“Imagine What a Few Hundred Future Doctors Can Do:” Climate Change and Health

Written by Megan Malgeri, M.D.’12, family medicine physician at Milton Family Practice and a member of the steering committee for the Vermont Climate Health Alliance

One year ago, more than 100 medical organizations, representing over six million health care professionals in 125 countries signed a global “call to action.” That statement began with the words“Climate change is a global health emergency (6).” The World Health Organization has a list of the top ten threats to global health, and climate change is at the top of the list this year (13). The message is clear: Climate change poses an alarming threat, and our health is on the line.

The Center for Disease Control, Vermont Department of Health, and the Vermont Agency of Natural Resources all report that climate change is happening now, and is impacting our state (1,11, 7, 9). As a primary care doctor, I see climate change impacting the health of Vermonters in my clinic. Vermont Department of Health’s research indicates that temperatures have risen two degrees in the summer and four degrees in the winter over the past 50 years (11). Although we are all susceptible to risk of heat stroke and dehydration during extreme heat, my patients with COPD, asthma, congestive heart failure, hypertension and many other persistent medical conditions are at increased risk of exacerbations or accidents related to their ailments on the hottest days of the year. My COPD and asthma patients clearly feel worse during weather extremes and they seek care more often during these times. The Department of Health’s research has shown that on days where the temperature is 87 degrees Fahrenheit or higher,emergency room visits are eight times more likely. And by the end of the century, the number of days this hot are expected to increase from six per year to more than 20 per year (11).

As temperatures rise, greater humidity leads to more natural disasters and weather extremes. This includes stronger heat waves, droughts, flooding, hurricanes and tornadoes. Locally, Hurricane Irene is perhaps the most formidable climate disaster. In Vermont, Irene caused six deaths, extensive mold/water and infrastructure damage and power outages, contaminated public water systems, compromised wastewater treatment facilities, and over $10 million estimated damage to farmlands. Vermont has already noted twice as many federally declared natural disasters this decade, compared to the last (12). The health impacts of disasters are not difficult to imagine, as we regularly read news coverage related to climate disasters in places like Puerto Rico, which was devastated by Hurricane Maria two years ago. But the magnitude of these events are felt every day for those who have lost their homes, family members, and who live with trauma related to the devastation.

A warmer climate means changing vectors of disease. The number of tick and mosquito related questions I receive in my office has increased dramatically in the past few years. Vermont and Maine currently have the highest rates of Lyme disease in the country (2,10). Another tick-borne illness, anaplasmosis, is increasing in prevalence (10). Though mosquito-borne West Nile and Eastern equine encephalitis have come to Vermont, cases remain rare (11).

Ecosystems are complex, and opposing extremes in weather can be a confusing aspect of climate change. Some areas of our country face drought, while others experience heavy precipitation and flooding. Vermont has so far been impacted more by heavy precipitation. The annual precipitation is seven inches greater annually now than it was 50 years ago (11). Whereas droughts cause issues with fire and poor crop volume, increased precipitation also affects our food supply. Floods can wipe out a farmer’s entire season’s crops. Floods and high rains can contaminate food and water, leading to gastrointestinal illnesses.

More globally, sea levels, which have already risen eight inches since 1880, are predicted to rise another 0.88-6.6 feet by 2100 (4). This would displace 187 million people around the world (5). Rising sea temperatures and ocean acidification will lead to disruptions of marine ecosystems, such as loss of coral, zooplankton and shellfish (4), which are part of the foundation of the marine food-web that billions of people rely on for protein and sustenance. If we continue at our current pace of warming, climate change could cause massive biodiversity loss, mass human migration, water scarcity, and dramatic loss of life.

Health care providers are action-oriented people who want to help–what can we do about climate change? Individual, societal and governmental changes are necessary to ameliorate this health crisis. Here are my suggestions:

Impact

• Calculate your carbon footprint (the carbon emissions you create through day-to-day living): Carbon Calculator from Carbon Footprint  or Carbon Footprint Calculator from the U.S. EPA

Food

• Eat less meat (especially red meat). Every day that we forego meat, we lower our carbon footprint by 8 pounds! (3)
• Choose organic or local food when possible. Our cafeterias at UVM Medical Center win national awards on sustainability!
• Reduce food and packaging waste through mindful purchasing, buying in bulk and eating leftovers.
• Compost your food scraps. Saving compostable materials from the landfill reduces the potent greenhouse gas methane. Once you are set up, composting takes 10 minutes a week (8). Here is the Sodgod website’s tips on getting started.

Clothing

• Don’t “buy in” to fast fashion. The average American discards 80 pounds of clothing per year, much of which ends up in the landfill (3).
• Wash in cold water. Detergents are designed to clean best in cold water (3).

Shopping

• Buy less-it takes energy to manufacture and ship purchases.
• Bring a reusable bag.
• Avoid items with excess packaging.
• Look for energy star appliances.
• Align your purchases with your values—support companies that are committed to sustainability.

Home

• Request an energy audit.
• Replace incandescent bulbs with LEDs.
• Turn the thermostat down in the winter and up in the summer.
• Install a low-flow shower head.

Transportation

• Air travel causes huge emissions—drive for short distance trips, fly non-stop if possible, use economy class, and use a carbon offset option to offset the carbon involved in your travel. A carbon offset is a way to invest in projects that reduce carbon emissions (planting trees, renewable energy investments, etc).
• Carbon offsetting companies (just a sampling):
  Green Mountain Energy
  Terrapass
  Sustainable Travel International
  My Climate
  Carbon Offsets to Alleviate Poverty

• Drive less, carpool, and take public transportation.
• Ride a bike or walk whenever possible.
• Keep car tires inflated.
• If purchasing a car, choose a hybrid or electric modest sized car. Electric cars make up for their manufacturing emissions in three years.

Education/Advocacy

• As physicians, your role is to translate science, and to advise when people need to make changes for their health. This puts you in a perfect position to educate patients on climate-related health issues, and to help patients view climate change as a public health issue, rather than a political one.

• Join together. As a medical student, I started an Environmental Health Student Interest Group–find interested colleagues and work together for change. Medical students, residents and doctors are welcome to join the Vermont Climate and Health Alliance (VTCHA), a group of healthcare professionals who advocate for climate solutions.

• Contact your representatives regularly to ask that they prioritize climate change:
  Governor’s Contact Information
  Database of Vermont Legislators

• Vote for politicians who prioritize climate change.

Finally, it is natural to feel overwhelmed when faced with a problem of this magnitude. Often when I think about these issues, I feel hopeless and sometimes I do nothing, returning to day-to-day tasks that feel more manageable. It is critical to realize that climate change is a human health issue, and that the later we address it, the more it will cost, in dollars and health impacts. Secondly, we can all help, by minimizing our own footprint, by voting with our dollars and supporting sustainable companies, and through education and advocacy. Pay attention and stay in a solution-oriented mindset. We are each far more powerful than we believe. If one sixteen-year-old student-activist mobilized over seven million people around the globe to march for climate action, imagine what a few hundred future doctors can do!

Sources

1. Center for Disease Control and Prevention. Climate and Health Program.

2. Centers for Disease Control and Prevention. Lyme Disease Data Tables.

3. Cho, R. State of the Planet. Earth Institute. Columbia University. Climate: the 35 Easiest Ways to Reduce Your Carbon Footprint. Dec. 27, 2018.

4. Fourth National Climate Assessment. Chapter 9: Oceans and Marine Resources. 2018.

5. Georgio, A. The sea is rising at such a catastrophic 700,000 square miles of land, displacing 187 million people. Newsweek. May 21,2019.

6. Global call to action on climate, health and equity, Center for Climate Change and Health.

7. J Cook et al. “Consensus on consensus: a synthesis of consensus estimates on human-caused global warming.” Environmental Research Letters Vol 11 No 4, (13, April 2016) DOI:10.1088/1748-9326/11/4/048002

8. Learn how to compost: composting basics for beginners. Sodgod.
9. Climate Change in Vermont. Vermont Agency of Natural Resources.

10. Suozzo, A. Data Dive: Vermont Has the Nation’s Highest Lyme Disease Rate. Where Does Your County Rank. Seven Days. Aug 2, 2019

11. Climate Change in Vermont. Vermont Department of Health.

12. Climate Change and Health in Vermont. Vermont Department of Health. October 2017.

13. Ten Threats to Global Health in 2019. The World Health Organization.

14. Harrington S. How Climate Change Threatens Public Health. Yale Climate Connections. August 8, 2019.