Physicians Starting to Claim Climate Change Is 'In My Lane'

Neha Pathak, MD

May 07, 2019

Like many frontline physicians, Kristie Ross, MD, a pediatric pulmonologist at University Hospitals in Cleveland, Ohio, is already seeing the health effects of climate change in her daily practice.

Ross was inspired to take action several years ago after she worked with a boy who had poorly controlled asthma but also had a burning desire to play football for his school team. Ross helped him stabilize his asthma and join the team.

A few weeks later, on a day on which there was a poor air quality alert and a high pollen count, the boy had a severe asthma exacerbation during a game and ended up intubated in the intensive care unit.

Ross had not counseled him to monitor for poor air quality days. "I learned that thinking about the health effects of the environment and climate change is in my lane...and I needed to talk to my patients about it," she told Medscape Medical News.

Ross attributes this experience as her inspiration for founding Ohio Clinicians for Climate Action, an affiliate of the Medical Society Consortium on Climate and Health.

I learned that thinking about the health effects of the environment and climate change is in my lane. Dr Kristie Ross

On April 28–29, Ross and other healthcare professionals from across the United States gathered for the 2019 Annual Conference of the Medical Society Consortium on Climate and Health in Arlington, Virginia. Their shared mission: to develop and advance a comprehensive policy agenda that targets the drivers of climate change to achieve immediate and long-term health benefits for patients.

The consortium is the brainchild of Mona Sarfaty, MD, MPH, FAAFP, who, with the aid of Edward Maibach, MPH, PhD, a colleague of Sarfaty's at the Center for Climate Change Communication at George Mason University in Washington, DC, where she is the director, began forging alliances with physician organizations in the United States.

What started as a conversation with three physician groups turned into an organization with nine founding members in 2017 and has since grown to include 23 medical societies, including the American Medical Association (AMA), the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics, along with 32 affiliated health and medical organizations, such as the American Heart Association and the American Lung Association.

All are in agreement about the scope of the crisis and the devastating health effects of climate change, which will continue to rise if sweeping action is not taken. And all see that this is not a problem of the future but a problem of now.

How Physicians Can Help Their Patients

Substantial evidence in reports from a wide range of organizations, including the Intergovernmental Panel on Climate Change, Lancet Countdown, and the National Climate Assessment, indicates that the load on the healthcare and public health systems will likely continue to grow.

According to John Balbus, MD, MPH, senior advisor for public health at the National Institute of Environmental Health Sciences, the need for change will be harder to avoid or dispute as the scientific evidence accumulates.

"One of the most salient aspects of the National Climate Assessment is that it is held to a level of scientific accountability far beyond anything you will see.... These are not 'speculatory' comments, these are statements based on the published literature that undergo multiple rounds of review, including a National Academy of Sciences review," he told Medscape Medical News.

When it comes to talking to patients, the facts speak for themselves. For example, according to the American Lung Association's 2019 State of the Air Report, more than 141 million Americans live in counties with unhealthy levels of air pollution, a 7-million-person jump from the previous year, which puts millions more people at risk for respiratory and cardiovascular disease.

The multiple reports suggest that physicians caring for those disproportionately affected by climate-related health concerns — such as children, the elderly, and vulnerable minority populations — should especially prepare for health problems caused by some of the following:

  • Toxic air quality: Smog (from ground level ozone), particulate matter, pollen

    • Advise patients to monitor the air quality index and to limit outdoor time on hot days.

    • Advise the elderly and those with lung and heart disease of increased risks for asthma and COPD exacerbations.

  • Extreme temperatures: Extreme heat

    • Discuss the higher risk for heat stroke with parents of young children, the elderly, and outdoor workers.

  • Extreme weather events: Flooding, wildfires, hurricanes

    • Advise patients to safeguard medications and to create emergency preparedness plans.

    • Monitor for illnesses from contaminated food and water after events.

  • Infectious diseases and vector-borne infections

    • Advise patients that ticks and mosquitos are spreading to new regions, bringing Zika virus, Dengue fever, West Nile virus, and Lyme disease.

    • Advise about higher risk for contamination of food by pathogens, such as Vibrio and Salmonella, as temperatures increase.

  • Mental health

    • Monitor for mental health conditions in those who have experienced extreme weather events.

"A Bonanza of Opportunities"

Responding to the increases in patients' needs will require urgent action from the healthcare system. There is a lot more that can be done besides simply managing the health effects. The good news, according to Sarfaty, is that there is a "bonanza of opportunities" when it comes to the healthcare sector's ability to respond to the climate change crisis at the root.

Opportunity beckons: The US healthcare sector's gross domestic product on its own would be the fifth largest economy in the world. The sector is the seventh largest producer of CO2, making it one of the world's biggest polluters. It has a large role to play in cleaning up, according to a report from the Commonwealth Fund.

Health Care Without Harm (HWH), a nongovernmental organization that works with hospitals worldwide, including in India and China, has shown that there is a business case for reducing the large carbon footprint of health systems, which would create significant financial savings.

"It ties in with the ethical framework, the oath that doctors take to 'do no harm,' " Gary Cohen, the founder and president of HWH, told Medscape Medical News. "It's a win-win-win situation" with lower costs, lower levels climate change caused by pollution, and improved health for surrounding communities.

Todd Sack, MD, FACP, a gastroenterologist and editor for, a free service offered by the Florida Medical Association and the World Medical Association to help medical offices adopt sustainable practices, told Medscape Medical News he agrees with this assessment.

He has seen doctors throughout the world take up these practices and save money. Doctors in India have signed up for the services in the highest numbers outside of the United States.

Sack also points to the opportunities to educate medical students on climate changes and health effects. The AMA is considering a requirement that climate change education be provided for all medical students. The goal is to empower the next generation of physicians with skills they will need to tackle the healthcare needs of patients, given the new climate realities.

The luxury of clean air is not something I'll ever take for granted again — not for me and not for my patients. Dr Trygve Dolber

Trygve Dolber, MD, an Iraq War veteran and resident in Emory University's Internal Medicine/Psychiatry program in Atlanta, Georgia, eagerly took in all of the information shared during the conference.

He came hoping to learn how to translate the grim climate science into actions that will help his patients. Dolber reported that while in Iraq, he was exposed daily to the smell of surface-level trash fires used to dispose of garbage. He recounted that he will never forget the smell.

He has been watching global response to climate change and the health effects with trepidation: "The luxury of clean air is not something I'll ever take for granted again — not for me and not for my patients," he told Medscape Medical News.

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