As hospitalists, our scope of practice is rapidly expanding. No longer can we be content addressing the chief complaint and the symptoms at admission. No longer can we even just focus on barriers to care and issues of inequity as the social determinants of health. The stealth advance of the climate crisis threatens the health of all our patients. In the face of environmental degradation, we must address ecological determinants of health, which extend far beyond our traditional medical training.
This week marks the release of the Fifth National Climate Assessment (NCA). Broad in scope and sophisticated in its analysis, this Congressionally mandated report is the most comprehensive federal analysis of climate change to date and serves to inform government policy at every level. In contrast to the last NCA released in 2018, the Fifth NCA is influenced by the social sciences and Indigenous studies. The report acknowledges that our fossil-fuel built society has been profoundly unjust, emphasizing the outsized impact on disadvantaged populations such as the poor, marginalized communities, and vulnerable populations like pregnant women, children, and the elderly.
Physicians need to recognize that this report is not just about the ice caps melting. The climate crisis directly affects patient care. Extreme heat leads not only to heat stroke but also to renal disease, adverse pregnancy outcomes, cardiovascular and respiratory diseases, and mental health impacts, with heat-related illness and death projected to increase without drastic steps toward adaptation and mitigation. Wildfires have impacted large swaths of the U.S., leading to dangerously poor air quality; this affects reproductive health, cardiac and pulmonary disease, and influences changes in cognition and brain activity, exacerbating declines in well-being and mental health. This can also lead to conditions such as post-traumatic stress disorder, anxiety, depression, and suicide. As our ecology changes, we see shifts in vector-borne illnesses, amebic illnesses, and fungal disease. Pollution from fossil fuel combustion leads to lung adenocarcinoma while proximity to fracking sites increases rates of childhood leukemia.
For all of these health reasons and more, the physician community should take the Fifth NCA as a wake-up call to recognize the perils of the climate crisis on human health outcomes. First, we need to educate ourselves on what these impacts are. There are many online lectures such as through Project Echo at the University of New Mexico or through healthcare professional groups. There are online certificate programs in climate health and programs leading to a diploma in Climate Medicine. Journals are expanding to meet the educational needs and reflect the burgeoning research in the field. The Lancet Planetary Health, climate change articles in the New England Journal of Medicine, and Journal of Climate Change and Health are just a few examples.
Next, physicians must understand how to effectively counsel patients on things like poor air quality or deadly heat. Using a platform like Climate RX can allow patients to follow up on information asynchronously without impeding the flow of the visit. Counseling on risk avoidance may involve using apps like the Occupational Safety and Health Administration/National Institute for Occupational Safety & Health (OSHA-NIOSH) app on heat or airnow.gov for air quality. It also involves less direct health impacts like empowering patients to vote for health issues relevant to them.
It should also inform how we practice medicine. This means moving to climate-smart healthcare, decreasing waste, transitioning to a circular economy and away from single-use disposables, and ultimately decreasing the carbon footprint. It involves looking for ways to change the supply chain, which accounts for 80% of a health system’s greenhouse gas emissions. Health systems such as the U.K.’s National Health Service have already committed to net zero emissions.
The most impactful changes are those implemented by government, so developing advocacy skills is paramount in a rapidly evolving landscape. To affect change in patient care means advocating for optimized environments where people are born, grow, live, work, play, and age. This means challenging the fossil fuel industry, just as we took on the tobacco industry decades ago. Pockets of healthcare professionals are collaborating across the country and organizing to support these goals on behalf of our patients — but all clinicians should contribute to the work.
Every ton of carbon dioxide we keep out of the atmosphere matters. Every fraction of a degree we can limit warming translates into real impacts on our patient’s lives and well-being. The Fifth NCA should be another wake up call to clinicians and remind us as a profession that the climate crisis is first and foremost a public health crisis. Those of us advocating for climate policies safeguarding health should not be the equivalent of climate Cassandras, destined to predict a future that no one will believe. We should embrace the possibilities that a clean, sustainable future could create.
Elizabeth Cerceo, MD, is an academic hospitalist and the chair of Health and Public Policy for the American College of Physicians, New Jersey chapter (ACP NJ). The ideas expressed in this article are solely her own and do not express the views or opinions of her employers or ACP NJ.
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