forage, breed and survive. Biologists have discovered that wireless electromagnetic radiation (EMR) can disturb internal magneto-receptors used for navigation, as well as disrupting other complex cellular and biologic processes in mammals, birds, fish, reptiles, insects, trees, plants, seeds and bacteria, with profound impacts on the natural environment.
Scientists have noted that wildlife may be more vulnerable to harm from manmade ambient electromagnetic fields than we have previously thought. Many researchers refer to manmade EMR as electromagnetic pollution (Levitt 2021) or just electropollution, a new toxicant in the environment that humans and
wildlife are increasingly exposed to with the deployment of more 4G and 5G telecommunication cell towers on land and in space. How will that effect the living planet? Levitt et al (2022) point out, “No radiofrequency (RFR) emission guidelines today take non-human species into consideration”.
This issue, like that of rocket emissions, has not been addressed in the mad rush to have ubiquitous wireless connection on every corner of the Earth, and now from space.
Low EMF Wireless Radiation Affects Wildlife and Plants
In their seminal, thoroughly referenced article, “Low-level EMF effects on wildlife and plants: What research tells us about an ecosystem approach” (Levitt et al 2022), the authors reveal to us the large body of evidence showing harm from wireless electromagnetic radiation to all biological systems, noting “Effects have been seen in all taxa, in various frequencies, intensities, and exposure parameters.” These effects are not only seen in the lab, but alterations in behavior, growth and reproduction have been seen in birds, bees, salamanders, tadpoles and many other species from cell tower emissions, causing declines in animal populations (Balmori 2009).
Scientists examined captive male kestrels exposed to EMR or controls and found, “Short-term EMF exposure (one breeding season) suppressed plasma total proteins, hematocrits, and carotenoids in the first half of the breeding season”, as well as melatonin, indicating oxidative stress (Fernie and Bird 2001). Large reviews of the science, including one by the Ministry of Environment, Forest and Climate Change in India in 2010, show varying negative impacts on two-thirds of wildlife studied, especially birds and bees.
Plants and EMF
Even plants are affected by EMF. Upadhyaya et al (2022) looked at the physiological, metabolic and nutritional changes in tomato plants grown near communication base stations. They discovered, “There was a significant decline
in total phenolic content (37.06%), flavonoid content (71.38%), Vitamin C content (72.45%), and DPPH (59.32%) as well as total antioxidant assays (71.89%) which revealed significant deteriorative effects on such waves on secondary metabolites and the antioxidant potential of tomato plants.” Additionally, they observed a reduction in photosynthetic pigment content of leaves noting curling of leaves, discoloration, and size reduction were more prominent with an increase in the exposure time. The authors offered cautionary policy recommendation in their conclusion, “Additionally, mobile communication agencies should be informed and installation of base stations for mobile communication towers should be prohibited at agricultural lands.”
A review by Panda et al (2024), on the effects of cell phone frequencies on green plants, revealed that a “range of frequencies, time durations, power densities, and electric fields were found to have differential impacts on the growth and development of green plants.” Researchers noted elevated oxidative status of the cell, macromolecular damage, and lipid peroxidation, in addition to, chromosomal micronuclei formation, spindle detachments, and increased mitotic indexes. They also found transcription factors were “overexpressed in many cases due to the cellular radiation impact, which shows effects at the molecular level.” This affected growth and development of the plants.
World Heritage Site: Species Disappear When Cell Towers Placed
Biodiversity is a critical planetary boundary connected to climate change and planetary health. One of the most carefully documented examples of multiple species decline with cell towers was carried out by ethnobiologist and forest researcher, Mark Broomhall, who lived and worked on Mt. Nardia, in Australia, for 40 years. He carefully catalogued widespread species disappearance from 2000-2015, with the introduction of more cell towers in the Mt. Nardia Nightcap National Park World Heritage Site. He found that that “from 70 to 90 % of the wildlife has become rare or has disap-
peared from the Nightcap National Park within a 2-3 km radius of the Mt. Nardi tower complex.”
He published his data in a report to the United Nations Educational Scientific and Cultural Organization (UNESCO). Broomhall noted that pulsed microwaves are particularly toxic and can affect not only the top of the life chain species but also the entire fabric of the wildlife community, “causing genetic deterioration in an insidious, massive and ever escalating scale. To truly understand what these studies reveal is to stare into the abyss.” He asked that this matter be considered a national emergency.
The Race into Space: Where is the Monitoring and What is the Plan?
Space has become crowded and is about to get even more congested. With today’s space entrepreneurs sending more cell towers in space broadcasting and beaming a variety of pulsed manmade frequencies around the globe this creates, “another low-level layer of novel exposures that do not now exist” in the atmosphere and on the earth itself (Levitt 2021). The authors note, “New complex multifrequency satellite networks are increasing and therefore Earth exposures are too. Large or small, most satellites communicate with earth-based stations at significant power outputs…None of these agencies or companies appear concerned about the massive infusion of novel RFR into various strata of the atmospheric or ground-based environment, and the U.S. Environmental Protection Agency—the agency with primacy over environmental radiation effects— has been defunded for nonionizing radiation research and regulatory oversight since 1996.”
Currently, we do not monitor EMF radiation levels over time, to see the impacts of increasing cell tower base stations, nor increased low level radiation from space communications, on the on flora and fauna of our planet. We do not fund independent studies to look at these effects to mitigate harm. Levitt (2021) points out that, “There have been no Environmen-
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tal Assessments (EAs) or Environmental Impact Statements (EISs) reviewed under NEPA by the FCC, which determined in 1986 that satellites were categorically excluded.”
The United Nations Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), however, has documented the massive and accelerating decline in Earths’ species which is multifactorial with pesticides, habitat loss and climate change high on the list, but without consideration of an obvious source of environmental toxicity, escalating unregulated, unmonitored electromagnetic pollution. “The measured rising EMF levels in ambient environments certainly elevate concerns, especially with 5G on the horizon using higher frequencies and novel signal characteristics/waveforms that are capable of affecting insects in particular with implications for the entire biome.” Levitt et al (2022)
E-Waste: Significant Yet Under-Appreciated Impacts on Climate Change
As technology has radically transformed the lives of modern civilization, the electronic waste (E-Waste) it produces is also transforming the landscape… and the climate as it turns out. According to the UN’s Global E-waste Monitor 2020 report, 53.6 million metric tons of electronic waste worldwide was generated in 2019, which was a 21% increase over a span of just five years. Fawole and colleagues in 2023 published a thorough review of E-Waste, Climate change Implications of Electronic Waste: Strategies for Sustainable Management. They point out, “Staggeringly, if we were to stack these wasted [5.3 billion] phones, they would ascend 50,000 km, a height that is 120 times the altitude of the International Space Station and about one-eighth of the journey to the moon. Only about one-fifth of all E-Waste is ever successfully recycled and E-Waste distribution sites are getting quickly saturated. (Zhao 2019)
E-Waste, one of the fastest-growing waste streams worldwide, surprising-
ly has significant yet under-appreciated impacts on climate change due to 1) open burning which generates CO2 and Methane, both potent greenhouse gases (GHG) and 2) unregulated landfill disposal, which releases refrigerants and insulating foams from waste electronic and electrical equipment such as hydrochlorofluorocarbons and hydrofluorocarbons, which are potent GHGs. E-Waste also includes an abundance of rare and precious minerals which, when not recycled, leads to more energy intensive and destructive mining.
Alaskar (2022) examined the global problem of electronic waste generated primarily by the Information and Communication Technology (ICT) sector and identified significant challenges in management, including poorly defined regulations, untrained waste handlers, high costs, and “poor coordination between manufacturers, customers, and government bodies.”
TMI…Too Much Information Technology: What About Digital Sobriety?
The Shift Project in 2019 noted that the rapid expansion and unchecked energy use of information technology with the rise of digital consumption is unsustainable and “High income countries alone bear the responsibility”. Their first report, Towards Digital Sobriety (2018), calls on the public authorities, “to set up a public database to enable stakeholders to analyze their environmental impact. Such a database could be based on the model of existing carbon impact databases such as the French “Base Carbone Ademe”. This would make it possible to carry out a carbon assessment of major digital projects before they are launched.” They note, “Any increase in global energy consumption hinders the success of this historical and vital challenge: preventing climate chaos.”
They propose a Lean Information Communication Technology (ITC) for organizations and individuals which advises:
• Buy the least powerful equipment possible
• Change them as rarely as possible, i.e. keep your devices as long as you possibly can
• Reduce unnecessary energy-intensive uses.
The Shift Project has published five studies- Towards Digital Sobriety (2018), Unsustainable Use of Online Video (2019), Deploying Digital Sobriety (2020), Environmental Impact of Digital Technology: 5-year trends and 5G governance (2021), Planning the Decarbonization of the Digital System in France (2023 and most recently Energy and Climate: What Virtual Worlds for a Sustainable Real World? (2024).
These reports all highlight the challenge of balancing our wants with our needs for a healthy society and planet. Promoting a “Less is more” approach, lowering our tech use may allow us to lift our heads up to see the real world, which we can positively impact with our choices, instead of virtual world where we have lost control. Using less digital tech is likely to improve our mental and physical health, as well being more cost effective all around.
We have persisted through 6 million years of human evolution, during which we have sharpened our minds to calculate, integrate knowledge and use critical thinking in relationship to nature for our mutual survival. Will our addiction and new-found dependence on digital technology in the last 2 decades, with its distractions, deep fakes, disconnection and displacement of human jobs be useful to us, or eventually wither away our ability to think clearly, leading us to an uninhabitable warmed planet, without us even noticing or caring?
Full references for this article available at:
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IT IS ESSENTIAL TO REMEMBER THAT ENSURING SAFETY IS A PREREQUISITE FOR THE SPREAD OF GEOTHERMAL POWER GENERATION. -JAPANNEWSEDITORIAL,AUGUST2023 AFTER GEOTHERMAL BLOWOUT
CINDY RUSSELL, MD Co-Chair SCCMA Environmental Health Committee
The transition to clean power for tech and our homes is easier for some people than others. It depends on where you were born and where you live in the world. The human and environmental costs are now being revealed, but not yet accounted for in our race to electrify everything and produce “green energy”. While climate change is looming and needs to be addressed, and YES, we need to electrify our energy, we also need to consider other factors to prevent human rights abuses and environmental degradation in the process. We could perhaps adopt a bit of “Voluntary Simplicity” to reduce our demand and work to restore nature rather than disrupt it.
Geothermal Energy Production: Drilling for Hot Water
Conventional Geothermal accounts for 0.4% of energy production, using surface drilling to access preexisting hot water reservoirs, heated primarily by primordial radioactive minerals in the rocks. These sources have largely been tapped out but are not without impacts. Traditional geothermal energy appears to be very clean, but has downsides noted by Fish and Wildlife. Harms identified include air and water pollution, contamination of aquifers, release of naturally occurring radioactive waste from deep rocks and hazardous waste. They note, “Steam vented at the surface may contain hydrogen sulfide, ammonia, methane and carbon dioxide. Dissolved solids discharged from geothermal systems include sulfur, chlorides, silica compounds, vanadium, arsenic, mercury, nickel and other toxic heavy metals. All of these releases, if concentrated, can create localized fish and wildlife kills.”
MINING
Fracking Oil or Water: Same Risks of Earthquakes and Blowouts?
Hydraulic fracking for oil has been used for decades, and creates significant well-known risks that include earthquakes, blowouts and water pollution. Will nascent Next Gen Geothermal carry those risks as well? While Geothermal seems to have worked well in Iceland where steam is much closer to the surface, a pilot fracking operation in Basel Switzerland in 2006 was shut down after it triggered a 3.4 magnitude earthquake causing cracks in the medieval buildings. In the Salton Sea in California in 2009, a geothermal project was shut down due to tremors which caused millions of dollars of damage. Geothermal energy is still being used there, despite frequent earth-shaking shock waves experienced by local residents. Well publicized earthquakes have been linked to Geothermal drilling and injection in a project in South Korea.
IS LIKE A SEARCH AND DESTROY MISSION. -STEWARTUDALL, FORMER SECRETARY OF THE INTERIOR
Earthquakes are common with Fracking. Residents in Oklahoma were rocking so much from the fracking disposal wells that policy makers intervened to tame them. In 2014 Oklahoma Governor Mary Fallin created an all stakeholders group, that eventually led to regulations greatly reducing the number and intensity of the earthquakes. The largest gas field in Europe resides in the Netherlands and it will be closed by 2030 due to sustained damage from earthquakes. Niyogi (2023) looked at carbon dioxide fracking in Kansas over a six-month period with finely tuned equipment and measurements, confirming that fracking causes slow, small earthquakes or tremors, likely due to frictional slip. Bhattacharya (2019) demonstrated that fracking can cause earthquakes tens of kilometers away.
Next Generation geothermal plants that have been piloted and are in development use injection and hydraulic fracking methods to crack open rock a mile beneath the surface, similar to gas and oil fracking. This opens a new steady stream of magma-heated water and liquid that can be used to generate steam, that runs turbines, that connects to electrical generators. It is said to be an unlimited source of energy. Oil and gas fracking equipment and techniques can be adapted for new geothermal. In fact, geothermal plants are now planning to use abandoned oil wells to access deep hot water.
Blowouts with bodily injury to workers has occurred in both oil and gas and geothermal systems in Australia, Chile and Japan. In 2023 a blowout in an exploratory well in Japan released toxic hydrogen sulfide gas and arsenic laden water. Do we know the long-term consequences of taking the heat from the earth and moving it to the surface?
Water pollution of public wells from fracking is a serious hazard. It has led to kitchen faucets catching on fire, as these manmade Earth cracks can connect deep methane to wells and aquifers used for drinking water (Gasland 2010). To initially crack and frack the sedimentary rock many chemicals are used - acids dissolve the rock; propellants apply pressure;
ENERGY USE AND TECHNOLOGY
gelling agents help carry proppants into fractures; biocides kill bacteria and corrosion inhibitors are used to prevent rusting of the steel. There are many more chemicals with many allowed to be propriety (not disclosed) in many states. “The EPA identified 1,084 different chemicals reported as used in fracking formulas between 2005 and 2013. Common ingredients include methanol, ethylene glycol, and propargyl alcohol.” (NRDC 2021)
A study from the University of Rochester was one of the first to directly link shale development with compromise of public drinking water causing pollution with effects on infant health (Hill and Ma 2022). The authors who carefully looked at data from all of the Pennsylvania fracking sites and found, “drilling near [within 1 Km] an infant’s public water source yields poorer birth outcomes and more SGD-related contaminants in public drinking water.” This is also linked to subsequent negative impacts on educational attainment, childhood asthma exacerbation and heart attacks. The authors call on policymakers to revisit regulations on the fracking industry, in addition to, updating water quality standards.
NOT ONLY IS DEEP-SEA MINING AN ENERGY-INTENSIVE INDUSTRY
WITH HIGH GREENHOUSE GAS EMISSIONS, BUT DISRUPTION OF THE OCEAN FLOOR, WHICH IS BY FAR THE LARGEST CARBON STORAGE RESERVOIR ON EARTH, CAN LEAD TO REDUCED CARBON SEQUESTRATION AS WELL AS THE RELEASE OF LARGE AMOUNTS OF THE POTENT GREENHOUSE GAS METHANE, EXACERBATING THE CLIMATE CRISIS.
- NATIONAL COMMITTEE OF THE NETHERLANDS
Do we know how many chemicals are used in Geofracking and will they also affect scarce fresh water sources we depend on? Many questions remain about the dangers of the Geo Fracking.
Greening Our Power: Mining Creates Environmental and Humanitarian Crisis
Many of the high-tech minerals for “green energy” are mined from poverty stricken developing countries. Extracting lithium, cobalt and other precious rare earth minerals to power our cell phones, electric vehicles and even wind turbines comes with a steep cost that is both human and environmental. There is a long list of rhyming minerals- Erbium, Cerium, Palladium, Lanthanum, Neodymium, Zirconium, Yttrium, Terbium, as well as copper, gold and silver that are critical to make these technological wonders.
About 75 percent of the world’s supply of cobalt, which is used in rechargeable lithium ion batteries, comes from the Congo. In “Cobalt Red: How the Blood of the Congo Powers Our
Lives” author Siddharth Kara documents his travels to the Democratic Republic of Congo witnessing mining operations that reveal a global modern-day slavery system with rampant human rights abuses. Children are the most heavily exploited in the “Artisanal” extraction of cobalt by hand, digging for less than a dollar a day, and being exposed to toxic cobalt dust. Food and water become contaminated with radioactive cobalt.
Cobalt extraction in the Congo has transformed millions of acres of fertile land and woodlands into a wasteland, with polluted streams from acid and mining waste, creating dead zones in rivers where fish can no longer survive. According to Global Forest Watch, the Congo lost 42.3 million acres of tree cover from 2001 to 2021. That not only has an impact on the health, wellbeing and survivability of the communities, it contributes to climate change that we all experience.
According to World Data, a Congolese person consumes about 356 Kw of energy per year, versus an average of 78,000 Kw per person in the United states. How does mining affect their Paris Agreement goals? Efforts are underway now to reforest the land but the path is uncertain. Kara questions the morality of our excessive consumption and so-called clean energy transition, which ignores the harm to individuals and causes widespread destruction in whole communities for our convenience.
Mining the Ocean: A New Frontier or the Final Frontier?
In the cold dark high-pressure zone of the deep sea lies what some say is the new frontier for mining clean energy minerals. Mineral mining in the sea is now being initiated after the discovery of slow-growing potato-sized rocks laying on the surface in vast areas of abyssal plains of all major oceans. These deepsea polymetallic rocks contain manganese, nickel, copper, and cobalt, in addition to, molybdenum, titanium, lithium, and the rare earth elements which have developed over thousands of years, just waiting to be harvested now that advancements in technology will allow it. The Clarion-Clipperton Zone in the Pacific Ocean already has 17 deep-sea mining contracts, cover-
ing 1 million square kilometers.
Sea Soil Sediment: A Microbial Base of the Sea Food Web
While we used to think the deep sea was lifeless, it is in fact abundant with life and the largest habitat space on the planet. Tens of thousands of species have been identified in deep ocean ecosystems and researchers expect there are millions more that have not been discovered. The seabed is much like our topsoil which has the largest reservoir of ancient carbon stored beneath it. Hoshino (2020) notes that, “Microbial life in marine sediment contributes substantially to global biomass and is a crucial component of the Earth system.”
Ocean mining vehicles scrape the seabed with large underwater tractor-like vehicles, scooping up the rocks and top layer of sediment that are pumped to a vessel that processes it and dumps the topsoil and waste back in the ocean. While mining the sea does not deforest land, pollute fresh water and skirts human rights issues, disrupting the sea-bed is predicted to speed up climate change by reducing carbon sequestration, as well as by releasing large amounts of stored methane, a potent greenhouse gas methane. (Souster 2024)
Mining activities can destroy biodiversity hotspots found in fields of these rocks, poison both deep and surface sea-life with wastewater, and with noise pollution, could alter whale activity, among other risks. These fragile marine ecosystems would likely be permanently damaged affecting coastal communities and indigenous people who depend on fishing for food. The in-
frastructure required for this new industry would increase shipping and like oil requires land for shoreline facilities that further threatens habitat. In Papua New Guinea, Indigenous communities across several island provinces are calling for a permanent ban on deep-sea mining within its waters.
The International Seabed Authority (ISA) was established under the United Nations Convention on the Law of the Sea and is responsible for the governance of deep-sea mining in areas of the ocean beyond national jurisdiction (DSM). Regulations are in process but not yet complete. 2025 is the target date set by the agency to have nations sign the agreement. Pickens (2024) notes in his research article that, “more than 30 major issues in the regulations remain outstanding”, due to lack of information and discussion by all nations that at present have disagreements. And the ISA target date is far too soon to protect the oceans and the climate.
We need to rethink where, when and what to mine from the Earth, carefully examining if this will indeed save the planet or push us closer to the climate edge. A full carbon cost accounting, environmental assessment and international regulation are needed, along with examining alternatives.
Full references for this article available at:
DR. CINDY RUSSELL AND DR. STEVE JACKSON
Co-Chairs SCCMA Environmental Health Committee
“While nearly every country acknowledges the potential health risks posed by heavy metals, microplastics, PAHs, and PFAS chemicals, very few have actually implemented artificial turf and crumb rubber infill regulations and/or established adequate surveillance measures to protect those regularly exposed to the fields.”
Zucarro (2022)
The Santa Clara County Medical Association was asked a year ago by students at Saratoga High School to write a letter in support of natural grass playing fields to replace artificial turf at their school to benefit the health of students and the environment. This was prompted by a minor fire alarm in which students had been moved on to the high schools’ artificial turf field, but many of these students had to be removed from the plastic field due to excessive heat. Taking note from this experience the students educated themselves and developed a full-fledged campaign to convince the administration to switch back to real grass, the way it had been in 2004. Moreover, in a Saratoga Falcon article, students reported that they preferred grass fields due to what they felt was a lower injury rate. Saratoga High School officials ultimately decided to replace the deteriorating plastic turf with new artificial turf, citing a loss of the field’s use for an extended time and difficulties with maintenance. Yet, the push for real grass continues across the United States with numerous cities and counties involved in the same discussions.
Cost, Water Use, Maintenance Vs Environment and Health
Costs, water use, maintenance and hours of playability are real issues and at the top of the list for soccer and some other coaches who argue to keep the artificial turf. We know they care about their players and want them to enjoy sports. Scientists and physicians, on the other hand, are also concerned with long term health, physical and heat injury, environmental contamination and that pesky disposal issue. We also argue that when examining the full life-cycle analysis, that natural grass fields’ costs are actually lower, water use is not as different as
advertised, and also that natural grass maintenance creates jobs and fosters careers in regenerative soil care that captures carbon rather than releasing it. Indeed, there is an ongoing global as well as local debate on this issue.
Santa Clara County Fairgrounds Soccer Fields: Artificial Turf or Natural Grass?
The SCCMA took notice of the plan to place artificial turf on 4 of the 8 playing fields at the Santa Clara County Fairgrounds with a proposed redevelopment, and in partnership with the San Jose Earthquakes. The SCCMA sent a letter to the Santa Clara County Board of Supervisors in March 2024 asking them to rethink the proposal and use natural grass soccer fields for all the areas instead of artificial turf. After many public comments by soccer moms and environmental groups, Supervisor Otto Lee proposed a ban on artificial on County property. It is still being deliberated.
The SCCMA Adopts Policy Recommending Removal of Artificial Turf
As more scientific information on the risks of plastic turf was revealed, the SCCMA adopted a policy recommendation on June 10, 2024, regarding synthetic fields, that includes numerous references on all aspects of artificial turf. It states:
Recommendations: After careful consideration of the current scientific evidence of plastic and chemical contamination, sports injuries, urban heat effects, disposal, potential short and long-term health effects, as well as direct and indirect environmental costs, the SCCMA believes artificial turf is potentially harmful to both human and environmental health and is not a sustainable option when compared with natural grass.
Taking a precautionary approach for the long-term protection of the children, the environment and public health, we recommend:
1. That artificial turf not be used on sports fields, playgrounds, landscaping, residential lawns or in schools, but instead that natural grass turf be used, a choice that will serve to benefit the health and safety of children, athletes and the environment, and
2. If artificial turf is in place, that at the end of its useful life it be replaced with natural grass
The California Medical Association Adopts Policy Supporting Removal of Artificial Turf
The California Medical Association also deliberated issues surrounding artificial turf and passed their policy resolution in August 2024.
Resolution 101-24: Removing Artificial Turf in Schools, Parks and Public Spaces.
RESOLVED: That, due to artificial turf’s harmful impacts on human and environmental health, CMA recommends replacing artificial turf with natural, drought-tolerant and hardiness zone appropriate turfgrass in parks, sports fields and lawns when it is to be replaced; and be it further
RESOLVED: That CMA supports natural, drought-tolerant and hardiness zone appropriate turfgrass as the preferred choice on sports fields or lawns, in all public and private schools and colleges, as well as in city parks.
Mount Sinai Children’s Environmental Health Center’s Position Statement on Artificial Turf
The Mount Sinai ICAHN Children’s Environmental Health Center at the Institute for Climate Change, Environmental Health, and Exposomics note that children throughout their teen years are especially vulnerable to harm from forever chemicals, endocrine disrupting plasticizers and metals in artificial turf, which can affect their development. They have formally recommended against its use. After reviewing the risks and benefits of artificial playing surfaces, they found “significant gaps in the evidence supporting the safety of artificial turf products.” Citing their own ICAHN study in a 2024 letter, they note, “Recent studies including one conducted by Mount Sinai and the Toxic Use Reduction Institute (TURI) found the presence of known carcinogens and neurotoxins including polycyclic aromatic hydrocarbons (PAHs), lead, zinc, and black carbon in almost all alternative infill materials examined.” Artificial turf also contains flame retardants, color-
ants, UV stabilizers and other “proprietary” compounds.
New Water Quality Regulations to Lower PFAS (per- and polyfluoroalkyl substances)
In a detailed letter to Burrillville Town Council ICHAN included recent changes in water quality regulations. They state, “Actions by the USEPA highlight increasing recognition that there is no safe level of PFAS exposure. On April 10, 2024 the USEPA finalized legally enforceable National Primary Drinking Water Regulations for six PFAS, dramatically lowering the recommended levels of PFOA and PFOS and citing scientific evidence of health impacts at drinking water levels close to zero. These guidelines also include advisories for newer PFAS chemicals PFNA, GenX, PFBS, and PFHxS.
ICAHN announced their formal position statement on artificial turf last year which,
“recommends against the installation of artificial turf playing surfaces and fields due to the uncertainties surrounding the safety of these products and the potential for dangerous heat and chemical exposures.” (Mount Sinai 2023)
The Netherlands Bans Artificial Turf
In a bold move that resulted from years of a careful science-driven approach, the Netherlands voted in 2023 to phase out artificial turf by 2030. Their main reasons were related to health and environmental concerns, and more specifically cancer risk as reported by the Ministry of Sports. A Dutch study was performed and it found, “Of the 60 clubs involved in the study, the fields of 58 of them were found to contain 1.5 to 3.7 times higher levels of carcinogenic compounds than what is permissible in consumer products.” The European Union has recently banned crumb rubber use on artificial turf fields for similar concerns.
Men’s Professional Soccer in the Netherlands Will Be Played on Natural Grass in 2025-2026
Eredivisie, the highest level of men’s professional soccer in the Netherlands, has opted to outlaw synthetic turf fields by the start of the 2025-26 season, “20 years after they were hailed as the future of football.” The League’s 18 clubs and its governing body voted on this decision at the General Assembly of Pro-
fessional Football. One article in Dutch News states, “players disliked the surfaces because of the perceived increased risk of leg injuries and the different way the ball behaves on them.
More Opposition to Artificial Turf
It is notable that in New Jersey two bond measures were rejected on the Nov 7, 2023 ballot that would have provided $11.8 and $3.8 million in funds to place several acres of plastic turf on playing fields. New York passed bill S834 in 2023 which prohibits the sale of carpet or artificial turf that contains PFAS. The Los Angeles City Council is also moving forward a proposal to ban artificial turf. It appears there are rational and forward-thinking arguments supported by municipalities weighing the benefits and risks, and deciding the risks and liability are too high.
Precaution on Artificial Turf
The SCCMA among other groups calls for a precautionary approach. In a recent letter the SCCMA writes, “We feel a course correction is needed with a shift from fossil fuel derived plastic products, including artificial turf which produces hazardous substances along its entire lifecycle to products that reduce our carbon footprint and regenerate rather than degrade our planet.” We know natural grass is much cooler to play on, helps to improve air and soil quality and is the preferred surface for athletes to play on.
Yes, natural grass needs maintenance and attention, but we have done that in the past. Grass fields were the original playing fields, and if organically managed will promote healthier, more resilient playing fields for the future. Plastic or plants, that is the question.
References
• Health Impacts of Artificial Turf: Toxicity Studies, Challenges, and Future Directions. M Murphy and GR Warner. Environmental Pollution. 2022 Oct 1;310. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC10262297/
• Letter from Children’s Environmental Health Center Department of Environmental Medicine and Climate Science to Burrillville Town Council July 23, 2024. https://www.burrillville.org/sites/g/files/ vyhlif2886/f/uploads/icahn_ltr_with_reply_from_trc.pdf
• Policy Recommendation on the Use of Artificial Turf on Landscapes, Schools and Playing Fields.
Santa Clara County Medical Association. June 10, 2024. https://www.sccma.org/Portals/19/Artificial%20Turf%20 Policy%20Recommendation%20SCCMA%20Final%20%20 6824%20.pdf
• Letter SCC Board of Supervisors. Recommendation to use Natural Turf Grass on Santa Clara County Fairgrounds. March 12, 2024. https:// www.sccma.org/LinkClick.aspx?fileticket=C0f6wf5p9uY%3d&portalid=19
• LA Council committee moves synthetic grass ban proposal forward. June 28, 2024. CBS News. https:// www.cbsnews.com/losangeles/news/la-council-committee-moves-synthetic-grass-ban-proposal-forward/
• The Netherlands to phase out artificial turf over health and environmental concerns. Oct 26, 2023. Ministry of Sport. https://ministryofsport.com/the-netherlands-to-phase-out-artificial-turf-over-health-and-environmental-concerns/
• Prominent soccer league bans problematic landscaping material with hazardous effects: ‘An almost unanimous preference’. Nov 20, 2023. https://www.yahoo.com/news/prominent-soccer-league-bans-problematic-063000318.html
• No more artificial turf in the Eredivisie from the 2025-26 season. May 28, 2024. https://eredivisie.eu/ news/no-more-artificial-turf-in-the-eredivisie-from-the2025-26-season/
• Eredivisie clubs vote to ban plastic pitches from 2025/26 season. Dutch News. June 6, 2023. https:// www.dutchnews.nl/2023/06/eredivisie-clubs-vote-toban-plastic-pitches-from-2025-26-season/
• Staff editorial: It’s time to rethink the value of artificial turf fields. Sept 29, 2023. Saratoga Falcon. https://saratogafalcon.org/18233/opinion/staff-editorialits-time-to-rethink-the-value-of-artificial-turf-fields/
BY JONATHAN RUBINGH AND LARRY LITTLE
Introduction:
Like preventative health practices in medicine, Environmental Health is a discipline that promotes positive behaviors, creates healthy environments, and prevents disease through research and action. In practice, environmental health identifies, assesses, and improves conditions of natural and built environments.
Educating the public; implementing and enforcing local, state, and federal environmental laws; and working closely with other agencies to address potential community health threats are typical tasks at the Santa Clara County Department of Environmental Health (DEH). Conducting this work requires staff in different roles at our main office in San Jose, including regulation, investigation, and enforcement. (Georgia Department of Public Health, 2015). Empathy is also a key tool in our toolbox, to acknowledge and understand the history and barriers experienced by community members, so staff can effectively inspire action and improvement (Khan, 2024).
Santa Clara County DEH regulates retail food safety; public swimming pools; body art establishments; small drinking water systems; transfer and other solid waste facilities, installation and operation of on-site wastewater treatment sites in unsewered areas, above and underground storage tanks and their cleanup; and medical and hazardous materials and waste. Also, DEH administers the Lead Safe Homes Program and a voluntary Healthy Nail Salon certification program.
What can I do?
Medical professionals play an important role in advising their patients about reducing environmental exposures and creating safe environments.
• Champion environmental health within your organization by promoting environmental health training for staff. For example, has your staff heard about the shortand-long term health risks associated with exposure to dust due to poor ventilation, toxic chemical fumes from products used in nail salons, as well as the common symptoms experienced by workers and clients?
1. Seek formal education opportunities in environ-
mental health topics. A broad topic, environmental health seminars and continuing education sessions are available for a variety of areas of interest.
2. You can also encourage schools you attended to include environmental health subjects as core or elective courses if they don’t already.
• Talk with your patients about choices that reduce their exposures to potential risks.
1. Recommend certified healthy nail salons for manicures.
2. Purchase food from permitted vendors/facilities as they are more likely to be practicing food safety techniques.
3. Encourage patients to contact a government health agency when experiencing illness from food, water, substandard housing, or environmental exposure.
• Ensure appropriate blood lead testing of children.
• Test blood or stool for foodborne pathogens when appropriate and follow reporting requirements quickly.
• Play an active role by participating in working groups and community advisory groups. Community advisory groups are opportunities to share information, expand perspectives, and your contribution can provide vital contributions in program development and steering.
The Lead Safe Homes program is currently accepting members in a Community Advisory Group. Information can be found at deh.santaclaracounty.gov/consumers/ home-safety-and-health/learn-about-lead-safe-homesprogram#community.
Environmental Risk: Food
Food regulations help to ensure food supplies are safe, with the United States food supply among the safest in the world (U.S. Food and Drug Administration, 2023). However, food still carries risk (U.S. Food and Drug Administration, n.d.). The Centers for Disease Control and Prevention (CDC) (2024) estimate that around 48 million Americans, or one in six, get sick from their food each year. About 128,000 Americans are hospitalized, and 3,000 die each year from foodborne diseases.
Recent examples of contaminated food in the U.S. food supply include lead-contaminated cinnamon and applesauce; possible Salmonella contamination in tahini and in black pepper; and E. coli 0157 in organic walnuts. If you encounter a patient who thinks they might have been sickened by a recalled food, you can find multistate foodborne outbreak investigation information on the CDC website. Food recalls and alerts are also published on the United States Food and Drug Administration (FDA) website.
In studying local outbreaks, the CDC identified five risk factors responsible for most foodborne illness outbreaks. These risk factors are:
1. improper food storage temperatures
2. improper cooking temperatures
3. poor personal hygiene
4. obtaining food from unsafe sources
5. use of contaminated of equipment
Keeping food safe means keeping cold food cold at 41 degrees Fahrenheit or below and keeping hot food hot at 135 degrees Fahrenheit or above. Washing hands, work surfaces, and equipment when switching tasks, such as switching from handling chicken to handling salad greens, helps ensure hygiene and sanitation. Buying food and ingredients from reputable, licensed suppliers reduces the chance that the food or ingredient is contaminated. These are the practices that DEH works to ensure are followed by retail food facilities feeding your patients in Santa Clara County.
Figure 2: Source: cdc.gov/food-safety/index.html
County of Santa Clara Retail Food Safety
For the more than 1.9 million residents in 15 cities and adjoining unincorporated areas throughout Santa Clara County,
DEH inspectors are at the heart of protecting the region’s diverse community from foodborne illness. Retail food facilities inspected by DEH are places food is provided, even if free of charge, to the consumer. Examples of retail food facilities include restaurants, bars, grocery and convenience stores, stadiums, schools, mobile food facilities, street vendors, vending machines, and businesses that provide food to employees. Enforcement takes place through regular inspections of each retail food facility and investigating complaints. We receive complaints from the public, and those range from reports of disease to vermin infestation or dogs in the grocery carts. Inspectors also approve designs for building food establishments laid out to optimize food safety: adequate and close hand washing stations, authorized hoods for greasy and other hot food prep, and separation of food prep from cooking areas. Fixed food facilities are categorized into one of three categories based on the risk associated with how they prepare their food. DEH conducts unannounced inspections one, twice, or three times each year, depending on the level of risk.
During the calendar year 2023, Santa Clara County DEH had 9,005 permanent restaurants and markets under permit. Of these, 3,387 were RC1-type facilities (grocery stores), 3,132 were RC2-type facilities (fast food restaurants), and 2,486 were RC3-type facilities (mostly dine-in restaurants).
DEH reports findings and raises public awareness of risk at facilities that prepare food by using a color-coded placard program. Through this program, retail food facilities receive a green (Pass), yellow (Conditional Pass), or red (Fail) placard. The color of the placard is determined by how many violations the inspector observed during the inspection associated with the 5 CDC risk factors and if they can be immediately corrected. Risk factor violations are considered major violations and may pose a significant threat or danger to health, thus requiring immediate correction.
Sites that receive a yellow or red placards require a reinspection to verify corrections were made to eliminate the risk factor violation(s) that were observed during the initial inspection. Yellow placards are issued when 2 or more major violations are observed that can be immediately corrected. Red placards are issued to facilities that have any major violation(s) that could not be corrected during the inspection. Red placards also indicate that a site has been closed by DEH because of one or more uncorrected major violations. Until a reinspection is conducted to confirm the violation was cor-
Figure 3
rected, the red placard and site closure remain. For example, food recently cooked but not kept at the right temperature on a steam table can be immediately reheated and the holding unit adjusted to immediately correct that violation. However, replacing/repairing a water heater to provide hot water or eradicating a vermin infestation require time to correct.
Placards are posted in full public view. Detailed inspection results are also available online at SCCDineOut (sccgov.org). In 2023, 11,016 placarding inspections were conducted by 43 Registered Environmental Health Specialists at restaurants and markets. Of these inspections, 10,261 green placards, 521 yellow placards, and 234 red placards were issued. Staff also performed 523 complaint inspections during that time.
If you have questions or want to know more about programs in Santa Clara County, visit deh.santaclaracounty.gov or call (408) 918-3400.
Through this work and other activities, environmental health practitioners like Santa Clara County DEH enable a safe and equitable environment for health (World Health Organization, 2021).
References:
• Centers for Disease Control and Prevention. (2024, April 29). About food safety. Centers for Disease Control and Prevention. https://www.cdc.gov/food-safety/about/index.html
• Georgia Department of Public Health. (2015, November 30). Rules and Regulations for Food Service – 511-6-1 Interpretation Manual. Food Safety and the Role of the Environmental Health Specialist. https://dph.georgia.gov/ sites/dph.georgia.gov/files/related_files/site_page/EnvHealthFoodSafetyRoleEnvironmentalist.pdf
• Khan, A. (2024) President’s Message: Building Hopeful Communities. Journal of Environmental Health, 87(1), 6-7. https://pubs.neha.org/view/362844202/6/
• National Conference of State Legislatures. (2024, August 12). Snapshot Reducing Foodborne Risks. https://www. ncsl.org/environment-and-natural-resources/reducing-foodborne-risks
• National Institute of Environmental Health Sciences (2023, November 16). Innovative program unlocks environmental health field for future doctors and nurses https://www.niehs.nih.gov/research/supported/centers/ core/spotlight/future-doctors
• Timeline for identifying and reporting cases in foodborne outbreaks. (2024, May 14). Foodborne outbreaks. https://www.cdc.gov/foodborne-outbreaks/ help-solve-outbreaks/timeline-for-identifying-and-reporting-cases-in-foodborne-outbreaks.html?CDC_AAref_ Val=https://www.cdc.gov/foodsafety/outbreaks/basics/ reporting-timeline.html
• U.S. Food and Drug Administration. (2023, March 30). FDA using advanced technology to cut back on foodborne illness cases. https://www.fda.gov/news-events/fda-voices/us-has-one-safest-food-supplies-world
• U.S. Food and Drug Administration. (n.d.). People at Risk of Foodborne Illness. https://www.fda.gov/food/consumers/people-risk-foodborne-illness
• U.S. Department of Health and Human Services. (n.d.). Food is Medicine: A Project to Unify and Advance Collective Action. https://health.gov/our-work/nutrition-physical-activity/food-medicine
Figure 4: Placards that are posted by DEH inspectors after completing a restaurant inspection
Figure 5
Figure 6: An inspector checking handwash sink water temperature during a mobile food facility inspection
Environment and Health Seminar - Webinar 1
Tuesday, September 17 | 6:30 PM – 7:30 PM (PST) with Q & A to follow
Location: Zoom
Registration: Free
Title Session 1: Confronting Climate Change: Carbon Storage, Reduction and Natural Regeneration
The Santa Clara County Medical Association’s Environmental Health Committee presents the 2024 Fall Environment and Health Series! The series comprises of three virtual webinars covering topics presented by various speakers.
SPP: Webinar Series - Winding Down Your Practice: Strategies for a Successful Retirement
Wednesday, September 18 | 12:15 PM – 1:15 PM
Location: Zoom
Registration: Free to Physicians and their Office Managers
Saving Private Practice (SPP) Webinar Series are free educational presentations designed for solo, small, and medium private practices. SCCMA Physicians Members and their Office Managers are welcome to attend.
SCCMA Book Club
Wednesday, September 25 | 6:30 PM - 8:00 PM
Location: SCCMA Office – 700 Empey Way, Second Floor, San Jose, CA 95128 (Free Parking)
Registration: Free for all SCCMA Members! Advanced Registration Required.
This quarter, SCCMA Book Club will read “Kitchen Table Wisdom: Stories that Heal” by Rachel Naomi Remen, MD. Dr. Remen has been counseling those with chronic and terminal illness for more than twenty years. She is cofounder and medical director of the Commonweal Cancer Help Program in Bolinas, California, and is currently clinical professor of family and community medicine at the University of California at San Francisco School of Medicine.
CMA Webinar: Patient Dismissal: The Last Resort Tuesday, October 1 | 12:15 PM – 1:15 PM
Registration: Free
Dismissing a patient, while sometimes necessary, is accompanied by risks that physicians should be aware of and have a clear understanding of. This webinar will provide information and guidance on best practices when dismissing a patient from your medical practice. The session will also provide guidance to avoid risking patient abandonment and how to appropriately document the patient dismissal process.
To register for any of these events, please visit www. sccma.org or scan the QR code
Environment and Health Seminar - Webinar 2
Tuesday, October 1 | 6:30 PM – 7:30 PM (PST) with Q&A to follow
Registration: Free
Title Session 2: Artificial Turf on Sports Fields: Promise or Peril?
The Santa Clara County Medical Association’s Environmental Health Committee presents the 2024 Fall Environment and Health three part webinar series! In this series we look at some ways to reduce the burden of climate change and illness, understanding that our health is inextricably related to a cleaner environment and a stable climate. This second session is on artificial turf on sports fields. We invite you to be part of the conversation and part of the change.
CMA Webinar: Documentation and Discoverability
Thursday, December 5, 2024 | 12:15-1:15 p.m.
This educational webinar is designed to present physicians with the essential knowledge to understand the scope of discoverability in malpractice litigation. From policies to casual conversations, every aspect of a physician’s professional life can be subject to discovery in the event of litigation.
Special Announcement: Annual Awards Gala will be in January 2025
SCCMA’s Annual Gala will be in January 2025. Please stay tuned on our website, emails, and social media platforms for more information to come! We can’t wait to see everyone in the new year as we thank 2024 SCCMA President, Gloria Wu, MD and welcome 2025 President, Fahd Khan, MD!!
For more information on all of these events, please visit https:// www.sccma.org/news-events/upcoming-events.aspx
