Health Care’s Climate Change

Stories that caught our attention this week

Banksy grafitti "I don't believe in global warming"

A climate change report recently released by the Intergovernmental Panel on Climate Change (IPCC) paints a dire picture for our world. If current warming trends continue, the global average temperature is likely to rise 2.7 degrees Fahrenheit by 2052 and 3.6 degrees by 2100. Those figures represent an increase in combined surface air and sea surface temperatures averaged over the Earth.

An increase of 2.7 degrees over three decades may not seem significant, but let’s put it into context: the Atlantic’s Robinson Meyer reports that it would leadEssential Coverage to “more deadly heat waves, more heavy rainstorms, and more intense and frequent droughts.” The IPCC warns of grave repercussions for “health, livelihoods, food security, water supply, human security, and economic growth” if such dramatic climate changes occur.

If that doesn’t sound alarming, consider this: The IPCC’s gloomy prognosis is a best-case scenario. If the Earth warms more rapidly — say, 3.6 degrees Fahrenheit over three decades — that would be far worse. “What has been called a genocidal level of warming is already our inevitable future,” David Wallace-Wells writes in New York Magazine. “The question is how much worse than that it will get.”

Unhealthy Planet, Unhealthy People

The IPCC report screams “health emergency” — not just for the biosphere, but for us individual inhabitants. CityLab’s Nicole Javorsky writes that the environmental stressors associated with climate change are linked to worsening mental health. A new study published in Proceedings of the National Academy of Sciences estimates that a shift from monthly average high temperatures between 77 and 86 degrees Fahrenheit to averages above 86 degrees “would result in nearly 2 million additional individuals reporting mental health difficulties over a 30-day period.”

While researchers haven’t shown direct causation between climate change and mental health issues, they hypothesize that it could have a negative impact due to a combination of factors: natural disasters worsened by climate change can be destructive and distressing; heat can disrupt sleep; and worsening weather fomented by climate change can result in medical conditions like asthma that impact mental health.

Older adults are particularly vulnerable to the growing threat of heat. Molly Peterson reports for KQED that “spiking heat worsens asthma and lung conditions and raises risks for older people.” This is because older people have a harder time staying cool — they sweat less effectively and retain less water than younger people. And in the usually temperate Bay Area, where many homes lack air conditioning, older people can succumb to the effects of excessive heat. Peterson cites data from the San Francisco Department of Public Health and Western Regional Climate Center showing that 79% of people who died from 2017 Bay Area heat waves were at home prior to their deaths.

Poorest Communities Pay the Highest Price

In the September 2018 issue of Health Affairs, UC Berkeley’s David Tuller, DrPH, highlights the uneven impacts of climate change: low-income and minority communities are “more vulnerable to environmental exposures, including those arising from climate change.” Low-income communities of color tend to be in areas that are exposed to more air pollution and are more vulnerable to drought and wildfires than affluent communities.

For example, Harriet Rowan writes for California Healthline that counties in the San Joaquin Valley, California’s agricultural heartland, have some of the worst rates of childhood emergency room (ER) visits for asthma. In 2016, the statewide rate was 75 ER visits per 10,000 kids. But in the San Joaquin Valley, Fresno County had 143, Madera County had 140, and Merced County had 130. These jurisdictions made up three of the five counties with the highest rates of childhood ER visits for asthma.

Nearly one in four children in San Joaquin Valley have asthma exacerbated by a toxic brew of emissions from heavy motor vehicle traffic, occasional wildfire smoke, toxic dust from a dying lake nearby, and — to top it all off — topography that traps these pollutants in the valley.

Regularly breathing bad air doesn’t just worsen asthma symptoms. In another Health Affairs Blog post, Adam Freed, MUP, principal at Bloomberg Associates, writes that it can lead to heart and lung disease and increase the risk of type 2 diabetes.

What Next?

In a Modern Healthcare commentary, Karen DeSalvo, MD, MPH, of the University of Texas at Austin, and Christine Petrin, MPH, of the Tulane University School of Medicine, warn that “the health costs of climate change events from 2000 to 2009 are estimated to total $740 million and add more than 760,000 encounters to the health care system.” If the planet continues warming at its current rate, the financial and health-related costs of climate change are bound to get steeper. The researchers say it’s too late to reverse the planetary damage that’s been done, and as Vox’s Umair Irfan points outs, “the costs of limiting climate change and the kinds of policies it demands are conspicuously absent in the IPCC report.”

The US health care system has a large role to play in mitigating global warming. Incredibly, the US health care system is the world’s seventh largest producer of carbon dioxide, and it must act now, experts say. In a Commonwealth Fund blog post, David Blumenthal, MD, MPP, and Shanoor Seervai, MPP, call on health systems to reduce carbon emissions, citing the success of Kaiser Permanente in reducing greenhouse gas emissions by 29% over the past decade even as membership increased by 20%. “Kaiser is already one of the top users of solar power in the United States and projected its annual greenhouse gas emissions would decrease from 806,000 metric tons to 617,000 metric tons by 2017 as a result of clean-energy purchases and other environmental initiatives,” they write.

Blumenthal and Seervai also encourage health systems to “build infrastructure that is more resilient to natural disasters to protect their patients and facilities.” As hurricanes become more devastating and sea levels rise, it is imperative that health systems fortify their buildings against flooding and reduce dependence on public utility grids for heat and power.

By taking these steps, health systems “might not only reduce the cost of care… but also help fulfill the obligations that come with the industry’s size, its huge carbon footprint, and its mission to improve health,” Blumenthal and Seervai write.

Give us some good news — what is your community or employer doing to mitigate climate change? Tweet at me with #EssentialCoverage or email me.