*Patient name has been changed
Mary Williams* saved for 15 years to purchase a home. She found a small house in South Shore (on Chicago’s south side), made an offer, and achieved her dream. A massive rainstorm flooded her basement 8 months later. So, Williams reached out to her insurance company only to find out floods were not covered. Calls to FEMA and her alderman received no response. She found herself without the money to repair her damaged, mold-infested basement. Williams also has a history of asthma, and the mold caused increasingly severe respiratory problems requiring two hospitalizations. Because her physician determined that she could not safely remain in that environment, Williams eventually had to leave — losing both her savings and her home.
Williams is not alone. In a warming world, more Americans face threats to their health and wellbeing. Greenhouse gas emissions from the burning of fossil fuels are leading to extreme weather, flooding, and rising sea levels, among other planetary changes. Those changes affect human health in several ways, both direct and indirect.
Indeed, within a decade, climate change is expected to cause approximately 250,000 additional deaths per year globally — from malnutrition, malaria, diarrhea, and heat stress. That’s approximately the equivalent of losing the entire population of Buffalo, New York, every year. A disproportionate number of those deaths will occur in vulnerable populations, including pregnant women, children, minorities, older adults, and the chronically ill, especially those in low-income communities. Health professionals can — indeed, must — help reduce those numbers.
Here’s what we are seeing in our clinics and hospitals. With increasing levels of ozone and particulate matter, both of which correlate with rising temperatures, there are more hospitalizations and emergency room visits for asthma. Rising temperatures mean higher pollen concentrations, as well as longer allergy seasons. This increases hay fever, coughing, sneezing, itchy eyes, and allergic rhinitis. Extreme rainfall is associated with indoor air quality concerns, including increases in mold, which worsens respiratory diseases like asthma. Climate change also leads to droughts and wildfires, which further reduce air quality. Smoke from wildfires causes chest pain, respiratory infections, and worsening asthma, which increase hospitalizations in addition to directly causing premature deaths.
Extreme heat — one of the deadliest climate impacts — causes deaths from heat stroke. Higher temperatures also lead to increased respiratory, cardiovascular, and renal hospitalizations. After heat, heavy precipitation leading to floods causes the second highest number of climate-related deaths, mostly from drowning in floods. Additionally, increased rainfall leads to more waterborne disease and mold contamination.
For pregnant women, climate change is in some cases linked to premature births; their babies may suffer from low birth weight and neurodevelopmental delay, in addition to increases in asthma, upper respiratory tract infections, coughing, and wheezing. Drought increases wildfires and dust storms, and worsens water and air quality. Displacement after such disasters contributes to mental health concerns, including post-traumatic stress disorder and violence against women.
Scientists estimate that the direct cost of health-related effects will be between $2 to 4 billion per year by 2030. The time for change is now — and healthcare professionals can play a part in reducing the morbidity and mortality related to climate change. It is our job to educate our colleagues and our patients. An environmental history is key. This includes asking patients about their work history, home exposures, and community exposures just as we take a medical or family history.
We can teach our patients to be aware of their environments, looking at air quality levels and wearing masks or staying inside when the quality is poor. We can provide instruction on finding cooling stations when needed. We can make sure our patients know how to be alerted about a disaster, and where to go for protection.
We can advocate to build community resilience. HHS defines community health resilience as “the ability of a community to use its assets to strengthen public health and healthcare systems and to improve the community’s physical, behavioral, and social health to withstand, adapt to, and recover from adversity.” For example, resilient communities nurture strong social connections and prepare for disaster by creating evacuation and reunification plans and distributing disaster kits.
We must collaborate with elected officials to improve the infrastructure of our communities. For example, planting urban forests and green spaces can reduce the urban heat island effect and absorb floodwaters. Rainwater harvesting can help maintain water supply during a drought. Identifying areas at risk of flooding and relocating vulnerable members of the community can save lives. Solar panels and energy-efficient insulation can save money, reduce emissions, and make homes more comfortable.
We can decrease our own carbon footprint — and teach others to do so — by simply unplugging devices when not in use, turning off lights when we leave a room, washing clothes in cold water, using LED light bulbs, eating less meat, walking, or biking more.
Finally, and importantly, we can advocate for society-wide efforts to mitigate climate change. Studies show that health professionals are trusted messengers on this issue. And there is so much that governments, nonprofits, and the private sector can do: transition to renewable energy, decarbonize facilities and supply chains, support public transit and energy efficiency, and more.
We can change the trajectory. We can move from increased mortality to increased resilience. And we need to start in those communities that need it most.
Yvonne Collins, MD, is a gynecologic oncologist and serves as the chief medical officer of the CountyCare Health Plan in Chicago, Illinois. She is currently a climate, health, and equity fellow with the Medical Society Consortium on Climate and Health.
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