Climate Change and the Trusted Messenger

Matthew Masiello, M.D., M.P.H

How we deliver a message, and by whom, are critically important tenets of public health practice. As that reliable messenger, studies continue to comment on the role physicians have as trusted sources of information. For the segment of our population that dismisses or doubts that climate change is happening, physicians were identified as their most trusted informants. They ranked higher than the CDC, WHO, politicians, and religious leaders. Studies have also demonstrated that the majority of physicians believe climate change is a reality that is affecting, and will further affect, the health and well-being of their patients. To effectively propagate climate change mitigation and adaptation education, physicians must become knowledgeable of how climate change presently and will, more dramatically, affect their patients in this upcoming decade and beyond (1).

Regardless of whether we believe global warming is an anthropogenic (human) phenomenon, there should be no doubt our planet is getting warmer. After decades of research and observation, science presented its first warnings of increased CO2 in the Earth’s atmosphere in the 1960s (2). We have made progress. In 1970, President Nixon passed the monumentally important Clean Air Act (3). Unfortunately, as we were approaching 2020 and the fiftieth anniversary of this landmark legislation and the amendments made since, we saw the removal of key regulations. More recently, the 2015 Paris Agreement announced to the world that we need to limit our global average temperature to well below 1.2 degrees Celsius by the end of this decade. Unfortunately, since 2015, our summers have been the hottest on record. Despite some notable successes, unhealthy greenhouse emissions continue to rise, associated with a rising number of climate-related deaths due to extreme heat exposure, extreme weather, and disease.

Global warming is increasing the geographical distribution of vector, food, and waterborne diseases. Terms, such as “climate suitability,” now describe the enhanced transmission of dengue, malaria, and pathogenic Vibrio bacteria. It is projected, with climate change as a key factor, by mid to late century an additional 3 to 5 billion people will be at risk for dengue infection, above the present 1.5 billion. Other catastrophic natural disasters have also taken their toll on the human population. The global increase in respiratory, cardiovascular disease, and the related mortality secondary to wildfires has been significant. Many countries are experiencing a significant increase in daily exposures to these catastrophic natural events. Compared to 2001-2004, the US has experienced close to a half million additional daily wildfire exposures (4,5). Global warming will also exacerbate existing negative human conditions. Prior to the pandemic, approximately 10% of US households, 35 million Americans, experienced some level of food insecurity. Over 1/3 experienced a serious disruption in their ability to be adequately nourished. In this pandemic, 20% of Americans are now challenged with food insecurities. Rising temperatures, more severe weather, air pollution, and sea level rise will only exacerbate the nutritional insecurities we are now experiencing globally (6). Between 1981 and 2019, there has been a worldwide reduction, 1.8 to 5.6%, in the production of our terrestrial crops - maize, winter and spring wheat, soybean, and rice production. This crop reduction will not be taking place in all countries and that may not necessarily be a good thing (4). By 2080, the permafrost in northern Russia will be reduced by 50% making it more habitable for human activity, allowing for the farming of previously inhabitable land. Associated with a more temperate climate and an expanded crop production will be an increase in per capita gross domestic product. Yet, the reverse will occur in China, India, and the United States (7).

What can physicians and our health systems do to decisively enter this national and global effort to stabilize and improve the health of our ailing planet? First and foremost, we will need climate knowledgeable and public health progressive healthcare leadership. Globally, the healthcare sector contributes approximately 5% to greenhouse gas emissions. In the US, our healthcare systems are responsible for 10% of these emissions. On an optimistic note, we are now seeing our medical students and residents stepping up to hold their medical schools, universities and hospitals accountable to the growing need for immediate and well-defined changes on how we educate these young professionals and in how green of an institution that education takes place. Several US health systems are already moving in this direction (8). The UK serves as that example of what the health sector can do to address climate change. They are committed to becoming the first net zero health system and have placed a timeline on that goal (4). Individual physicians and our professional organizations must become more civically active on the climate change issue. We need more readily accessible climate change education to inform our families, patients, and communities of the concerning consequences of global warming (9,10). New and more politically accepted messaging strategies need to encourage the voting for politicians and policies that bring us all to better and sustainable health. Physicians need to identify the right to vote as preventive medicine (11).

Healthcare providers must begin a climate change educational process that is deliberate and deep. The pandemic forced healthcare systems to look at hospital operations beyond that of the four walls of the hospital and into the larger community and how that larger community could dramatically affect the daily operations of the system (12). As we emerge from this pandemic, we cannot settle back to life as we once knew it. The workforce realignment and technological advancements healthcare systems developed for the pandemic must now be carried over to addressing the health-related consequences of climate change. We have a challenging decade before us. These next several years will be critically important as we recover from the devastation of COVID-19 and move deliberately towards meaningful climate change education and policy development. With the same courage and fortitude we saw with the pandemic, we must now make every attempt to develop, implement, and evaluate our individual and institutional climate mitigation and adaptation initiatives. +

Matthew Masiello, M.D., M.P.H is a Clinical Professor of Pediatrics, University of Massachusetts Memorial Children’s Medical Center, and Climate Change Adaptation Practitioner. His blog (https://pp4sr.com) Pediatric Providers for Social Responsibility is available for review and participation. Email: drmatt@mattmasiellomd.com

References

1. Roser-Renouf, C., et al. Global Warming’s Six Americas, October 2014: Perception of the Health Consequences of Global Warming and Update in Key Beliefs. Yale University and Mason University/New Haven, CT: Yale Project on Climate Change Communication. P 36.

2. Figueres, C., Rivett-Carnac, T. The Future We Choose. Alfred A. Knopf. 2010, p1.

3. EPA.gov. Evolution of the Clean Air Act. https://www.epa.gov/ clean-air-act-overview/evolution-clean-air-act

4. Watts, N., et al. The 2020 Report of The Lancet Countdown on Health and Climate Change: Responding to converging crises. https://doi.org/10.1016/50140-6736(20)32290-x

5. Hales, S., et al. Potential effect of population and climate change on global distribution of dengue fever: an empirical model. Lancet. Vol 360, Issue 9336, 14 September 2002, pp 830-834.

6. Owens, M., et al. Prevalence and Social Determinants of Food Insecurity among College Students during the COVID-19 Pandemic. Nutrients 2020. 12,2515: doi:10.3390/nu12092515

7. Lustgarten, A. Catastrophe’s Harvest. The New York Times Magazine. December 20, 2020.

8. Planetary Health Report Card.phreportcard.org

9. The Center for Climate, Health and Global Environment at Harvard T.H. Chan School of Public Health. https:// www.hsph.harvard.edu/c-change/issues/climate-md/

10. The Medical Society Consortium on Climate and Health. https://medsocietiesforclimatehealth.org

11. American Medical Association. VoteHealth2020 and the vital role of physicians in voting advocacy. https://www.ama.assn.org/delivering-care/ patient-support-advocacy/votehealth2020-and-vital-role-physicians-voting-advocacy

12. American Hospitals Association. Managing Population Health: The Role of the Hospital. Chicago. Health Research & Educational Trust. 2012.