Physician group spells out its position on environmental crises and the medical community

The Environment and Doctors

Physician group spells out its position on environmental crises and the medical community.

The state of the world’s environment isn’t just about pollution, hurricanes, flooding, wildfires, drought and heat.

It’s about human health. That’s the gist of a position paper on environmental health issued this fall by the American College of Physicians and published in the “Annals of Internal Medicine.” Individual doctors can play a direct role, according to the College, but the collective voice of ACP’s 160,000 members will probably hold greater sway over policymakers.

It’s not the first time ACP has weighed in on the public health implications of air pollution, water contamination and climate change. The new paper reflects many concerns expressed in its 2016 paper, “Climate and Health,” but addresses a wider array of environmental exposures that impact human health. It also emphasizes environmental justice, that is, the belief that all communities – including people of color, those with low income, and marginalized populations – deserve to live, work, learn, and play in a safe and healthy environment.

The environment and health

“Human health is affected by the quality of the air we breathe and the water we drink, the substances to which we are exposed, and changes in Earth’s climate,” according to ACP in its paper, citing World Health Organization data showing that modifiable environmental factors contributed to 24% (13.7 million) of global deaths and 28% of deaths among children younger than 5 years in 2016.

“The quality of the environment can contribute to common diseases, such as stroke, heart disease, asthma and cancer. Interventions such as reducing air pollution and water contamination, providing protection from ultraviolet radiation, and mitigating climate change can improve health outcomes for persons with communicable and noncommunicable diseases.”

Older adults, pregnant people and children are particularly vulnerable to environmental pollution, says ACP. Outdoor workers are at higher risk for heat-related illness. Low-income and racial and ethnic minority populations are disproportionately likely to reside in areas with higher levels of air, water, and other types of pollution. Globally, 92% of pollution-associated deaths occur in low- and middle-income countries.

To address environmental challenges, ACP made six recommendations.

Recommendation 1: ACP recognizes that human and planetary health are interconnected, and that climate change is a global human and environmental health crisis. ACP calls for immediate action to limit global temperature rise to 1.5 degrees Celsius above preindustrial levels.

ʯ ACP supports efforts to mitigate and adapt to climate change, including interventions that provide health-related co-benefits, such as accelerating the transition from fossil fuels to clean, zero-emissions energy sources; promoting active transportation (i.e., walking, biking); installing early-warning systems; offering cooling centers during heat waves;

and adopting sustainable agricultural, food production, and food consumption practices.

ʯ Health equity and justice should be at the core of efforts to address climate change, and sufficient investment should be dedicated to vulnerable communities and populations that are disproportionately affected by it. ʯ The health sector should adopt environmentally sustainable and energy-efficient practices to reduce its greenhouse gas emissions.

ʯ Climate change and health content should be integrated into internal medicine continuing medical education and medical school and residency curricula. ʯ Physicians should be encouraged to inform their communities and policymakers about the health effects of climate change, and they should coordinate and collaborate with local public health agencies to track, prevent, and adapt to climate-change–related health effects.

‘Human health is affected by the quality of the air we breathe and the water we drink, the substances to which we are exposed, and changes in Earth’s climate.’

Recommendation 2: ACP calls for comprehensive action to achieve environmental justice and affirms that all communities, including people of color, people with low income, and marginalized populations, deserve to live, work, learn, and play in a safe, healthy environment.

ʯ Environmental and health impact assessments should be conducted for infrastructure, housing and commercial development, and other construction projects.

ʯ Ongoing funding and support should be directed at resources to research, collect data on, map, and monitor environmental health threats in high-risk communities.

ʯ Research should be conducted on how environmental health burdens relate to racial and ethnic health disparities.

ʯ A sufficient proportion of federal resources for clean energy, clean transit, clean water infrastructure, workforce and training, and affordable, sustainable housing should be directed to communities that are disproportionately affected by pollution and climate change.

Recommendation 3: ACP supports efforts to reduce indoor and outdoor air pollution

and affirms support for the Clean Air Act. The Environmental Protection Agency (EPA) should set robust air quality standards for ozone, particulate matter, nitrogen dioxide, carbon monoxide, and other pollutants to protect public health and welfare.

ʯ Air quality standards should be regularly evaluated and amended to ensure they are based on scientific evidence and provide maximum benefit to public health and safety.

ʯ State, local, and tribal governments should be provided funding and technical assistance to monitor and implement air quality standards, especially in high-need areas.

Recommendation 4: ACP supports improvements to the Safe Drinking Water Act, Clean Water Act, Lead and Copper Rule, and other laws and regulations dedicated to ensuring access to clean, potable, safe water.

ʯ Public health agencies should be provided with sufficient resources to detect, monitor, and respond to waterborne illnesses and prevent outbreaks.

ʯ Physicians and public health officials should collaborate to report and respond to waterborne illness cases and water contamination events.

Recommendation 5: ACP supports action to protect the public from harmful exposures to toxic substances, including new and existing chemicals, with particular attention to children, pregnant people, and other susceptible populations.

ʯ EPA should be provided with sufficient funding and workforce to carry out its role in assessing and regulating toxic chemicals and substances.

ʯ Chemical manufacturers should be required to provide health and safety information on new and existing chemicals.

ʯ Sufficient funding should be provided for lead abatement and lead exposure screening and treatment.

Now’s the time

“The ACP’s recommendations cannot be implemented soon enough,” commented Emily Senay, MD, MPH, Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, New York; and Andrew Hantel, MD, Dana-Farber Cancer Institute and Harvard Medical School Center for Bioethics, Boston, Massachusetts, in an accompanying editorial to the ACP position paper in “Annals.”

‘Internists, medical subspecialists, and the entire healthcare community are already caring for those harmed by climate and environmental causes.’

Recommendation 6: ACP recommends sustainable and sufficient funding for federal agencies with an environmental health mission.

ʯ ACP supports funding for federal agencies with an environmental health mission, including the EPA and the

U.S. Department of Health and

Human Services (including the

Centers for Disease Control and Prevention, the Agency for

Toxic Substances and Disease

Registry, the National Institute for Environmental Health

Sciences, and the Office of

Climate Change and Health, among others).

ʯ Research should be conducted on emerging environmental health issues, such as the potential health effects of exposure to nanomaterials, microplastics and newly synthesized chemicals.

“Worldwide, pollution is responsible for an estimated 9 million deaths annually,” they wrote. “Under current emission scenarios, excess global heat mortality is expected to reach 83 million people by 2100. Internists, medical subspecialists, and the entire healthcare community are already caring for those harmed by climate and environmental causes.

“Pollution- and climate-mediated pathogenesis has been linked to virtually every organ and body system, worsening cardiopulmonary disease, allergies, asthma, infectious diseases, renal disease, maternal fetal outcomes, neurologic conditions, mental health, trauma and cancer risk. All of this increases demand for care from stressed delivery systems still struggling with the COVID-19 pandemic.

“Improving clinical care will require a greater understanding of the role of environmental exposures in disease processes and advocacy for rapid reductions in dangerous exposures.”