Climate and Health
Alarm would certainly be a reasonable reaction to the challenges posed by climate change (cf., David Wallace-Wells in his now infamous New York Magazine article). The obvious truth is that the effects of a warming climate can already be felt today, and the consequences for the healthcare industry need to be addressed quickly, as things are bound to get worse especially for the most vulnerable among us.
Measuring the effects of climate change and pollution on health is hard but the consensus is that they are overwhelmingly negative. To understand the ramifications of a worsening climate crisis, it is useful to make a distinction between the impact on health and on healthcare delivery. Adding to the voices of the World Health Organization, the Centers for Disease Control and Prevention, and the US Federal government to name a few, The New England Journal of Medicine published a remarkable guide to the climate crisis and its impact on health laying out dozens of studies (all published by the journal) showing effects in nearly every medical specialty. The most fragile populations, such as children, pregnant people, and the elderly, are unsurprisingly the most at risk from extreme weather and rising heat.
The NEJM guide also outlines the danger of a shifting climate on care delivery, especially around cost, utilization, and disruption of care. Many examples from the guide detail the disruptions in care delivery stemming from extreme events such as Hurricane Sandy in NYC or Hurricane Maria in Puerto Rico. Although the circumstances, wealth, and populations were vastly different in the two occurrences, important lessons about how to better prepare and how to build a more resilient system can be drawn from both. A more recent example is what happened in Texas over the last week. Not only did the cold wave endanger patients locally through power outages, but it disturbed vaccine distribution throughout the US, highlighting once more the weaknesses of an infrastructure built in and for another age.
Two recent publications also highlight the scale and ingenuity of studies required to accurately measure and address negative effects of different parts of the climate change problem such as air pollution. In the first publication from 2017, the authors conducted a nationwide cohort study involving all Medicare beneficiaries from 2000 through 2012 — a population of 61 million, with 460 million person-years of follow-up. This monumental undertaking found that health was negatively impacted by exposure to small particles and ozone at concentrations even below current national standards, with the burden falling more heavily among self-identified racial minorities and people with low income. The second publication from last month aimed at developing a method to identify epigenetic markers of prenatal exposure to air pollution.
The otherworldly images from Perseverance on the surface of Mars this week provide an important reminder of the uniqueness of the habitability of the planet we call home, and the need to protect it and all of us on it from the continued encroachment of climate change.