Tackling Climate Change, Our Apex Predator

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Introduction

Mark Shapiro, M.D., a practicing hospitalist and creator of the Explore the Space podcast, delivered a compelling presentation emphasizing the urgent need to address climate change as a critical determinant of health. Drawing upon his personal experiences with devastating wildfires and current events like hurricanes and wildfires, Dr. Shapiro framed climate change not merely as an environmental issue, but as an "apex predator" threatening the health and well-being of every individual and community. He highlighted that no person, organization, city, region, or country is immune from its impacts.

Dr. Shapiro began by establishing a sense of urgency through a personal narrative of the Tubs Fire in Santa Rosa, California, in 2017, which profoundly impacted his community, including the near loss of his hospital and the displacement of numerous colleagues. This experience underscored the immediate and tangible threats posed by extreme weather events, the frequency and intensity of which are exacerbated by climate change. He further illustrated the pervasive nature of this challenge by referencing a second-grade writing prompt asking children to consider how to cope with very hot days, indicating that climate change is now a reality shaping the daily lives and concerns of even young children.

At the core of the discussion was the central dogma of climate change: that it is caused by human activity, primarily the burning of carbon-based fossil fuels. Dr. Shapiro emphasized that this is a foundational principle, not a subject for debate, and from it stems the increase, intensification, and prolongation of extreme weather events such as hurricanes, wildfires, and floods. He cited Dr. Katherine Hayhoe, a climate scientist, who stresses the importance of focusing on communication, storytelling, and evidence to engage many people who accept the science of climate change and are eager for action, rather than trying to persuade those who deny it.

Impacts of climate change on human health

The presentation then delved into the myriad impacts of climate change on human health, with a specific focus on heat and air quality. Dr. Shapiro presented data showing the alarming rise in average global temperatures since the Industrial Revolution, emphasizing that all of human civilization has developed during a climate that no longer exists due to man-made greenhouse gases. This shift has rendered our infrastructure and societal systems less resilient to the uniformly hotter conditions we now face.

The phenomenon of the urban heat island index was explained as a significant contributor to increased heat exposure in cities, where the removal of vegetation and water and the prevalence of heat-absorbing infrastructure like buildings and roads lead to measurable increases in ambient temperatures. Focusing on Houston, Dr. Shapiro noted that a substantial portion of the population lives in areas significantly affected by the urban heat island effect, leading to prolonged exposure to dangerously high temperatures. He connected this to the emerging issue of Mesoamerican nephropathy, a form of chronic kidney disease observed in agricultural workers exposed to extreme heat, suggesting that this condition may already be present in the United States, including potentially within the Texas Medical Center. This highlighted how climate change acts as a threat multiplier, exacerbating existing health risks and vulnerabilities.

The impact of heat as a threat multiplier was further illustrated by data showing a significant increase in emergency department visits for heat-related illnesses. Dr. Shapiro also presented research indicating a correlation between increased daily ambient temperatures and an increased risk of firearm violence in US cities, underscoring the far-reaching consequences of extreme heat on societal well-being. He emphasized that marginalized communities, including Black and Indigenous populations, those experiencing homelessness, and those living in poverty, disproportionately experience the adverse effects of urban heat and climate change.

Shifting to air quality, Dr. Shapiro addressed the growing threat of wildfire smoke, emphasizing that no region is immune. He vividly described the detrimental effects of wildfire smoke, including its toxicity and the wide range of health impacts it can have on nearly every part of the human body. He cited a study showing that wildfire smoke exposure increases the risk of death for individuals recovering from lung cancer surgery. Furthermore, he discussed the impact of service interruptions during wildfires on delaying patient care and leading to poor outcomes. Personal anecdotes, such as canceling his son's soccer practices due to poor air quality, highlighted the practical and personal challenges posed by wildfire smoke. Emerging research on the negative impacts of wildfire smoke on cognitive function and an increased risk of developing dementia further underscored the severity of this threat. Dr. Shapiro also pointed out the structural inequities in mitigating wildfire smoke exposure, as measures like updating home filtration systems are expensive and staying indoors is not feasible for many essential workers.

Solutions and opportunities

Despite the daunting nature of these challenges, Dr. Shapiro emphasized that solutions, mitigations, and real opportunities exist. He urged the medical community, particularly institutions like Baylor College of Medicine, to become catalysts for change. He outlined strategic opportunities for medical educators and organizations, including:

• Looking out for their people: This includes ensuring the well-being of trainees, faculty, and staff during extreme weather events, addressing issues like work hour violations during emergencies, and providing mental health support. Practical measures like providing rain boots in flood-prone medical centers and considering disability insurance were also mentioned. Extending the continuum of care to patients' experiences outside the medical facility, such as providing water and shade at bus stops, was also highlighted.
• Maintaining operations: Proactive planning for events like hurricanes and ensuring access to essential resources like food are crucial for maintaining hospital functionality during crises. Transparency in these planning efforts can also reduce climate-related anxiety among staff.
• Curricular focuses: Integrating climate change into medical education across specialties is essential to prepare future healthcare professionals to address these evolving health challenges. Leveraging the expertise within Baylor to create high-quality curriculum and potentially establish the institution as a global leader in this area was strongly encouraged.
• Recruiting and retention: Demonstrating a commitment to sustainability and addressing climate change can be a significant factor in attracting and retaining talent, as many individuals seek employers whose values align with their own. Legitimate financial investment in sustainability projects, rather than mere "greenwashing," is key.
• Organizational engagement: Dr. Shapiro urged institutions to be transparent and involve individuals at all levels in addressing climate change, moving beyond hierarchical structures to leverage diverse expertise. He highlighted initiatives like the White House/HHS Health Sector Climate Pledge and the Joint Commission standards on sustainability (though currently optional) as opportunities for engagement and accountability.
• Leveraging meetings and conferences: Dr. Shapiro expressed concern about the lack of representation from the medical community at major climate change conferences like Climate Week NYC and strongly encouraged Baylor College of Medicine to actively participate and even host such events. He emphasized the importance of having the voices of healthcare professionals present in these critical discussions.
• Enhancing situational awareness: The adoption of publicly accessible air quality sensors, such as those provided by Purple Air, was presented as a crucial step in improving situational awareness and empowering individuals to take protective measures. Dr. Shapiro noted the current lack of such sensors in the Texas Medical Center as an opportunity for immediate improvement.

The Intersection of Climate Change, Urban Development, and Civic Engagement in Healthcare

Dr. Shapiro also briefly touched upon the expanding habitats of dangerous species like rattlesnakes, fire ants, and brown recluse spiders due to warming climates, adding another layer to the urgency of addressing climate change. He emphasized that decisions made today regarding urban growth and infrastructure development will have long-lasting consequences, either exacerbating the challenges of climate change or fostering more sustainable and resilient environments. He used the examples of Dallas's urban sprawl and Boston's "Big Dig" project to illustrate the potential impacts of different approaches to urban development.

In his concluding remarks, Dr. Shapiro stressed the power of personal stories in driving engagement and change and encouraged everyone to share their experiences related to climate change. He also emphasized the importance of mutual support within the medical community, particularly during stressful periods like wildfire season in California or hurricane season in Houston. Finally, he made a strong call to action regarding voter registration and participation, providing a nonpartisan resource (vote.org) and highlighting the historically low voting rates among healthcare professionals. He underscored that voting is a critical means for healthcare professionals to influence policies and decisions that impact both patient care and the broader environment.

Overall, Dr. Shapiro’s presentation served as a powerful and multifaceted call to action for the medical community, urging a swift and comprehensive response to the urgent threat of climate change. He presented compelling evidence of its far-reaching impacts on human health and highlighted the significant opportunities for institutions like Baylor College of Medicine to lead the way in education, mitigation, and advocacy.

Artificial intelligence (AI) was used to transcribe the presentation’s contents and create a summary of the information contained in the presentation. This is an experimental process, and while we strive for accuracy, AI-generated content may not always be perfect and could contain errors. This summary has not been reviewed by the presenter to guarantee completeness or correctness of the content, so it should not be used for medical decision-making without reviewing the original presentation.

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