Op-Ed: Climate Change Is in Our Lane

Allergies & Asthma

As the world starts to emerge from the COVID-19 crisis, another global — and even more devastating — existential threat persists: climate change.

Worldwide, climate-driven disasters including storms, droughts, fires, and floods displaced more than 10 million people since last September.

Here in the western U.S., we face increasingly catastrophic wildfire seasons with powerful effects on health and the healthcare system. Climate change poses an immediate threat both to our patients and our businesses, with a new normal of fires causing hospital evacuations, medical office buildings closures, and supply-chain disruptions.

The issue of climate change is very much “in our lane” as physicians and healthcare professionals.

Physicians’ decisions — including prescribing, medical device use, and testing — account for about 80 cents of every healthcare dollar spent, and each one of our decisions can impact climate change. We have a responsibility to educate, advocate, and take action to reduce the impacts that the healthcare sector — which accounts for an astonishing 10% of all greenhouse gas emissions in the U.S. — places on our climate.

To mitigate climate change and its effects on human health, I recommend five steps physicians can take, including lessons learned from the pandemic, to reduce our collective impact and improve healthcare operations.

Increase the Use of Telehealth

Innovations like telehealth can help us meet climate goals while positively affecting other sectors of the economy. For example, in 2020, Northwest Permanente increased our total virtual visits — including those for primary care, specialty care, and mental health — from an average of 24% in 2019 to 55% of all clinical interactions. An added benefit of this conversion was a decrease in what we call “carbon intensity per appointment.” Virtual appointments saved our members from driving tens of millions of miles in 2020. Such savings also reduced wear and tear on infrastructure, greenhouse gas emissions, and time lost from work.

Raise Awareness Among Patients

More severe and longer wildfire seasons are worsening the symptoms of patients with asthma or chronic lung disease, driving many of them to the emergency rooms. Simultaneously, warming temperatures and increasing carbon dioxide in the air from fossil fuels contribute to longer and more intense pollen seasons, which can worsen allergy and asthma symptoms. During discussions with patients about adapting to health risks associated with climate change, physicians can increase patients’ knowledge and even motivate behavior change, both to protect their health and to mitigate climate change. For example, physicians can suggest walking or biking for shorter distances and introducing more plant-based, carbon-friendly options into patients’ diets.

Choose and Use Supplies Prudently

Last year, Northwest Permanente saved about $1 million in soft and hard costs from just three operating rooms through a waste reduction project. The project simplified and standardized surgical case cards while encouraging physicians to examine whether they were likely to need an item before selecting and opening new equipment and supplies. While the carbon benefits are not yet quantified, the financial savings demonstrate that environmental policies like these also benefit bottom lines while maintaining the highest standards of safety.

Provide Supply-Chain Redundancy

The pandemic underscored the need for supply-chain redundancy, as we learned when global disruptions cut off the supply of masks and personal protective equipment from China. Investing in alternative supply chains contributes to the resilience of local economies and communities. Such investment can also help reduce overall emissions and provide redundancy during natural disasters, when they disrupt distant suppliers or distribution channels.

Advocate for Health Equity and Corporate Social Responsibility

New research indicates that air pollution may in part explain why COVID-19 has disproportionately affected people who are systematically marginalized due to their race or ethnicity. Physicians can support policies that address the social and environmental determinants of health to ensure the most vulnerable communities are represented in planning climate policies and climate-related health interventions.

As trusted advisers and advocates, physicians have a tremendously positive impact in their communities. And we can do more. Now is the time to leverage lessons learned — including insights gained during the pandemic about innovation, waste reduction, supply-chain redundancy, and health equity — to advocate for and implement environmentally responsible behaviors that best support our patients, our communities, and our Earth.

Imelda Dacones, MD, is president and CEO of Northwest Permanente and chair of the National Permanente Executive Committee at the Permanente Federation.

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