Lessons learned from responding to the COVID-19 pandemic can also be applied to fighting climate change, Renee Salas, MD, MPH, said Tuesday at an event sponsored by the Harvard T. H. Chan School of Public Health and WGBH‘s The World.
The first lesson “is recognizing that prevention has to be prioritized,” said Salas, an emergency physician at Massachusetts General Hospital and the Yerby Fellow at the Center for Climate, Health, and the Global Environment at Harvard. “We have to recognize that we have to stop things at the source … We have to run upstream to prevent patients being in the river in the first place. And that is true both for the pandemic and for climate change.”
“The second lesson learned is that we need a rapid, coordinated, global response,” she said. “We have to recognize we are all in this together. And what we do here does impact countries and people halfway around the globe, and vice versa. And so the Paris [Climate Accord] in many ways can be viewed as the world’s largest public health agreement.”
Same Heat Wave, Different Outcomes
The effects of climate change — even the same change — on humans can vary depending on the region in which the change occurs, Salas said. A study of peak hospitalizations for heat-related illness “found that it differs across different regions in the U.S., so for Arizona — which is typically really hot — it begins around 101° F, but for Oregon, they see the spike at 81° F,” said Salas. “That really puts into context the Pacific Northwest heat wave, given that they were seeing temperatures in Portland, Oregon of 116° F, so that is astronomically above what the previous peak was for heat-related illness.”
In addition to causing new diseases, climate change is a “threat multiplier” in that it also worsens existing problems, according to Salas. “The ways in which climate change harms health is enormously broad, [including] from heat and extreme weather, which I think we all are seeing in our headlines and recognize very clearly … But there are other ways in which health is harmed and that can include air quality implications, such as aeroallergens from pollen levels being driven higher because of climate change, or ground-level ozone being driven by increased heat and sunlight. There are impacts to our food and water, vector-borne illnesses, and social factors like displacement.”
Climate change also affects healthcare delivery, she noted. “As a doctor, I can have all the knowledge in the world, but if I don’t actually have the supplies in the building with which to optimally provide high-quality healthcare, then I can’t practice the way I want,” Salas said. “So we have to think about how our health systems are disrupted, whether that’s damage to infrastructure or power outages or supply chain vulnerabilities. So all of that is a foundation with which to stand that I see climate change harming my patients.”
Effects Along a Continuum
Climate change’s effects are felt along a continuum, according to Salas. “So for some people, that may just be worsening of their allergic rhinitis because of higher pollen levels, or a cough because wildfire smoke is worsening air quality, all the way to really severe illness and death, including for example heatstroke in an outdoor construction worker.” One global study that used a methodology called ‘detection and attribution’ — which tries to figure out exactly what are the fingerprints of climate change on these extreme events — found that “more than a third of heat-related deaths in 210 cities across the U.S. were actually attributable to climate change. And so as I see heat illness, I think about how I can make those ties … because if we don’t make the diagnosis of how climate change is harming health, then we won’t implement the right treatments.”
Climate change is also “not an equal opportunity harmer,” said Salas. “There are actually three areas that I think about in regards to vulnerability … and those are susceptibility, exposure, and one’s ability to adapt.” For instance, “one especially vulnerable population is Black, indigenous, and other people of color who have long suffered health disparities as a result of structural racism, and especially environmental racism.” One thing to think about there is “why do we place pollution-filled industrial complexes and highways in certain communities versus others?” she said. “Individuals who are Black or indigenous, and other people of color are, for example, more likely to potentially suffer asthma, due to higher air pollution exposure by living closer to power plants and highways, so they have an increased susceptibility.”
In addition, neighborhoods that were previously “redlined” — a now-outlawed practice in which people living in particular neighborhoods were turned down by banks and other institutions when they tried to get home loans or borrow money for other purposes — “are hotter than other neighborhoods around them,” said Salas. “And so they actually have higher exposure to climate threats, notably heat, which we know has significant downstream health consequences.”
Climate Change Is Personal
Salas was asked for her thoughts on the recent report from the United Nations’ Intergovernmental Panel on Climate Change, which found that temperatures on Earth have risen so much that there is no way to prevent extreme weather from getting worse in the next 30 years.
“It really shows that now is the time for action,” said Salas. “There is nothing harder for me than having a patient in front of me that I don’t have a treatment for, but we have the treatments we need — we just need the political will.” She continued: “If we can urgently move now to be able to achieve the low or very low emission pathways, we can still try to limit warming to 1.5 [degrees] if we are swift and collaborative and aggressive in doing this, and that is going to take all of us in order to do that.”
It’s important to get all health professionals to recognize that “climate change is personal — it is here and now; it is affecting not only ourselves, but our patients, and that it actually impacts what we do day to day,” said Salas. “Evidence has shown that health professionals are the optimal trusted messengers to deliver that information, and it’s been shown even to be true for people who do not actually engage much with climate change. We have seen the power of health professionals in the pandemic in trying to disseminate information, and we need to do that again for climate change.”
In addition, the healthcare industry needs “to not contribute to the problem [by getting] to net zero in our emissions,” she said, and “we need a dynamic education, because we recognize climate change is rapidly changing.” Salas pointed out how doctors practicing in areas that have never seen Lyme disease before could start seeing rashes from the disease as a result of changing climates.