Climate change is a global killer, contributing to over 5 million deaths annually. Extreme temperatures and weather not only worsen chronic health conditions but can lead to new physical and mental health issues. Primary care providers are already facing challenges with managing climate-driven health problems, and are certain to face more. For my primary care colleagues, what conversations about climate are you having with patients? What steps are you taking to prepare them for climate change?
A silent killer
The climate problem is worsening. Over the past 20 years, the planet has experienced the hottest years on record and the mean global temperature has increased by more than 1 °C since the preindustrial era. The Intergovernmental Panel on Climate Change (IPCC) report, which describes the current trend of global warming and projections, recommends we limit global warming to below 1.5 °C to ensure favorable living conditions. Unfortunately, this year, we momentarily exceeded that limit.
The impacts of climate change are often not immediately obvious in health care. Our patients do not always recognize the connection between health symptoms and the environment. However, clinicians are aware that weather (including summertime heat) impacts their patients.
Also, 85% of clinicians report that more than one type of weather event has affected their own practice. Weather resulted in closures, staff shortages, interruptions in technology, cancellations, and no-shows. You should prepare for climate change as your medical practice will be impacted.
Climate-related health conditions
The health effects of climate change can be severe. Heat stroke and other extreme heat conditions are higher in areas prone to heat waves, particularly when combined with agricultural or construction occupations involving prolonged outdoor exposure. Increased frequencies of cardiovascular and respiratory illnesses are found in areas prone to wildfires and in communities affected by poor air quality. Gastrointestinal disease and water-borne illnesses are more common in areas with flooding associated with rising seas. All of these conditions are expected to increase because of climate change.
Climate change also appears to negatively impact mental health, including conditions such as grief and trauma. There is also a newly recognized mental health condition called climate change psychological distress (CCPD), or climate anxiety, characterized by chronic fear of environmental catastrophe. CCPD can also either conceal or worsen pre-existing mental health issues, particularly in marginalized communities. A recent study, for example, found that Hispanics/Latinos (21%) were significantly more likely than other groups to express interest in or already be engaged in discussions with a therapist or counselor regarding their concerns about global warming.
Primary care providers regularly serve vulnerable populations. Children, pregnant women, people with chronic health conditions, and older adults are most severely affected by climate change. Poverty and structural racism place racial and ethnic minority groups and low-income communities at higher risk of the impacts of climate change. They often live in regions with a higher burden of air pollution caused by fossil fuel combustion. They experience hotter temperatures and lack reliable infrastructure to support extreme weather.
Prepare for climate change discussions in clinical encounters
There is momentum in health care for greater climate action. More than 230 healthcare journals across the world have cited climate change as the single greatest threat to public health. Last January, The Medical Care Blog published its own consensus statement on the need for climate action signed by its contributors.
However, healthcare providers appear not to know whether (or how) to initiate discussions on climate change in clinical encounters. In one study, although most clinicians agreed that climate change impacts health, more than 75% of clinicians said they lacked the knowledge to advise patients. And 60% feared that bringing up climate change may harm their relationship with the patient.
On the other hand, patients (at least in one qualitative study in Germany) are eager to discuss the link between climate change and health with their healthcare provider. And patients will likely find it most valuable when there is already an established trusting physician-patient relationship. To be effective, climate change conversations should focus on the health of the patient and the greater public health issue.
Steps to address climate with patients
As primary care clinicians, a first step can be as simple as evaluating which medications you prescribe. Pharmaceuticals are a main source of carbon emissions in primary care. As a result, more sustainable prescribing can help meaningfully reduce greenhouse gases. Choose, for example, a dry powder inhaler rather than a meter-dosed inhaler (which contains a powerful greenhouse gas) for respiratory conditions. Additionally, telemedicine has been shown to reduce carbon emissions.
Clinicians can also address social determinants of health with our patients. For example, access to air conditioning during heat waves can be critical for older adults and those with chronic conditions. You can ask at-risk patients about access to air conditioning, and if necessary help them to make a plan for how to stay cool. Clinicians can identify local community cooling centers and help patients make plans for when and how to use them.
Providers can also help patients prepare for climate emergencies in areas prone to severe weather. Patients should have access to extra medications and hydration plans. You can discuss climate friendly practices and interventions to ensure patients have extra life-saving medication and plans of action for care, like dialysis, during an emergency. Include climate change conversations in your shared decision-making.
Before it’s too late
Taking a prevention approach is the best way to prepare for climate change and its impact on your patients’ health. In 2016, in the first Lancet Journal Countdown reports on climate change, the editors stated that “climate change has the potential to wipe out all worldwide health gains of the past 50 years, but addressing climate change presents just as great an opportunity to save lives and improve health.” The trusted voice of the primary care provider can fight against climate change by educating and empowering their communities.
Yalda Jabbarpour