How climate change is making your patients sick, and what you can do about it

Asthma. Allergies. Eczema. Type 2 diabetes. All these disease states can be exacerbated or caused by climate change. “I have pediatricians coming to me saying, ‘I am already seeing children under 2 years old pre-polluted,” began Nathaniel DeNicola, MD, MSHP, from the American College of Obstetricians and Gynecologists, Johns Hopkins Medicine, Washington, DC, at the 2022 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting on a session titled, “Trading spaces: how pediatrics, emergency medicine, and medical society leadership are treating the climate crisis.” DeNicola was joined by Emily Sbiroli, MD, emergency medicine physician, national physician fellow in Climate and Health at the University of Colorado, San Diego, California; Vi Nguyen, MD, AAP California State Government Affairs Expert Committee on Environmental Health and Climate Change, in San Diego; and Colin Nackerman, MD, Associate Director of Policy & Operations, Medical Society Consortium on Climate and Health, San Diego, who all shared their insights as to how climate change affects vulnerable populations such as pregnant women and children. Sbiroli spoke of her experiences treating patients with respiratory exacerbations from heat waves and wildfires, wildfires, that, Nackerman added, “used to be just a few months long and now can be all year long in California.” Nguyen added, “the health effects linked to climate change are profound. I see kids with asthma struggling from air pollution; eczema and allergies from hurricanes and pollen; type 2 diabetes [which can be triggered from temperature changes]; even early puberty. I think nearly every pediatric condition has a link to climate.”

Amidst all the doom and gloom, however, are several silver linings for health care providers. “As doctors, you are the ultimate influencers. It’s about trust equity, and if your patients trust you, they will believe you, so talk to them about this,” urged Nguyen.

But what exactly do you say? DeNicola suggested easy ways to weave how climate conditions affect health into conversations with patients. “Ask them, do you exercise? Do you exercise outdoors? The heat index is very high today, it might not be a good day for that.”

Additionally, in this "car-centric culture of California," as Nguyen noted, "talk to patients about walking or biking instead of driving somewhere," which is clearly a win-win: protect the environment and keep yourself moving as well.

Other questions: ask patients about their nutrition, and educate them on why, for example, they should avoid eating large fish, because of heavy metals fish have ingested at sea, (a sobering example of how polluted our seas have become). Endocrine disruptors like plastic can also be discussed, with advice, especially during pregnancy, to choose other containers. “I also ask about home environments,” DeNicola added. “Heavy metals are present in dust particles, so frequent cleanings and vacuuming is important.”

What else can health care providers do to address these environmental issues? Suggestions included asking hospitals to decarbonize; getting involved with advocacy groups like Health Care Without Harm; and supporting the Protecting Moms and Babies Against Climate Change Act, a federal bill which establishes grants and directs other activities to address health risks associated with climate change, particularly for members of racial and ethnic minority groups, pregnant or postpartum individuals, and children younger than age 3.

“Climate change is one of the biggest public health crises of our time,” said Nackerman. “We all have the power to amplify and advocate for climate change solutions.”

Reference

DeNicola N, Nguyen V, Sbiroli E, Nackerman C. Trading spaces: how pediatrics, emergency medicine, and medical society leadership are treating the climate crisis. 2022 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting. May 7, 2022. San Diego, California.