Climate and Health on the Front Lines

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Introduction

This summary features insights from Dr. Sorenson's presentation on "Climate and Health on the Front Lines".

Dr. Sorenson is the Director of the Global Consortium on Climate and Health Education at Columbia University, an Associate Professor of Emergency Medicine and Environmental Health Sciences, and a physician investigator focusing on the nexus of climate change and human health.

Her research translates into policy, clinical action, and education, aiming to build resilience in vulnerable communities.

The Urgency of Climate Change and its Health Impacts

Dr. Sorenson, an emergency physician, began working in this field after witnessing numerous climate change-related impacts in her practice and international humanitarian work. She highlights the growing frequency of climate-related events globally, such as heatwaves, poor air quality, and inland flooding, leading the World Health Organization to declare the climate crisis as the biggest health threat facing humanity.

The Intergovernmental Panel on Climate Change (IPCC) report from 2022, dubbed a "code red for humanity", specifically examined health impacts. It found that climate-sensitive diseases are estimated to comprise 70% of global deaths, encompassing conditions affected by air and water quality, storms, heat, and atmospheric stability. Furthermore, the report indicates that climate change is worsening health inequities, disproportionately affecting economically and socially marginalized groups, the elderly, and those already shouldering morbidity costs via Medicare and Medicaid in the US. A crucial finding is that the severity of climate-related health risks is highly dependent on how well health systems can protect people, suggesting that timely, proactive, and effective adaptation could significantly reduce or avoid many risks.

Specific Health Impacts of Climate Change

Climate warming leads to physical hazards, including:

• Extreme Heat:
  • The 2021 Pacific Northwest heatwave, deemed "literally impossible without climate change", resulted in a 100-fold increase in heat-related emergency department visits, overwhelming hospitals and 911 services. Deaths were higher in areas with social deprivation, less green space, and among those with mental illness, substance use disorders, and females aged 65-85. Most US cities still lack comprehensive heatwave plans.
  • In New York City, health impacts begin at 85°F, affecting vulnerable populations (elderly, those on multiple medications) with symptoms like syncope, heart attacks, and dehydration. Heat exposure is also associated with preterm delivery, domestic violence, and suicidality. Globally, annual deaths of adults aged 65 and older attributable to heatwaves continue to rise. Children, from the prenatal period through critical developmental windows, bear an estimated 88% of climate change's health impacts.
• Extreme Rainfall and Storms:
  • A disturbed atmosphere leads to more extreme rainfall and severe, stalling storms. Examples include Hurricane Henley, which surrounded a hospital with floodwaters, and the Baxter facility in North Carolina, a major IV fluid manufacturer, going offline for months.
  • The National Oceanic and Atmospheric Administration (NOAA) tracks "billion-dollar disasters" (weather and climate events causing at least $1 billion in damage), with 25-30 events annually, costing approximately $350 billion in infrastructure damage alone in 2024.
  • Crucially, new evidence suggests that increased mortality in disaster-affected communities persists for at least 15 years after each event, due to long-term mental health, physical health, loss of healthcare access, and economic losses.
• Air Pollution and Wildfires:
  • Air pollution is now the fourth or fifth leading cause of death worldwide, primarily from fossil fuel use.
  • The transition to renewable energy sources promises immediate health gains.
  • Wildfires are becoming more frequent and severe, with at least 50% of the acreage burned attributable to climate change. Wildfire smoke is 12-14 times more hazardous than simple tailpipe emissions because it combusts diverse materials, including household chemicals, which can travel thousands of kilometers. Long-term impacts of smoke exposure include reduced lung function.
  • Direct impacts of fossil fuel pollution include premature mortality, accelerated cardiovascular disease, reduced lung function and cognition, neurodegeneration, poor birth outcomes, and cancers. Studies show a strong correlation between air pollution/heat exposure and adverse birth outcomes like preterm births and stillbirths. Conversely, the retirement of coal power plants has been associated with an immediate decrease in preterm births.
• Infectious Diseases:
  • Climate change creates environments permissive for disease vectors to thrive. The Culex mosquito (West Nile virus) thrives in stagnant waters and floods, while Aedes aegypti (dengue, chikungunya, yellow fever) thrives in warmer conditions, droughts (leading to water storage), and floods. Dengue is becoming endemic in new regions.
  • In the US, tick populations (carrying Lyme, babesiosis, anaplasmosis) are increasing due to warmer winters that no longer feature deep freezes to kill them off, leading to a rampant spread of Ixodes ticks.

Individual vulnerability to climate change depends on their exposure to climatic events, their sensitivity (e.g., an elderly person with multiple comorbidities), and their adaptive capacity (e.g., access to air conditioning, social support systems). Economically, climate change is projected to lead to an additional 15 million deaths by 2050, $12.5 trillion in economic losses, and push 44 million people into extreme poverty by 2030.

The Healthcare Sector's Role and Call to Action

Paradoxically, while dedicated to healing, the healthcare sector inadvertently contributes to environmental harm. If the global health care sector were a country, it would be the fifth largest emitter of greenhouse gases. The US contributes 27% of all healthcare emissions globally, despite its population not justifying this share. Emissions are categorized into Scope 1 (direct from owned/controlled sources), Scope 2 (purchased energy), and Scope 3, which accounts for the lion's share, largely from supply chains, pharmaceuticals, and medical devices, many of which are imported globally. This creates a "non-virtuous cycle" where the public health damages from healthcare operations (e.g., air pollution, waste) lead to significant disability-adjusted life years. Dr. Sorenson emphasizes that "pollution prevention is the new patient safety movement".

Health professionals, as trusted community voices, have an ability to influence change at individual, organizational, and macro (regulatory/government policy) levels. Bioethical principles underpinning the need for action include:

• Non-maleficence: Balancing immediate patient care with preventing broader population health harms, given the inadvertent harm caused by healthcare operations.
• Environmental Justice and Health Equity: Addressing the disproportionate impacts on vulnerable communities, where healthcare facilities often concentrate pollution.
• Intergenerational Ethics: Ensuring that today's resource-intensive care does not compromise future generations' ability to access care or the sustainability of healthcare practices.

Dr. Sorenson outlines action in three key areas:

1. Clinical Action and Adaptation:

• Developing protocols for climate-sensitive conditions, such as heat stroke.
• Increasing surveillance for climate-sensitive infectious diseases.
• Educating patients on climate-related health risks, like heat exposure.
• Integrating climate change and health concepts into the education of medical, nursing, and other health professionals.
• Aligning clinical practices with high-value care by reducing low-value tests, procedures, and treatments (which constitute 30% of care provided) and care that causes harm (10%). This immediately reduces the carbon footprint of clinical practices and can be guided by campaigns like "Choosing Wisely".

2. Environmental Sustainability and Stewardship:

• Healthcare systems can significantly reduce their environmental footprint through operational changes.
• The Gunderson Health System is a prime example: by investing in efficiency upgrades, waste reduction, and on-site renewable energy (geothermal, biomass, wind, solar), they became the first US health system to achieve energy independence by 2014, producing more energy than they consume. This resulted in $3-4 million in annual energy savings and over $1 million in waste management savings, with investments repaid within 5-7 years.

3. Resilience Building:

• Hospitals and health systems need to invest in infrastructure resilience to withstand climate events.
• The Texas Medical Center provides a case study: after sustaining $2 billion in damages from Tropical Storm Allison in 2001, they invested $756 million in rebuilding better, relocating critical systems, building floodgates, and elevating new facilities. This strategic investment proved successful during Hurricane Harvey in 2017, a larger storm, as their hospitals remained functional, with no patient evacuations or infrastructure damage, effectively avoiding further losses.

Resources and Outlook

For those interested in engaging in this work, Dr. Sorenson recommends:

• Healthcare Without Harm: A leading organization for decarbonization of the health sector, offering extensive free resources.
• Health Affairs: A journal that has published special issues on climate and health.
• The Lancet Countdown on Climate Change and Health: A resource for research on health harms, benefits, and adaptation from an epidemiological, global, and economic perspective.
• Global Consortium on Climate and Health Education: Provides free resources, courses, and certificates for health professionals interested in the field.

While progress at the national level in the US faces challenges due to political shifts and funding cuts, Dr. Sorenson believes that the most meaningful work happens at the local level—within states, cities, hospitals, and individual departments. Globally, Europe has set strong standards, and the Asia-Pacific region and development banks are increasingly investing in climate and health initiatives. Regarding international law, Dr. Sorenson suggests that good policy, economic incentives, and investment in new technologies are more effective than potentially unenforceable international laws, emphasizing that societal engagement and shifts in social norms are crucial for change. Positive developments, such as court orders to unfreeze EPA funding, offer some hope.

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