One Sick Planet

Health professionals in all areas – patient care, public health, organizational management and policy making – will be on the front lines in facing and addressing the effects of climate change.

For this reason, along with the inherent charge of health care, these professionals must take a lead role in countering the consequences of this global crisis.

When you think of climate change – if you think of it at all – what comes to mind? If you imagine only panicked polar bears clinging to their shrinking ice platforms or tree-huggers strapped to sequoias, you should think again.

If you don’t believe climate change is happening, you should consider the reams of evidence and piles of response plans produced by entities ranging from the U.S. Environmental Protection Agency and NASA to the World Health Organization and the United Nations.

And if you’re unsure whether climate change is occurring because of human activity or natural causes, don’t worry. It doesn’t really matter. “Whether you’re on the red side and say it’s natural, or if you’re on the blue side and say it’s man-made, I don’t care,” says J.D. Polk, D.O., M.S., M.M.M., CPE, FACOEP, dean of the DMU College of Osteopathic Medicine. “The data show we are experiencing more superstorms, less ice, longer fire seasons, wider spread of pests and resulting diseases, and higher sea levels. Regardless of the causes, we need to prepare for and respond to these changes.”

The assistant secretary (acting) for health affairs and chief medical officer of the U.S. Department of Homeland Security before he came to DMU, Polk – like his former colleagues, the Obama administration and the U.S. Defense Department, among other entities – view climate change as a national security issue. Alice Hill, senior adviser to the President’s Assistant for Homeland Security and Counterterrorism, has stated that “the danger from climate change is real, urgent and severe” and that it “will affect water security, food security, energy systems and the stability of our critical infrastructure.” As “multipliers” of these threats, she adds, climate change and its associated trends can fuel violence and terrorist activity.

All these outcomes endanger human health, Polk says. “Politics aside, climate change is a health issue given its impact on air quality, temperature, the weather, agriculture, national security and much more,” he notes.

That concern led Polk and Yogesh Shah, M.D., M.P.H.’14, associate dean of global health, to create the Heartland Climate and Health Consortium (HCHC). Representatives of various Iowa colleges and universities, the city of Des Moines, nonprofit organizations and health care first gathered on a snowy Feb. 4, 2014, when last winter’s polar vortex seemed to be poking fun at the concept of global warming.

“We’re here to talk about the impact of climate change on all our resources, including our most precious resource – human life,” Shah began the meeting.

Consortium members’ discussions through 2014 covered a variety of topics, but consensus emerged on these points:

• While the impact of climate change has hit the poorest regions of the world first and likely hardest, no nation or individual is or will be immune to its effects.
• Too many people still deny or are unaware of the threats of climate change. In a recent national survey by the Pew Research Center, fewer than half of those polled named climate change as a potential threat. Hence, education is critical.
• Reducing the causes of climate change and mitigating
  and adapting to its outcomes will require the collective engagement of a wide range of entities, from governments and industries to researchers, entrepreneurs, farmers and consumers.
• Those entities must include the health sector, because climate change is not just an environmental issue. It already is having, and increasingly will have, serious consequences for individual and public health.

“For public health, climate change is the defining issue for the 21st century,” stated World Health Organization (WHO) Director-General Margaret Chan, M.D., in a series produced by The Huffington Post last September, during which the United Nations’ Climate Summit 2014 and Climate Week NYC occurred. “Climate and weather variables affect the air people breathe, the food they eat, the water they drink, and the chances that they will get infected with a life-threatening infectious disease.

“The evidence is there, and it is compelling,” Chan concluded. “Here is my strong view: climate change, and all of its dire consequences for health, should be at center-stage, right now, whenever talk turns to the future of human civilizations. After all, that’s what’s at stake.”

Why should health care care?

People typically enter the health care profession because they want to enhance the quality of life of individuals and communities. And what shapes our life more than the environment in which we live, the food and water we consume and the air we breathe?

“As physicians we can provide people with concrete examples of the medical consequences of climate change and thus help convince them that we have no choice about whether we preserve the global environment: our health and our lives depend on our doing so,” states Eric Chivian, M.D., in the April 2, 2014, issue of The BMJ (formerly the British Medical Journal), an international peer-reviewed medical journal. In his article titled “Why doctors and their organizations must help tackle climate change” (BMJ 2014; 348:g2407), he argues that physicians are “ideally placed” to translate the complex science of climate change into meaningful information for patients.

Founder and former director of the Center for Health and the Global Environment at the Harvard School of Public Health, Chivian also acknowledges that changing public opinion and sparking action to counter global environmental degradation will be enormously challenging. Cofounder in 1980 of the International Physicians for the Prevention of Nuclear War, recipient of the 1985 Nobel Peace Prize, he contrasts the graphically dramatic and catastrophic destructive power of nuclear weapons with slow, intermittent and hard-to-perceive global environmental changes. “We have no Hiroshima or Nagasaki to serve as concrete examples of what will happen,” he states.

Still, he says physicians can apply to climate change the strategies they used to explain the “abstract, technical science of nuclear weapons, which world class scientists had been warning about for decades, into the concrete, personal terms of human health, in everyday language that people could relate to and understand – namely, what would really happen to us in such a war.”

He uses the analogy of pediatricians who give antibiotics to infants with fevers of more than 100.4 degrees after fluids are drawn for bacterial cultures. The physician doesn’t wait until the cultures come back two days later before starting treatment with antibiotics, even though more than 90 percent of fevers in infants are, in fact, caused by viruses, not bacteria, and only a small fraction of those that are caused by bacteria go on to cause serious problems or death. “But the risk of not giving antibiotics to all infants with high fever – that a child will die – is so grave that no pediatrician is willing to take it,” he writes.

In the same way, Chivian continues, delaying action on climate change “until we have absolute proof of what will happen is to take a risk with the physical, chemical, and biological systems of the planet, to do a global experiment with our own health and lives, that no member of parliament or Congress, no prime minister or president, no one should ever be willing to take. That is the lesson of medicine.”

All health professionals can play a role. Local health departments were largely why the federal government in 1978 finally banned the use of lead in virtually any paint for sale to consumers, even though that was after decades of industry lobbying, propaganda and denial. Physicians were among the first, in the 1930s, to urge automobile manufacturers to put seatbelts in new cars, approximately 50 years before national standards were established.

Everyone, including health care professionals, then, must call loudly for reforms to address climate change. The difference with this issue, however, is that we don’t have the luxury of decades to do so.

How does climate change make us sick?

According to the Environmental Protection Agency (EPA), the impacts of climate change on health will depend on factors including the effectiveness of a community’s public health and safety systems to address or prepare for the risk; the age, gender, behavior and economic status of individuals; and society’s ability to adapt to change. Regardless, it will affect Americans as well as people around the world.

The biggest villain in climate change is emission of carbon dioxide and other greenhouse gases, primarily from fossil-fuel combustion and industrial processes. In its strikingly urgent assessment report released in November, the U.N.’s Intergovernmental Panel on Climate Change (IPCC) declared that man-made emissions of these gases are the highest in history; warming of the climate system is “unequivocal,” with each decade successively becoming warmer; and “recent climate changes have had widespread impacts on human and natural systems.”

Most of us struggle, however, with understanding how more parts per million of carbon dioxide in our air, the disappearing mass of the Greenland and Antarctic ice sheets and shrinking glaciers affect our health, much less what we should do about them. What does climate change do to our bodies and lives? According to the WHO and other organizations:

What does climate change do to our bodies and lives? Plenty, unfortunately.

• Climate change has increased the frequency and severity of extreme weather events such as heavy rains, floods, hurricanes and heat waves. These events harm and destroy lives, property and livelihoods. Extreme temperatures contribute to deaths from cardiovascular and respiratory disease and raise air pollution and pollen levels, which can trigger asthma. Prolonged droughts threaten or wipe out crops, causing malnutrition, starvation and population displacement. Extremely high temperatures endanger lives and reduce outdoor work and recreational capacity.
• Rising sea levels increase the risk of coastal flooding, also causing death and population displacement. Floods can bring increased risks of infection from water- and vector-borne diseases.
• More variable rainfall patterns compromise supplies of fresh water. Globally, water scarcity affects four out of every 10 people. A lack of water and poor water quality threaten health and hygiene, increasing the risk of diarrhea, which already kills approximately 2.2 million people per year.
• All of these factors also have huge implications for food security by reducing crop yields, boosting pest populations or destroying crops altogether. These problems are made worse in areas, including the American Midwest, by those agricultural producers who unsustainably irrigate crops, inefficiently apply fertilizers that end up in waterways, or fail to use soil conservation practices.
• In addition, increasing ocean acidification, resulting from oceanic absorption of man-made carbon emissions, will continue threatening and killing off various species of sea life. That threatens people whose diets and livelihoods depend on the fish and shellfish in our oceans. According to the National Oceanic and Atmospheric Administration, more than one billion people worldwide rely on food from the oceans as their primary source of protein.
• Higher temperatures stimulate the number and lifespan of mosquitos, ticks and other disease-carrying pests, or “vectors.” That is increasing the spread of debilitating vector-borne diseases such as chikungunya, dengue, Lyme disease, malaria and West Nile virus, including in regions where they hadn’t occurred before.
• Climate change kills people and consumes vast resources. A WHO assessment, taking into account only a subset of the possible health impacts and assuming continued economic growth and health progress, estimated that between 2030 and 2050 climate change will cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrhea and heat stress. Research published in Health Affairs in November 2011 asserted that just six climate change-related events in the U.S. between 2000 and 2009 – ozone air pollution, heat waves, hurricanes, outbreaks of infectious disease, river flooding and wildfires – cost more than $14 billion in the “value of lives lost prematurely” and related health care expenses.

What now?

We must prepare for and respond to the impacts of climate change. Health care professionals have the expertise, platform and public trust to speak out and take action.

The grim realities of climate change bring to mind the gloom-and-doom fish in Dr. Seuss’ The Cat in the Hat: “This mess is so big and so deep and so tall, we can not pick it up. There is no way at all!” The November IPCC assessment report baldly states that even if man-made emissions of greenhouse gases are stopped – an event this world is nowhere near – that “many aspects of climate change and associated impacts will continue for centuries.”

Without the option of relocating to another planet, however, we have no choice but to be aware of, ready for and responsive to the impacts of climate change. Health care professionals can use their expertise, status in organizations and communities, and the general respect and public trust they command to do the following.

• 

  “First, do no harm” by making your health care organization as sustainable as possible. According to a 2007 study published in the Journal of the American Medical Association (JAMA), the U.S. health care sector produces 8 percent of the nation’s total greenhouse gas emissions and generates an average of 26 pounds of waste per patient each day, or nearly 7,000 tons. The EPA, the American Hospital Association and other entities encourage health care organizations to pursue best practices in proper waste management, recycling, water and energy conservation, environmental purchasing, food service sustainability, “green” building design and other areas.

• Promote the positive benefits to patients of countering climate change. Encourage them to walk or use a bicycle when possible, which is better for personal health and the environment. So is consuming a more plant-based diet, as the production of meat and dairy requires large amounts of pesticides, chemical fertilizer, fuel and water; generates greenhouse gases, manure and wastewater; and is linked to higher rates of heart disease and obesity. Make sure they understand the importance of wearing sunblock and insect repellant.
• Advocate for community environments that offer greater walkability, more parks, accessible sources for healthy foods and opportunities to recycle.
• Prepare to respond to health issues created or exacerbated by climate change, such as heat-related disorders, vector-borne diseases and asthma and other respiratory diseases.
• Support research that increases the understanding and evidence base of climate change’s impact on physical, mental, environmental, economic and public health.
• Support research to discover ways to address, mitigate and adapt to a changing environment, from new vaccines to renewable energy sources to more sustainable agricultural practices.
• Promote and engage in discussions about climate change and the dangers it poses. Work with other individuals and organizations to demand change – urgently. An example is the group of scientists, researchers and physicians at Iowa universities and colleges who, since 2011, have issued an annual “Iowa Climate Statement.” The 180 individuals who signed the 2014 statement – including DMU global health Associate Dean Yogesh Shah, M.D., M.P.H.’14 – issued a clear message: Climate change in Iowa is real, and it’s making Iowans sick. Its negative effects include extreme weather events, degraded water quality, greater risk of respiratory and cardiovascular problems, increased and new infectious diseases, and growing mental health problems.
• Educate others, including fellow and future health care professionals, on the very real threats of climate change. DMU is doing that with topical elective courses, sessions, conferences and off-campus experiences for students, including internships with major health organizations.

“It is critical to recognize that climate change poses the same threat to health as the lack of sanitation, clean water, and pollution did in the early 20th century,” state Howard Bauchner, M.D., JAMA editor in chief, and Phil Fontanarosa, M.D., M.B.A., executive editor, in the journal published online Sept. 22, 2014. “Understanding and characterizing this threat and educating the medical community, public, and policy makers are crucial if the health of the world’s population is to continue to improve during the latter half of the 21st century.”