Climate change impacts the health of our communities

By Keith A. Hovan

Today began as most normal days do for me. Drink coffee, read the online versions of several digital newspapers: The New York Times, Washington Post, Boston Globe, LA Times, and the Wall Street Journal. After that, but before going to work, it’s time to go for a walk or hike through the beautiful pastures, woods, and bogs that surround our home. My wife Erin and I often bring our two Chevalier King Charles Spaniels, Tobey and Tucker, with us on those outings.

Today as we strolled past the beautiful and historic Eastover Farm, we were suddenly struck by a sense of sadness. There looking at us from the field was one of our horses, William, standing in a field that was completely brown. His playful and normally happy demeanor seemed different. A year ago, at this time the field was green, almost lush. Leonard’s Pond that abuts the farm had a water level that has been reduced nearly three feet, as we could see by the watermarks on the walls that hold back the pond, which has begun to reveal rock formations that many of us have not ever seen.

While we fully accept that our planet is being threatened by climate change and global warming, we have never seen our local environment as threatened as it has been this summer.

Here in Rochester, Massachusetts, we have received just 0.35 inches of rain over the past several weeks. The expected average for this same period is ten times that amount. According to the National Weather Service, during the month of July the average daily temperature locally was two degrees higher than normal. In early August it was six degrees warmer than expected. Within the past week there have been other even more dramatic weather events nationwide: flash flooding and mudslides stranding a thousand people in Death Valley after record rainfalls, floods after massive storms dropped 10 plus inches of rain in Kentucky, tornadoes, hail—the incidents are too numerous to name them all.

Impact on physical health

So why write about this subject? Why state the obvious? The reason is simple: we all need to play a role in reducing the effects of climate change on our planet. All of us.

As a clinician and healthcare executive, I have had the opportunity to see the direct impact of climate change on many of the patients we serve. The patient with Chronic Obstructive Pulmonary Disease sitting in a non-airconditioned apartment in high humidity struggling for breath. The effects of extreme heat or cold on those who must labor outdoors in order to provide for their families. Not all of the populations that we serve as providers are impacted the same. We know that many factors—where a person lives, their economic status, access to transportation, and the number of people in your household, for example—can determine how well or how long they live.

As providers we have used the CDC/ATSDR Social Vulnerability Index (SVI) to better determine how disasters or disease outbreaks impact the most vulnerable disproportionately. The SVI can be utilized as a tool in determining the most appropriate way to bring care to those who might otherwise struggle with access to prevention such as vaccines or treatment. Where you live, often influenced by where you can afford to live, can increase your exposure to the impacts of climate change and global warming. Are you exposed to pollution spewing from local factories that have the potential to damage air, water, or soil quality? Do you live in an area at risk for wildfires as the planet becomes warmer and drier? If you have access to food, is it safe to eat, and can it provide the proper nutrition that your body needs?

Warmer temperatures are interrupting natural processes that prevent sickness. Diseases carried by vectors such as fleas, ticks and mosquitoes are increasing in frequency as the planet warms. As an example, as the planet become warmer the seasonal die-off of ticks in New England that have historically happened during the colder winter months no longer occurs. As a likely result we have seen an increase in tick-borne diseases such as Lyme, Anaplasmosis, Babesiosis, Ehrlichiosis, Powassan disease, Borrelia and Rocky Mountain spotted fever. Members of my own family, including myself, have required treatment for Lyme disease this year.

Algae blooms due to fertilizer runoff and warmer temperatures occur in water sources that have been depended on to provide safe, clean water for human or animal consumption, as well as a home to the aquatic life that exists there. We have also been exposed to the devastating impact that Eastern Equine Encephalitis carried by infected mosquitoes can have on a human being as well. As the planet continues to warm and as the global economy expands, diseases carried by vectors that were once considered only illnesses of the tropics are likely to become widespread.

Impact on mental health

It is not just our physical health that can be impacted by the effects of climate change. These environmental changes we are experiencing can be a source of stress that affects our emotional health, which in turn impacts one’s overall well-being.

The Centers for Disease Control and Prevention (CDC) cites the impact of climate change on stress and mental health:

“In addition, some patients with mental illness are especially susceptible to heat. Suicide rates vary with weather, rising with high temperatures, suggesting potential impacts from climate change on depression and other mental illnesses. Dementia is a risk factor for hospitalization and death during heat waves. Patients with severe mental illness, such as schizophrenia, are at risk during hot weather because their medications may interfere with temperature regulation or even directly cause hyperthermia.”

In a 2022 study conducted at the University of Hawaii at Manoa and published in Nature Climate Change, researchers examined the relationship between greenhouse gas emissions causing climatic hazards and the effects on human pathogenic diseases. The results of the study are absolutely startling. They found that of the 375 pathogenic diseases that affect humans around the world, 58% of those diseases were found to have been exacerbated by climate hazards caused by greenhouse gas emissions. The most frequent climate hazards that caused a worsening of pathogenic disease by unique type included: warming (160), precipitation (122), flooding (121), drought (81), storms (71), land cover change (61), ocean climate change (43), and fires (21).

As might be expected the authors also noted the increase in an individual’s vulnerability to cope with illnesses related to pathogens as a result of stress, exposure to hazardous environmental conditions, damaged infrastructure, lack of access to medical care, etc. The body of evidence demonstrating a link between the social vulnerability index scores of populations exposed to climate hazards and higher risk of poor outcomes is steadily growing.

Addressing the issue as individuals and healthcare providers

So, what can we do about climate change? How can we make a difference? The most urgent objective is to reduce the amount of carbon dioxide (CO2) and other greenhouse gas emissions (GHGE) being introduced into the atmosphere. The sooner we level off and then reduce emissions, the better our planet will be. It is truly a matter of survival that we must all be committed to.

There are some basic actions we can all take, some of which are very easy or inexpensive to implement, while others might require more of an investment of time or finances, such as conversions of systems or sourcing or implementations of new technology. Recent actions in Washington, including the Inflation Reduction Act, a $370 billion climate, tax and health care package, have the potential to go a long way towards incentivizing actions that will help reduce GHGE. Those incentives include tax credits on electric vehicles (new and used), rebates on new energy efficient and electric appliances, tax credits for energy producers who build emission-free energy, and penalties for companies whose methane emissions exceed federal standards beginning in 2024.

So, where do we start? We need to begin by educating ourselves, our friends and family, and our colleagues. There are many respected, reliable sources of information on the topic of climate change and the actions we can all take to begin to decrease GHGE. For general information about actions you can take at home or work here is a list of some websites that provide excellent information to begin that education:

We have all heard the expression that “change begins at home.” So too should our initial actions to have an impact on climate change. Here is a partial list of actions that we can all take:

Make your vote count. Choose to elect those whose priorities reflect concerns for their constituent’s well-being and the health of our planet.
Decrease food waste at home. It has been estimated that Americans throw away up to 40% of the food they buy. Minimize food waste by buying only what you need, eating leftovers, and composting scraps.
Drive electric. The Inflation Reduction Act mentioned earlier locks in incentives for new and used electric vehicles (EV). Data shows that there are less CO2 emissions from EVs even when the carbon footprint of manufacturing, battery production, and supply chain are considered.
Share a ride. Carpool and use public transportation whenever possible.
Convert all of the lighting in your home to LED. LED lighting uses substantially less energy than incandescent and fluorescent bulbs.
Conduct a home energy assessment. Many states offer free home assessments that evaluate the energy performance of your home including lighting, insulation, options for upgrading to clean heating and cooling systems, and more energy efficient appliances. There may be incentives for the recommended changes offered as a result of the assessment.
Recycle. Recycled products generally reduce energy consumption in repurposing.
Buy local. Buying locally produced goods and food help to decrease CO2 emissions related to transportation and supply chain.
Plant a tree.

These are just a few ideas of where we can get started in our personal lives and homes. Yet, it is imperative that we go beyond our homes and into our businesses to make an impact.

My career has been focused on the delivery of healthcare to populations. I would often opine on the challenges of getting services and care delivered to diverse populations that were often socially economically disadvantaged. A tactic that we used in my health system was the deployment of a mobile van that we would move throughout the region to bring preventative and diagnostic services to those who faced transportation hurdles.

Calling this vehicle a “mobile van” is a bit of an understatement. This diesel-powered behemoth was so large that it required a driver with a commercial license to operate it and bring the four to five staff members aboard from location to location. Often, because of the vehicle’s size, it would park in a shopping center or church parking lot where it would sit and idle for several hours in order to keep power and climate control systems operating.

As we began to evaluate our population health strategies at the system level, we began to recognize that while we were able to move the van around to the communities we served, we were still not reaching those who were most vulnerable. The van simply would not fit on most neighborhood streets so we could get closer to where the patients who needed us most resided. We had two issues to solve: first, getting services to our highest risk, most vulnerable patients, and, secondly, the impact our diesel-chugging van, which was expensive to operate, was having on the environment.

The solution to our challenge was transitioning to smaller, nimbler EVs. The EVs allowed our teams to also be smaller and nimbler, bringing services directly into the neighborhoods and homes that had the greatest needs. Because of this increased ability to move throughout the region rather than being parked in a lot for an entire day we could have a greater impact on our patients’ health outcomes. The operating costs of using the EVs were also much lower than the van, as they could be recharged daily utilizing renewable sources of energy. Adding to the cost savings was the fact that we no longer needed a driver with a commercial drivers license simply to drive and park the van.

Hospitals are often large contributors to GHGEs in the communities where they are located. Healthcare supply chains often extend from the U.S. to China for products that are utilized every day. Hospitals consume vast amounts of energy and produce excessive amounts of waste, both biohazardous waste and large amounts of trash. Our health system became committed becoming more energy efficient, replacing lighting with LEDs in over 2 million square feet of owned and leased space. We deployed a strategy to upgrade our HVAC systems with newer, more highly efficient products, and required all new construction to undergo a review to ensure the inclusion of high efficiency building products and systems.

There is much work that remains to be accomplished in healthcare. If you work in healthcare, I would encourage you to check out Healthcare Climate ActionWorks led by Neal Hogan and Jonathan Fullerton. These innovative leaders are helping healthcare providers identify, analyze, and support the implementation of the most impactful and successful emission reduction tactics for their organizations.

In most communities, healthcare workers are looked upon for the example they set for others. The healthcare community needs to lead in climate change as well. The health and well-being of our neighbors depends upon it.

The time for us to act is now.

Resources

NOW Data Set – Rochester MA COOP, National Weather Service

Storm Prediction Center, 8/5/2022, National Weather Service

Mental Health and Stress-Related Disorders, Centers for Disease Control and Prevention

Over half of known human pathogenic diseases can be aggravated by climate change, Nature Climate Change

What can we do to slow or stop global warming?, Climate.gov

What Can Be Done About Climate Change, Massachusetts Institute of Technology Climate Portal

10 ways you can help fight the climate crisis, United Nations Environment Program

Leading on Climate Change: How Healthcare Leaders Stop Global Warming by Neal Hogan