Climate Change, Climate Justice, and Healthcare: A Beginner's Primer, Part 2

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:

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.
4. Explore advocacy around slowing, mitigating effects of, and planning/adapting to climate change and climate change emergencies.

[0:00] Intro

• Co-hosts Dr. Marianne Parshley and Dr. Elisa Choi welcome guest experts Dr. Robert McLean and Dr. Erika Moseson back from Part I from the Climate and Health episode.
• Climate change is changing how we live across the globe and impacting some communities far more than others.
• This episode continues the discussion related to climate justice, heat exposure, and the impact of emissions on our lungs.

[2:03] Health Impacts Attributed to Changing Climate

• Dr. Moseson shares that the hazard ratios for death for fibrotic interstitial lung disease are highest from particulate matter exposure and discusses a groundbreaking paper published in JAMA (Alexeeff, 2023). When particulate matter (PM) is elevated, it is like we are all smokers. Dr. Moseson describes the effect and risks of elevated PM on the cardiovascular, pulmonary, and neurological systems.
• Dr. Moseson discusses the health toll of climate change on displaced people around the world (“international climate refugees”) and within our own communities (“internal climate refugees”). Reasons include destructive events related to weather (e.g., wildfires) and also the destabilization of communities due to agricultural changes (e.g., famine).
• Dr. McLean and Dr. Parshley discuss the effect of climate change on mental health and those who have social determinants of health challenges. The level of public awareness, anxiety, and concern have grown dramatically in the last few years.

[7:33] Evidence-Based Data for Changing Climate Conditions

• Dr. Choi inquires about evidence-based alerts and projections on health and Dr. Moseson emphasizes the important role that physicians can play in translating and communicating “science” at a level that patients and others can understand. This can be done independent of politics during routine conversations about managing chronic conditions or integrating climate as part of regular anticipatory guidance discussions. Resources such as the air quality index at AirNow.gov can be introduced.
• Dr. McLean and Dr. Moseson discuss the role of evidence-based data related to advocacy, submitting testimony, and policy-making. Many different stakeholders provide information to the Environmental Protection Agency (EPA) before a ruling, so physician voices are powerful, especially in advocating for a more health protective standard. Raising the awareness that patients may remain particularly vulnerable at certain health protective standards is important for policy-makers and legislators to know.

[15:27] Strategies to Adapt to Climate Change and Climate-Related Events

• Dr. McLean discusses the importance of preparedness, mitigation, and adaptation. With adaptation, there is a need for systematic level change and how business is done within healthcare systems and the healthcare industry. This will require investment.
• Dr. Moseson discusses preparing for resiliency and adaptation on the local level and the importance of ensuring that those most affected are not burdened by the costs of doing so. Dr. Moseson describes how she would counsel individuals who must face a wildfire or “dirty air” and the plans they can enact if and when those events or emergencies occur so they have access to better air quality, clean water, and affordable energy sources. At the community level, plans for shelters and housing after events is important as is the perspective that these events will continue to happen and they are not “one-off” events.

[18:30] How to Help the Environment

• Dr. Parshley asks about long term solutions or options about how to adapt and prepare for coming changes, such as changing the urban tree cover to reduce pollen counts, work which take many years.  And she asks about adapting the boundaries and composition of larger forests near where people live and are at risk from wildfires.
• Dr. Moseson discusses the evolution of human understanding about the role of fire in forest health. In the recent past, fire suppression has been the most commonly used method to control forest and wildfires.  She then reflects on traditional Native American forestry practices which included controlled burns which contrast with recent forestry practices. Using this background and understanding, Dr. Moseson advocates letting scientific evidence lead: “It’s all hands on deck and we need to reach out to all the communities we can.”
• Dr. McLean uses wind power as an example and adds thoughts on the impact of how we choose to mitigate and adapt to climate change. He urges thinking broadly enough to recognize that each option will have its own impact and agrees with Dr. Moseson advocating for an evidenced based approach and letting science lead.

[21:02] How to Adapt to Climate Change in an Equitable Way

• Dr. Choi asks Drs. McLean and Moseson to address the question of equity and inclusion in envisioning and enacting strategies around responding to climate change and our health.
• Dr. McLean highlighted the advocacy needed from healthcare organizations.  He references discussions and work happening at the AMA in the last couple of years on both equity, inclusion and justice as well as around climate and health. There has been progress. He urges us to continue this work through our health profession societies, in order to have an important voice in the legislative and regulatory arenas.
• Dr. Moseson discusses the importance of including all communities at the table and of not leaving anyone out. She uses the example of work in Multnomah County, Oregon on air quality. County workers went first to the people renting, then to the landlords, and discovered much in common between the groups. The group was able to consider creative solutions such as identifying specific areas where county support would have the most impact, areas like helping renters to get HEPA filters or helping with energy costs. She underscored that the decisions which are made around a table with everyone represented are better solutions, thus worth the time and effort to do the work together.

[25:19] Advocacy for Adapting to and Mitigating Climate Change

• Dr. Parshley asks the guests to share a few things that individual clinicians can advocate for, either at the local, state, or federal level for adapting, mitigating, and hopefully slowing climate change.
• Dr. Moseson shares that one of the most cost-effective methods is transitioning to a fully electrified transportation sector as well as human powered forms of transportation. She states that these types of decisions are made locally and physicians can be powerful advocates for communities when connecting infrastructure concerns with the effect on patients, especially for historically redlined and excluded communities who disproportionately bear the burden of the ill health effects of the transportation sector.
• Dr. McLean emphasizes the importance of local advocacy and also paying attention to what is happening at the state legislative level in terms of bills around climate and connecting those issues to how they affect our patients as trusted health professionals.
• Dr. McLean also discusses the importance of leaders in large health systems to advocate for systematic changes related to waste and recycling. At the patient level, it is important to make patients aware of these issues so that they can better plan and manage their own care and to introduce them to resources.

[29:07] Closing

• Dr. Parshley and Dr. Choi conclude this episode and encourage The DEI Shift listeners to continue this conversation online through Twitter and Instagram by sharing stories, questions, advocacy challenges, and specific barriers to continue making a difference together on behalf of our patients and communities!

[29:44] Outro

• Additional resources, references, and links will be available in the episode transcript.
• ACP Climate Change Toolkit: https://www.acponline.org/advocacy/advocacy-in-action/toolkit-climate-change-and-health

Resources from Dr. Moseson:

• Dr. Moseson’s AirHealthOurHealth podcast and website
  • airhealthourhealth.org
  • https://airhealthourhealth.org/category/indoor-air-quality/
• Patient resources from Dr. Moseson: https://www.thoracic.org/patients/patient-resources/resources/climate-change-health-effects.pdf

Resources from Dr. McLean:

• https://medsocietiesforclimatehealth.org/
• Ed Maibach & Center for Climate Change Communication https://www.climatechangecommunication.org/climate-change-in-the-american-mind/
• 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/
• Great graphic and visual data explanations with continuing health and climate data: https://www.lancetcountdown.org/

Other Selected References

• 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 Network Open. 2023;6(2):e230561. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801820
• Balbus, J., et al., After COP26 — Putting Health and Equity at the Center of the Climate Movement. April 7, 2022, N Engl J Med 2022; 386:1295-1297. https://www.nejm.org/doi/full/10.1056/NEJMp2118259?query=TOC
• Centers for Disease Control and Prevention. Health, United States Spotlight: Racial and Ethnic Disparities in Heart Disease. April 2019. www.cdc.gov/nchs/hus/spotlight/HeartDiseaseSpotlight_2019_0404.pdf
• 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. https://pubmed.ncbi.nlm.nih.gov/34908495/
• Tessum CW, Paolella DA, Chambliss SE, et al. PM2.5 polluters disproportionately and systemically affect people of color in the United States. Sci Adv. 2021;7. https://www.science.org/doi/10.1126/sciadv.abf4491
• 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. https://www.acpjournals.org/doi/full/10.7326/M22-1864?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
• 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. https://www.acpjournals.org/doi/full/10.7326/M15-2766?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
• 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. https://www.acpjournals.org/doi/10.7326/M22-1241

Credits:

Guests: Dr. Robert McLean, Dr. Erika Moseson

Co-hosts/Producers: Dr. Marianne Parshley, Dr. Elisa Choi

Executive Producer: Dr. Tammy Lin

Co-Executive Producers: Dr. Pooja Jaeel, Dr. Maggie Kozman

Senior Producer: Dr. DJ Gaines

Editor/Assistant Producer: Joanna Jain, Sanika Walimbe

Production Assistants: Leyna Nguyen, Dr. Erynn Beeson

Website/Art Design: Ann Truong

Music: Chris Dingman

Disclaimer: The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.

Season 5 of The DEI Shift podcast is proudly sponsored by the American College of Physicians Southern California Region III Chapter.

The DEI Shift theme music is by Chris Dingman. Learn more at www.chrisdingman.com.

Contact us: thedeishift@gmail.com, Instagram or Twitter @thedeishift, thedeishift.com

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: Abbott Labs; AbbVie, Inc.; Cybele Microbiome

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:  September 22, 2023

Expiration Date: September 21, 2026

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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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