Addressing the health, safety, welfare, and dignity of all humans

FigureFigureFigureA series of major national and international reports, released in the fall of 2018, highlighted the urgent need for action on climate change, and the importance of understanding the health implications of this environmental crisis. The first of these was the Intergovernmental Panel on Climate Change (IPCC) 1.5° report, which documented that serious effects on human health as well as other sectors and planetary systems would occur with an increase in global average temperature of 1.5° C, below the 2° C target set in the Paris Agreement of 2015, and estimated that efforts to limit temperature increases to 1.5° C would need to be initiated in about 12 years.1 The second major international report was submitted by the World Health Organization to the United Nations Framework Convention on Climate Change (UNFCCC), the body that oversees the international climate change negotiations.2 This report documented both the substantial global burden of disease anticipated to result from future climate change, especially in developing countries, as well as the substantial benefits to health of reducing greenhouse gas emissions through reductions in conventional air pollutants. A third report, the US Fourth National Climate Assessment, stated that: Climate change affects the health of all Americans Although all patients are exposed, exposure and resilience vary across populations and communities. Adaptation reduces risk and improves health. Reducing greenhouse gas emissions results in health and economic benefits.3 Finally, the Lancet 2030 countdown produced international and national reports, which documented worsening health risks and ongoing progress in climate action from a health perspective.4,5 Here are some of the most important points to take away from all of this information: First, climate change affects the health of your patients. Increased exposure to heat can affect patients with chronic diseases and interact with their medications, including diuretics, antihistamines, beta-blockers, and a range of medications for mental health disorders.6 Infectious diseases may be changing in onset or severity or even appearing or disappearing in your region.7 The full extent of anticipated changes is detailed in the US Global Change Research Program's climate and health assessment (https://health2016.globalchange.gov). Although the health effects of climate change are numerous and daunting, physician assistants (PAs) are not powerless to combat them. On a daily basis, PAs identify and target the unique risk factors that predispose entire communities and individual patients to acute and chronic disease. Climate change interacts with our health in similar fashion, and by combining a patient's health profile and projected local climate effects, clinicians can give targeted, often novel medical advice. To help healthcare professionals learn more, the National Institute of Environmental Health Sciences has developed free climate change and human health lesson materials, available at http://nih.gov/lessonsinclimatechange. These materials teach interested clinicians how to reframe the discussion of climate health through a clinical lens, targeting their specific treatment populations of choice. Second, healthcare facilities have a critical role to play, both in ensuring their continuity of operations despite increasingly severe and frequent extreme weather events, and also in minimizing their environmental footprint and contribution to greenhouse gas accumulations.8 Nearly 10% of all US greenhouse gas emissions come from the healthcare sector alone. If the US healthcare system were a country, it would rank 13th for greenhouse gas emissions as of 2016. Non-greenhouse gas emissions are responsible for significant indirect morbidity, from increased smog days, particulate matter-associated respiratory disease, and environmental acidification, all of which affect human health.9 The calculated health burden of healthcare-associated emissions specifically is on the same order of magnitude as patient deaths due to preventable medical errors.9 Focusing on minimizing waste can be economically and environmentally beneficial for healthcare providers and patients. PAs can use the Choosing Wisely Campaign (www.choosingwisely.org) to deliver high-value care, eliminate unnecessary interventions, and reduce the environmental effect of their practice. More information on sustainability in healthcare systems is available from the Advisory Board at www.advisory.com/community-impact/health-care-sustainability-initiative. Advocating for institutional sustainability in hospital systems, for example through membership in an organization such as Practice Greenhealth (https://noharm-uscanada.org/content/us-canada/practice-greenhealth), can amplify the positive effects of daily waste reduction and reduced emissions. In areas with major anticipated climate effects, clinicians can advocate for smarter, forward-looking construction and mitigation strategies to anticipate damage caused by severe weather.3,10 Third, healthcare professionals have a unique voice and privilege in society to raise awareness on the seriousness of climate change. The need for global action to curb greenhouse gas accumulation and avert the most severe and most rapid climate change has been made clear by the 2018 reports. PAs can educate their patients and join with other healthcare professionals through groups such as the Medical Society Consortium on Climate and Health and Health Care Without Harm. PAs are trusted members of the community, responsible for translating science into tangible, accessible concepts for their patients. Patients trust and rely on us to stay up-to-date, to practice evidence-based medicine, and to guard their well-being. The health risks posed by climate change merit similar counseling to the risks posed by driving without a seat belt, eating too much salt, or smoking cigarettes. Armed with the right tools and awareness, PAs can be peer leaders in climate health advocacy and patient safety.

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