Social EM, Health Policy

This is Also Our Lane - Climate Change and Public Health

The issue of climate change and public health is what the World Health Organization calls the greatest health challenge of the 21st century. Climate change is happening now, patients are being affected now, and now is the time for the medical community to respond.

         A 66-year-old woman is brought to the emergency department via ambulance. Lying on a stretcher being wheeled into the room, she is struggling to keep her eyes open. The nurse asks her name, if she knows where she is, and why she is here. Weakly turning her head and trying to figure out what is happening, she stares blankly, confused and scared. Reaching down to feel her pulse, her skin is scorching. “Can we get a temperature reading on her?” “What happened?” The lead paramedic starts giving the report, working simultaneously to get the patient connected to the vital monitors: “She was found in her apartment by her granddaughter. The place was like a sauna, her AC unit had stopped working.”

*** 

         It is 2 a.m. at a busy hospital in Queens, NY. In the pediatric ED, a father bursts through the doors carrying his 8-year-old son in his arms - the boy’s body is limp, his head tilted upwards and back, with visible foam around his mouth. “No breathe, no breathe,” the father shouts in broken English. Within seconds the boy is lying in a bed, a nurse at each side placing IVs, the lead physician tilting the child’s head up and squeezing breaths of air into his lungs. More team members file into the room - a pharmacist, a respiratory therapist, an additional physician, 2 more nurses, a Spanish translator. The translator reports, “The father says his son has asthma and it has been getting progressively worse over the past few days. They have been unable to afford his medications, and tonight his breathing got worse and worse until it stopped.”

***

         A 54-year-old woman comes to the ED reporting 4 days of fevers, abdominal pain, nausea, vomiting, muscle aches, headaches, and a skin rash. Her husband reports she has become progressively weak, confused, and disoriented. Speaking incoherently and with slurred speech, she is unable to answer questions. Fluid from her spinal canal is extracted, leading to a presumptive diagnosis of viral meningoencephalitis. She is admitted to the hospital for antiviral treatment, and after a few days her test results come back positive for West Nile Virus. After an extended hospitalization, her strength and speech improve only partially, and she will likely have permanent deficits. 

This Is Also Our Lane
         When the NRA tweeted that physicians should "stay in their lanes" after the Thousand Oaks shooting, the medical community responded in uproar, which launched the #ThisIsOurLane movement. Doctors around the country shared their stories, graphic depictions of their intimate experience with gun violence. The movement was powerful. It revealed to the country how close physicians are to the issue of gun violence. It forced people to realize that patient care extends beyond the hospital or clinic. The responsibility of a medical provider is to care and advocate for those who are unable to do so, and speaking up about the issue of gun regulation in America is a vital part of that responsibility. It therefore follows that climate change must similarly be considered within the purview of the medical community.

The issue of climate change and public health is what the World Health Organization calls the greatest health challenge of the 21st century.1 The opening vignettes are real cases demonstrating the effects that climate change is currently having in this country. In the United States, heat injury kills more people than hurricanes, tornadoes, lightning, and floods combined, and it’s getting worse.2 In New York, there are currently around 13 days over 90℉, but by 2050 that number will climb to 40 per year.3 One study predicts that in California by the year 2050, the number of premature deaths per year due to heat exposure is going to nearly triple.4 Likewise, the incidence of respiratory conditions is intimately tied to climate change. The effects of ambient ozone changes, increased fire frequency, and increased thunderstorms and floods that are occurring with climate destabilization results in increased visits for conditions such as pediatric asthma, COPD, and other respiratory conditions.5–8 Vector transmitted diseases such as West Nile Virus, Lyme disease, malaria, dengue, hantavirus, and zika virus are also increasing as a direct result of a warming planet.9–13 Due to various causal mechanisms, the warming planet is facilitating vector-borne pathogen transmission, especially in the Northern Latitude of the United States.

These cases serve to illustrate a point: climate change is happening now, patients are being affected now, and now is the time for the medical community to respond. Our ‘lane’ is human health and wellbeing, seen through an evidence-based lens. Just as in 1954 when the American Medical Association acted as a prime advocate for car safety belts 13 years before the U.S. government made it officially mandatory, and just as the #ThisIsOurLane movement has inspired physician advocacy for improved gun safety, the medical community must also take an evidence-based stance on climate change because it is, also, our lane.


References

  1. WHO calls for urgent action to protect health from climate change – Sign the call. World Health Organization. https://www.who.int/globalchange/global-campaign/cop21/en/
  2. Gokany I. Deaths and Death Rates from Extreme Weather Events: 1900-2008. Journal of American Physicians and Surgeons. 2009(14):102-109.
  3. Patz JA, Frumkin H, Holloway T, Vimont DJ, Haines A. Climate change: challenges and opportunities for global health. JAMA. 2014;312(15):1565-1580. doi:10.1001/jama.2014.13186
  4. Ostro B, Rauch S, Green S. Quantifying the health impacts of future changes in temperature in California. Environ Res. 2011;111(8):1258-1264. doi:10.1016/j.envres.2011.08.013
  5. Kim K-H, Jahan SA, Kabir E. A review on human health perspective of air pollution with respect to allergies and asthma. Environ Int. 2013;59:41-52. doi:10.1016/j.envint.2013.05.007
  6. Moore K, Neugebauer R, Lurmann F, et al. Ambient Ozone Concentrations Cause Increased Hospitalizations for Asthma in Children: An 18-Year Study in Southern California. Environ Health Perspect. 2008;116(8):1063-1070. doi:10.1289/ehp.10497
  7. Li S, Williams G, Jalaludin B, Baker P. Panel studies of air pollution on children’s lung function and respiratory symptoms: a literature review. J Asthma. 2012;49(9):895-910. doi:10.3109/02770903.2012.724129
  8. Strickland MJ, Darrow LA, Klein M, et al. Short-term Associations between Ambient Air Pollutants and Pediatric Asthma Emergency Department Visits. Am J Respir Crit Care Med. 2010;182(3):307-316. doi:10.1164/rccm.200908-1201OC
  9. O’Neill BC, Dalton M, Fuchs R, Jiang L, Pachauri S, Zigova K. Global demographic trends and future carbon emissions. PNAS. 2010;107(41):17521-17526. doi:10.1073/pnas.1004581107
  10. Centers for Disease Control and Prevention (CDC). Serosurveys for West Nile virus infection--New York and Connecticut counties, 2000. MMWR Morb Mortal Wkly Rep. 2001;50(3):37-39.
  11. Statistics & Maps | West Nile Virus | CDC. Published June 3, 2020. Accessed August 31, 2020. https://www.cdc.gov/westnile/statsmaps/index.html
  12. Reisen WK. Landscape epidemiology of vector-borne diseases. Annu Rev Entomol. 2010;55:461-483. doi:10.1146/annurev-ento-112408-085419
  13. Reisen WK. Ecology of West Nile Virus in North America. Viruses. 2013;5(9):2079-2105. doi:10.3390/v5092079

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