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    Sicker patients serve as clarion call for doctors to take on climate change

    Health care professionals must confront the crisis through patient care, medical student education, changes in how hospitals function, and public policy advocacy.

    Shaneeta Johnson, MD, MBA, Aaron Bernstein, MD, MPH, and Renee N. Salas, MD, MPH, discuss climate change and health during a plenary on Nov. 14 at Learn Serve Lead 2022: The AAMC Annual Meeting.
    Shaneeta Johnson, MD, MBA, Aaron Bernstein, MD, MPH, and Renee N. Salas, MD, MPH, discuss climate change and health during a plenary on Nov. 14 at Learn Serve Lead 2022: The AAMC Annual Meeting.
    Credit: Richard Greenhouse

    When a young girl suffering from asthma made her third visit in a week to the emergency department at Massachusetts General Hospital in Boston, Renee N. Salas, MD, MPH, MS, was struck by the emotions of the mother sitting next to the stretcher as her child’s chest heaved up and down.

    “I’ve done everything the doctor told me to do, and she just keeps getting worse,” the mother said, her voice cracking. “What am I missing?”

    Salas went looking for what she and her colleagues might have missed in their diagnosis and found that the family lived close to a highway.

    “Evidence shows that long-term exposure to air pollution, especially from vehicles, causes asthma in children,” Salas explained at a plenary session on Nov. 14 at Learn Serve Lead 2022: The AAMC Annual Meeting, in Nashville, Tennessee. In fact, pollution is linked to asthma in 1 of every 5 children in major U.S. cities, she said.

    Efforts by the doctors to treat the girl’s asthma according to standard protocols were stymied when she returned to the very environment that sickened her, said Salas, who gave the opening talk in the session, “Why Climate Action Is the Future of Medicine and How Health Care Professionals Can Make a Difference.”

    As the burning of fossil fuels and the resulting acceleration of climate change make people more ill and complicate how to care for them, Salas and two of her colleagues urged the medical field to confront the crisis more directly by integrating climate change factors into patient care and medical student education, reducing the carbon footprint of the health care industry, and advocating for public policies that protect the environment.

    “Our voice is critically important to talk about how climate change matters to our ability to do our jobs,” said panelist Aaron Bernstein, MD, MPH, interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health. “As health care providers and physicians, we have the strongest argument about the climate change crisis we are facing. We are the game-changer in this.”

    The basis of that argument is the effect of air pollution, rising temperatures, and increasingly severe weather events on human health, including more heat stroke, asthma, stress-based mental illness, preterm births, and premature deaths, the increased spread of insect-borne disease, and complications to illnesses that people already have, the panelists said.

    “My patients come to me sicker,” said Shaneeta Johnson, MD, MBA, interim chief of surgery and professor at Morehouse School of Medicine in Atlanta, who moderated the discussion. “More cardiovascular disease, more pulmonary disease.”

    Dealing with the health impacts of climate change “can start at the bedside,” Bernstein said. He and Salas urged doctors to integrate the environmental conditions in which their patients live into their diagnosis and treatment.

    For example, Salas recalled an elderly man whose wife called 911 to their apartment because he was acting confused. "[Paramedics] opened the door and felt like they were hit with a heat wave.” The outdoor temperature was extremely high that day, the apartment had no air conditioning, and the man’s body temperature was 106 degrees. 

    “His chief complaint was a fever, but the diagnosis was heat stroke,” based in part on the paramedics’ observation of his living conditions, Salas said.

    Emergency hospital visits rise during heat waves, she noted, and during those times staff should ask incoming patients about the heat conditions where they live. Even outside of climate emergencies, she said, health care providers should ask incoming patients about environmental conditions at home that might affect their health.

    “Too often we don’t think about climate in health care delivery,” Bernstein said. He said that climate conditions should inform such decisions as what medicines to prescribe and how to safely release a patient if they are returning to a home with extreme heat or poor air quality.

    Climate change factors should also be integrated into medical school curricula, the panelists said. That can be as simple as inserting an instructional slide into a lesson plan or adding a climate-based learning module to class instruction, Salas suggested.

    The country’s future doctors should “understand how climate change is going to impact what our communities are going to need in the future,” she added. “If climate change drives more vector-borne diseases, how can we begin to prepare for that?”

    Looking inward, speaking out

    The panelists acknowledged that the health care industry itself is a big part of the problem. Salas referred to studies showing that the health care sector accounts for 8.5% of greenhouse gas emissions in the United States. Among the major contributors in hospitals, Johnson said, are energy use overall and waste and anesthetic gas emissions from operating rooms.

    Kate Walsh, MPH, president and CEO of Boston Medical Center — who introduced the session —  even took note of the fact that many of the 4,200 people who attended the conference traveled there by car or airplane, big greenhouse gas producers. “AAMC is mindful of the carbon footprint made by a conference of this size,” Walsh said.

    The panelists also said hospitals and other health care facilities have been taking steps to reduce their carbon footprint but must do more. The strategies have included changing to alternate fuel sources, buying supplies from companies that have pledged to produce net-zero emissions through the creation and delivery of their products, and cutting down on the use of some supplies and increasing materials that can be recycled.

    They urged health care providers to press their companies to makes such changes. “People in the health care industry really want this to happen,” Bernstein said.

    Ultimately, however, no single industry can make enough of an impact alone. “We will not get ourselves decarbonized unilaterally,” Bernstein said. He urged health care providers to “be a voice in the halls of power.”

    The panelists said health care professionals should speak out in their communities about the health impact of climate change, advocate with policymakers for changes that can affect the environment, and recruit their colleagues into the mission.

    “Once people see the connections and see that this is fundamentally tied to the very reason we get up in the morning, then people want to act,” Salas said. “Climate change touches everything that we care about. It touches whatever that person you’re talking to cares about.”

    “Most people want clean air,” Salas said. “They want clean water, they want a healthy future for their families.”

    Keep the conversation going

    Discuss this session and more while networking with your peers in academic medicine during, and long after, Learn Serve Lead, by joining the AAMC’s virtual community. More than 3,000 of your peers are already there!