Climate Change, Climate Justice, and Healthcare A Beginner’s Primer, Part 1

The DEI Shift's mission is to create a podcast series on diversity, equity, and inclusion (D.E.I.) in medicine that sparks discussion and provides practice-changing data and stories for a physician, student, allied health professional, and health care leader audience. Listeners will be able to gain useful information to improve their practices and environments, to gain empathy, cultural competency, and humility, and to learn more about emerging D.E.I. concepts. The DEI Shift will discuss issues related to gender, race, sexuality, religion, ability, socioeconomics, and so much more.

Guests: Dr. Robert McLean, Dr. Erika Moseson

Co-Hosts: Dr. Marianne Parshley, Dr. Elisa Choi

Editor/Assistant Producer: Joanna Jain, Sanika Walimbe

Production Assistants: Leyna Nguyen, Dr. Erynn Beeson

Clean Air Saves Lives
Don’t light things on fire and breathe them in.
…this means tobacco, diesel, wildfires and more…

-Erika Moseson, MD

"We in health and medicine have an obligation to act, and to start treating climate change as the public health crisis that it is. We have a duty to advocate for health and equity to be at the center of climate change planning and policy."

-Victor Dzau, MD (2021 Annual President's Address to the NAM Membership)

Learning Objectives:

Part 1:

1. Explore the intersection between health, healthcare disparities, and climate change.
2. Describe the breadth of the impact of climate change on historically marginalized and disinvested communities and individuals.
3. Understand the various strategies to respond to climate change being adopted at the community level, frontline, and systems level in two different areas in the United States.

[0:00-2:05] Welcome and Introductions

• Introduction of co-hosts, guests, and episode topic

[2:05-4:42] Introduction to Guests: Dr. Robert McLean and Dr. Erika Moseson

• Dr. McLean
  • Internal medicine and rheumatology at New Haven
  • Past president of ACP
  • Associate Clinical Professor of Medicine at the Yale School of Medicine
  • Immediate past Chair of the Medical Society Consortium on Climate and Health Steering Committee
  • Member of National Academy of Medicine's Action Collaborative on Decarbonizing the U.S. Health Sector
• Dr. Moseson
  • Pulmonary critical care physician with Legacy Medical Group of Oregon
  • Member of the American Thoracic Society's Environmental Health Policy Committee
  • American Lung Association Health Professional for Clean Air and Climate Action
  • Serves on the board of the American Lung Association of Oregon
  • Founder of Air Health Our Health podcast
  • Worked with the Oregon Medical Association to promote healthy climate action

[4:42-13:04] “Be the Change” Segment

• Dr. Moseson
  • Dr. Moseson’s interest in climate health began while working with Oregon Thoracic Society and understanding the impact legislation has on the health of patients
  • Using legislation and connecting with lawmakers is a tool to make patient and physician voices heard
  • Air is invisible: lawmakers do not see the impact of tobacco, air pollution, unregulated diesel emissions, for example, however physicians are in a position to see these effects
  • Dr. Moseson also started a bilingual podcast regarding pollution and lung health to empower people with knowledge
• Dr. McLean
  • Dr. McLean's involvement in climate health began with ACP Advocacy work, recognizing the impact he had as a physician when working with legislators and policymakers
  • The ACP Policy paper in 2016 put climate health on the radar
  • Becoming the Chair of the Medical Society Consortium on Climate and Health’s initial Steering Committee helped grow his passion of advocating for climate solutions

[13:04- 15:33] Marianne’s Anecdotes about Intersection Between Climate and Health

• Marianne’s experience working with a local health cooperative in El Salvador
  • Many young, healthy farmers were being diagnosed with chronic kidney disease
  • Dr. Ramón García-Trabanino, a nephrologist, would later describe this as Mesoamerican nephropathy
    • Mesoamerican nephropathy is an epidemic of kidney disease across Central America, primarily in young male farmers without other risk factors for chronic kidney disease
    • There’s a movement to promote preventive measures such as safe drinking water, adequate hydration, and reduced exposure to toxins
• Marianne’s anecdote involving Portland’s heat dome event in 2021
  • The heat dome event brought temperatures up to 116 degrees Fahrenheit
  • A patient died in the hospital from a heat stroke due to a lack of air conditioning in her room

[15:33- 21:00] How Do You Define Climate Justice in Healthcare?

• Dr. Moseson
  • Climate justice means everyone being in the same boat in terms of having access to resources that can protect them from heat-related illnesses and being able to use paid leave when it’s unsafe to work outdoors in hot weather
  • We must work to ensure that everyone has access to clear air and decrease the health risks of those who are exposed to poor air quality
  • We need to address areas where there are limitations on resiliency
• Dr. McLean
  • There are also global inequities where countries that aren’t contributing to pollution are still suffering from it
  • According to the Lancet Countdown report, there are developing countries who are suffering from more frequent flooding and other significant weather events
  • The U.S. and other major countries are contributing to fossil fuel pollution, but we’re not experiencing the brunt of the impact it has on the world’s climate
  • We need more awareness of local and global climate injustices

[21:00- 30:52] Effects of Climate Change that Impact People and Communities the Most

• Dr. McLean
  • Neighborhoods that live at or near interstate intersections experience much different air quality than neighborhoods who live farther away from interstate intersections
  • Every time an individual hits the brakes of their vehicle, there’s an increased emission of particulate matter and thus, more air pollution
  • Local laws can mitigate the difference in air quality of these neighborhoods
• Dr. Moseson
  • Freeway intersections are generally localized in communities with lower socioeconomic resources and often in historically redlined communities
    • A study in California found that Hispanic children are more likely to live close to freeways and be exposed to traffic pollution compared to non-Hispanic white children
    • Also, Hispanic children with indigenous ancestry were even more likely to live close to freeways
  • Wildfires are increasing particulate matter emissions and the particulate matter can cause disease
  • A warming climate has led to infectious diseases spreading further and longer pollen seasons with pollen that’s more intense and allergenic
  • The warming climate and increased particulate matter emissions have also increased ozone exposure and formation
  • Massive climate events, such as floods and hurricanes, are costly and are happening more frequently, so we need to invest in addressing the issue now

[30:52-31:26] Closing

This is the end of Climate Change, Climate Justice, and Healthcare: A Beginner’s Primer, Part 1. Stay tuned for Part 2!

[31:26-32:17] Outro

References (Climate and Health-Season 5 ep 3)

Guests’ Mentions

Dr. Moseson’s podcast and website:

https://airhealthourhealth.org/category/indoor-air-quality/

https://www.thoracic.org/patients/patient-resources/resources/climate-change-health-effects.pdf

Dr. McLean:

https://medsocietiesforclimatehealth.org/

https://www.climatechangecommunication.org/

https://nam.edu/programs/climate-change-and-human-health/

https://acpinternist.org/archives/2021/09/pollution-hurts-health-may-pose-pandemic-risk.html

https://climateforhealth.org/

Climate Justice and Health Equity

After COP26 — Putting Health and Equity at the Center of the Climate Movement
John M. Balbus, M.D., M.P.H., C. Joseph McCannon, A.B., Arsenio Mataka, J.D., and Rachel L. Levine, M.D.,April 7, 2022,N Engl J Med 2022; 386:1295-1297, https://www.nejm.org/doi/full/10.1056/NEJMp2118259?query=TOC

Liu J, Clark LP, Bechle MJ, et al. Disparities in air pollution exposure in the United States by race/ethnicity and income, 1990-2010. Environ Health Perspect. 2021;129:127005.

Intergovernmental Panel on Climate Change (IPCC) SIXTH ASSESSMENT REPORT (AR6) Synthesis Report :Climate Change 2023 https://www.ipcc.ch/report/ar6/syr

Lemire  E, Samuels EA, Wang W, et al. Unequal housing conditions and code enforcement contribute to asthma disparities in Boston, Massachusetts. Health Aff (Millwood). 2022;41:563-72. [PMID: 35377754] doi:10.1377/hlthaff.2021.0140

Dumping  in Dixie : race, class, and environmental quality; Robert D. Bullard; Boulder, Colorado : Westview Press, [2000]

Historical Redlining Is Associated with Present-Day Air Pollution Disparities in U.S. Cities  Haley M. Lane, Rachel Morello-Frosch, Julian D. Marshall, and Joshua S. Apte Environmental Science & Technology Letters 2022 9 (4), 345-350 DOI: 10.1021/acs.estlett.1c01012

https://www.nature.com/articles/s41370-022-00434-9
    
https://www.washingtonpost.com/climate-environment/2022/03/09/redlining-pollution-environmental-justice/

Air pollution (PM 2.5 particulates)

Rajagopalan S, Landrigan PJ.,  Pollution and the heart. N Engl J Med. 2021;385:1881-92. [PMID: 34758254] doi:10.1056/NEJMra2030281

Alexeeff SE, Deosaransingh K, Van Den Eeden S, Schwartz J, Liao NS, Sidney S. Association of Long-term Exposure to Particulate Air Pollution With Cardiovascular Events in California. JAMA Netw Open.2023;6(2):e230561. doi:10.1001/jamanetworkopen.2023.0561

Anondo Mukherjee, Michael C. McCarthy, Steven G. Brown, ShihMing Huang, Karin Landsberg, Douglas S. Eisinger, Influence of roadway emissions on near-road PM2.5: Monitoring data analysis and implications, Transportation Research Part D: Transport and Environment, Volume 86, 2020, 102442, ISSN 1361-9209, https://doi.org/10.1016/j.trd.2020.102442

Brook RD, Rajagopalan S, Pope CA, et al; American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331-78. [PMID: 20458016] doi:10.1161/CIR.0b013e3181dbece1

Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med. 2019;381:705-15. [PMID: 31433918] doi:10.1056/NEJMoa1817364

Aguilera R, Corringham T, Gershunov A, et al. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nat Commun. 2021;12:1493. [PMID: 33674571] doi:10.1038/s41467-021-21708-0

D’Amato G, Chong-Neto HJ, Monge Ortega OP, et al. The effects of climate change on respiratory allergy and asthma induced by pollen and mold allergens. Allergy. 2020;75:2219-28. [PMID: 32589303] doi:10.1111/all.14476

Air Pollution and Mortality in the Medicare Population; Qian Di, M.S., Yan Wang, M.S., Antonella Zanobetti, Ph.D., Yun Wang, Ph.D., Petros Koutrakis, Ph.D., Christine Choirat, Ph.D., Francesca Dominici, Ph.D., Joel D. Schwartz, Ph.D.; June 29, 2017 N Engl J Med 2017; 376:2513-2522

Yu Z, Bellander T, Bergström A, et al; BAMSE COVID-19 Study Group. Association of short-term air pollution exposure with SARS-CoV-2 infection among young adults in Sweden. JAMA Netw Open. 2022;5:e228109. [PMID: 35442452] doi:10.1001/jamanetworkopen.2022.8109

Johnson, N.M., Hoffmann, A.R., Behlen, J.C. et al. Air pollution and children’s health—a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter. Environ Health Prev Med 26, 72 (2021). https://doi.org/10.1186/s12199-021-00995-5

Mikati I, Benson AF, Luben TJ, et al. Disparities in distribution of particulate matter emission sources by race and poverty status. Am J Public Health. 2018;108:480-5. [PMID: 29470121] doi:10.2105/AJPH.2017.304297

Heat Related Illnesses and Injuries

Trabanino RG, Aguilar R, Silva CR, Mercado MO, Merino RL. [End-stage renal disease among patients in a referral hospital in El Salvador]. Revista Panamericana de Salud Publica = Pan American Journal of Public Health. 2002 Sep;12(3):202-206.

Sanchez Polo V, Garcia-Trabanino R, Rodriguez G, Madero M. Mesoamerican Nephropathy (MeN): What We Know so Far. Int J Nephrol Renovasc Dis. 2020 Oct 22;13:261-272. doi: 10.2147/IJNRD.S270709. PMID: 33116757; PMCID: PMC7588276. https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-022-02861-0

Wesseling, Catharina,Newman, Lee S.; Chronic Kidney Disease of Unknown Cause in Agricultural Communities; 2019;New England Journal of Medicine;PG 1843-1852;V380-19; New England Journal of Medicine May 9, 2019 380(19):1843 https://www.nejm.org/doi/full/10.1056/NEJMra1813869

Johnson, Richard J., Wesseling, Catharina,Newman, Lee S.; Chronic Kidney Disease of Unknown Cause in Agricultural Communities; 2019; New England Journal of Medicine May 9, 2019 380(19):1843;  https://www.nejm.org/doi/full/10.1056/NEJMra1813869

Advocacy and Governmental actions around Climate and Health

Intergovernmental Panel on Climate Change (IPCC) SIXTH ASSESSMENT REPORT (AR6) Synthesis Report :Climate Change 2023 https://www.ipcc.ch/report/ar6/syr/

Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021;398:1619-62. [PMID: 34687662] doi:10.1016/S0140-6736(21)01787-6

Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. Lancet 2021;398:939-941.

Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in the United States: an update. Health Aff (Millwood) 2020;39:2071-2079.

World Health Organization. Countries commit to develop climate-smart health care at COP26 UN climate conference. November 9, 2021. https://www.who.int/news/item/09-11-2021-countries-commit-to-develop-climate-smart-health-care-at-cop26-un-climate-conference

Tools for Advocating

For great graphic and visual data explanations and continuing health and climate data https://www.lancetcountdown.org/ which Dr. McLean referred to in the PodCast.

ACP Climate Change Advocacy Toolkit https://www.acponline.org/advocacy/advocacy-in-action/toolkit-climate-change-and-health

Ryan Crowley, Suja Mathew, David Hilden, et al; Health and Public Policy Committee of the American College of Physicians . Environmental Health: A Position Paper From the American College of Physicians. Ann Intern Med 2022;175:1591-1593. [Epub 25 October 2022]. doi:10.7326/M22-1864.

Ryan A. Crowley, for the Health and Public Policy Committee of the American College of Physicians . Climate Change and Health: A Position Paper of the American College of Physicians. Ann Intern Med.2016;164:608-610. [Epub 19 April 2016]. doi:10.7326/M15-2766

Sarju Ganatra, Sourbha S. Dani, Sadeer G. Al-Kindi, et al. Health Care and Climate Change: Challenges and Pathways to Sustainable Health Care. Ann Intern Med.2022;175:1598-1600. [Epub 25 October 2022]. doi:10.7326/M22-1241 https://www.acpjournals.org/doi/10.7326/M22-1241

Healthcare Sector Contributions

Health Care Without Harm. Health Care's Climate Footprint. Climate-Smart Health Care Series. Green Paper Number One. https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf

Chen A, Murthy V. How health systems are meeting the challenge of climate change. Harvard Business Review. 18 September 2019. https://hbr.org/2019/09/how-health-systems-are-meeting-the-challenge-of-climate-change

U.S. Department of Health & Human Services.HHS Launches Pledge Initiative to Mobilize Health Care Sector to Reduce Emissions. www.hhs.gov/about/news/2022/04/22/hhs-launches-pledge-initiative-mobilize-health-care-sector-reduce-emissions.html

Donahue LM, Hilton S, Bell SG, et al. A comparative carbon footprint analysis of disposable and reusable vaginal specula. Am J Obstet Gynecol. 2020;223:225.e1-e7. [PMID: 32067971] doi:10.1016/j.ajog.2020.02.007

Contributors

Pooja Jaeel, MD, ACP Member - Staff

Maggie Kozman, MD, ACP Member – Staff

Dirk Gaines, MD, ACP Member - Staff

Robert McLean, MD, MACP, FRCP - Faculty/ Speaker

Erika Moseson, MD – Faculty/ Speaker

Marianne Parshley, MD, FACP – Moderator

Elisa Choi, MD, FACP – Moderator

Leyna Nguyen  - Staff

Erynn Beeson, MD - Staff

Joanna Jain - Staff

Sanika Walimba - Staff

Reviewers

Tiffany Leung, MD, MPH, FACP, FAMIA, FEFIM

Independent Contractor: PlushCare, Inc

Tammy Lin, MD, MPH, FACP

Stock: Gilead Sciences, Inc., Sanofi US

None of the contributors or reviewers for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All financial relationships have been mitigated.

Release Date:  July 27, 2023

Termination Date: July 26, 2026

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the DEI Shift.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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