ACP Urges Physicians to Step up Climate Change Fight

Marcia Frellick

April 18, 2016

Climate change poses a catastrophic risk to human health, including more respiratory and heat-related illness, vector-borne diseases, malnutrition, and behavioral health problems, and physicians have a crucial role to play in fighting it, according to a position paper from the American College of Physicians (ACP).

Ryan A. Crowley, writing for ACP's Health and Public Policy Committee, said the ACP "strongly concurs with the finding of the Intergovernmental Panel on Climate Change...which has stated that 'human influence on the climate system is clear,' " listing causes such as burning of fossil fuels and power plant emissions, which release carbon dioxide and other greenhouse gases, trapping heat that then elevates global temperatures.

"The [ACP] urges physicians to help combat climate change by advocating for effective climate change adaptation and mitigation policies, helping to advance a low-carbon health care sector, and by educating communities about potential health dangers posed by climate change," ACP President Wayne J. Riley, MD, MPH, MBA, MACP, said in an ACP news release.

He continued, "We need to take action now to protect the health of our community's most vulnerable members — including our children, our seniors, people with chronic illnesses, and the poor — because our climate is already changing and people are already being harmed."

The article was published online April 19 in the Annals of Internal Medicine.

Healthcare Providers Can Help

The healthcare sector is ranked second in energy use after the food industry, and the Environmental Protection Agency estimates that by increasing energy efficiency and using renewable energy sources, 30% of healthcare's energy use could be reduced without compromising care quality.

Specific recommendations for healthcare organizations are included in a report called "Addressing Climate Change in the Health Care Setting: Opportunities for Action," published by Health Care Without Harm and Practice Greenhealth. They include actions such as reducing transport vehicle emissions, choosing suppliers with efficiency or alternate-fuel standards, offering to subsidize employees' use of alternative transportation instead of parking, purchasing energy-efficient shipping, designing green buildings, disposing of waste locally, and collecting and recycling nitrous oxide anesthetic gases.

Physician practices can help individually as well, according to ACP. The My Green Doctor website, supported by the Florida Medical Association, provides resources to physicians and their staffs on energy and water efficiency, recycling programs, proper disposal of medications and chemicals, transportation, and commuting.

The ACP recommends that medical schools and continuing medical education providers incorporate climate change coursework into classes, and not just in the United States.

"ACP has 18 international chapters that span the globe," Dr Riley said in the news release. "This paper was written not only to support advocacy for changes by the U.S. government to mitigate climate change, but to provide our international chapters and internal medicine colleagues with policies and analysis that they can use to advocate with their own governments, colleagues, and the public, and for them to advocate for changes to reduce their own health systems impact."

Utah Healthcare Providers Seeing Reductions

In an accompanying editorial, Elizabeth A. Joy, MD, MPH, from Intermountain Healthcare in Salt Lake City, Utah, and colleagues give specific examples of how one health system's efforts are getting substantial results.

The authors, from the mountainous Wasatch Front, where temperature inversions result in the accumulation of pollutants, write that "changes in air quality are routinely palpable."

Healthcare providers and policymakers wanted to make meaningful change and formed the Intermountain Air Quality and Health Workgroup in 2014 with three aims: to further research on health effects of air pollution, expand sustainability efforts, and educate physicians and patients about air quality and health outcomes.

As part of that effort, Intermountain is transitioning its vehicle fleet from gasoline to natural gas, hybrid, and electric power. They added driver tracking devices on fleet vehicles, which reduced idling by more than 500 hours per year. Employees are encouraged to use public transportation, which has contributed to a reduction of 3.5 million pounds in emissions. They added rooftop solar panels, which have saved 45 tons of carbon. They also set a goal for all new facilities to achieve Leadership in Energy and Environmental Design Silver certification and to be Energy Star certified.

A team of physicians, researchers, administrators, and writers developed the Outdoor Air Quality and Health care process model (CPM). The CPM provides evidence-based guidelines on how air quality affects health and helps providers counsel patients about outdoor activity when air quality is poor.

For example, a physician seeing a child with asthma could see in the CPM that if the Air Quality Index enters the moderate zone, the recommendation is to limit outdoor play time, and the child should have a fast-acting inhaler nearby.

Fact sheets have been developed for patients at the point of care or from community members accessing the patient education website.

Dr Joy and colleagues write that they hope others will follow their example, although conceding that change in healthcare is only part of the solution: "Combating climate change requires initiatives beyond the control of individual health care systems, clinicians, and patients, but we, as health care systems, clinicians, and patients, can bring about meaningful change if we act locally," they write.

2015 Was the Hottest Year on Record

The statement points to the urgency for fighting global warming: "The average surface air temperature of Earth has increased by 0.8 °C (1.4 °F) since 1880. In the Northern Hemisphere, the period from 1983 to 2012 was likely the warmest 30-year period of the past 1400 years, and 2015 was Earth's hottest year on record."

The Intergovernmental Panel on Climate Change predicts that by the end of this century, global average temperatures could increase by another 2.6°C to 4.8°C (4.7°F - 8.6°F).

"However, if coordinated, aggressive mitigation efforts are made to reduce carbon emissions, the planet could warm by 0.3 to 1.7 °C (0.5 to 3.1 °F)," the article states.

The ACP provided funding for development of the guideline. The authors and editorialists have disclosed no relevant financial relationships.

Ann Intern Med. Published online April 19, 2016.

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