Perspectives from a physician teaching future health professionals to advance climate change solutions
By Caroline Wellbery, Deputy Editor of American Family Physician and Professor in the Department of Family Medicine in the Georgetown University School of Medicine
A cataclysmic heatwave hit India’s Uttar Pradesh province that resulted in 20 million deaths. After the electricity went out, hundreds of desperate residents took refuge in the town’s lake. The water itself was so warm it brought no relief, and by morning the lake’s surface was floating with corpses, leaving only a single survivor.
So begins Kim Stanley Robinson’s cli-fi novel, The Ministry for the Future, set in 2025. The visceral impact of this scenario is all the more haunting in the context of real heat waves that have continued to multiply since the novel’s publication in late 2020. Most of us have heard about last summer’s heat dome in the Northwestern U.S.; about temperatures rising 15 to 35 degrees higher than normal in Italy; those reaching as high as 123.3°F in Western Australia; and yes, about India’s recent exposure to the hottest month in its recorded history.
Global and regional scope of climate disasters
Heatwaves along with other climate disasters are on the rise. For those looking for details, NASA’s website offers predictions for a variety of global climate phenomena including heat waves, precipitation, hurricanes, drought and sea level rise. These informational maps speak to the causes and effects of climate change.
Many climate effects are regional. For example, Southwestern states in the US will continue to suffer severe drought and wildfires, while Northeastern states will experience heat waves, downpours and sea level rise. Regional variation and the sense that climate disasters are mostly limited, albeit repeating, events make it difficult to provide a one-size-fits-all response. Yet because these disasters have large-scale economic and health impacts, we should familiarize ourselves with the nuts and bolts of institutional and local preparedness.
Surprisingly few people (including most health professionals) recognize the health impacts of climate change. Yet, from a disaster perspective, climate events cause considerable morbidity and mortality.
Heat waves have the most widespread health impacts, given their prevalence and the body’s limited ability to adjust to higher temperatures, particularly when compounded by humidity. Children, pregnant women, and older adults are especially vulnerable to heat injury. Socio-economic factors also disproportionately expose certain groups to develop underlying health conditions, due to such factors as outdoor work and no air conditioning.
In addition, wildfires have broad respiratory impacts from the release of particulates and toxins from burning material. Flooding exposes people to infectious diseases and water contaminants. Any climate disaster causes psychological trauma, both directly due to the immediate event and indirectly because of loss of home and other assets, often aggravating poverty and forcing displacement. In many individuals, mental health impacts can linger as a lasting post-traumatic stress disorder.
The health harms previously mentioned don’t just add up—they multiply. A paper published in The American Journal of Respiratory and Critical Care Medicine recently released the results of their California study showing the synergistic effects of heat and air pollution. All-cause mortality increased 6.1% and 5% respectively on extreme heat and high air pollution days, but increased 21% when both were present.
Thus, health professionals have an important role in the event of climate disasters. Most of these will be emergency room physicians responding to bodily injury, heat stroke, and respiratory distress, but also mental health crises, though health professionals in certain specialties: pediatricians, pulmonologists and allergists, for example, see lower-grade climate-related problems in their offices every day.
Numerous online sources evaluate geographic areas prone to specific climate disasters with the underlying premise that prescient users may want to move their households to avoid their exposure to future climate disruption.
Most people, however, lack the wherewithal to move to a cooler, less disaster-prone area. As such, we require further investment in community disaster preparedness.
Community preparedness efforts recognize the importance of connectedness and collective engagement. Broadly speaking, emergency management requires structural oversight, beginning with the Federal Emergency Management Agency (FEMA), which offers resources and information to help communities become more resilient. The FEMA Strategic Plan discusses prospects for community-based climate resilience and related issues of societal inequities that make some communities vastly more susceptible to climate injury.
For example, hospitals as institutions need to prepare for an influx of patients during storms, heatwaves or wildfires by ensuring adequate personnel and attending to facility infrastructure. Ambulances need to be able to forge through flooded areas to transport patients. Generators need to be moved from ground-level to high-up areas. Evacuation plans and protocols need to be in place when patients require urgent transfer. We know from our experience with COVID how quickly hospitals are overwhelmed and run out of supplies, so preparedness also requires solid communication channels and collaboration with public health institutions.
At the same time, we need to know how ordinary citizens can prepare, starting with our local communities. Most current personalized disaster preparedness advice focuses on individual families, recommending advance assembly of emergency supplies (flashlight, bottled water, generators, food reserves etc.).
Georgetown University’s personal preparedness page provides a wealth of links on individual preparedness and related government resources, as well as advice on such topics as how to provide first aid in an emergency until help arrives.
In March of this year, Georgetown’ Office of Emergency Management conducted a full-scale emergency preparedness exercise (Hoya Storm). According to Marc Barbiere, OEM’s director, this experience allowed members of the Georgetown community to respond to a simulated severe weather event of the kind most likely to impact the campus (storms and tornadoes). Nonetheless, says Barbiere, it can be challenging to get people to pay attention to the need to prepare for and mitigate against the threats associated with climate change.
Some thinkers argue that because of our high-level global inaction on climate change, our best bet is for citizen responders to organize in preparation for climate extremes. They have concluded that survival requires deep adaptation, the creation of resilient, self-sufficient, and prepared communities. According to this model, nests or networks of participating individuals offer a share of practical skills focused on immediate and long-term community preparedness needs, including medical care, food and water, and protection.
Ultimately, we need to keep our focus on the bigger picture because true resilience rests on prevention. Disasters affect entire ecosystems: crops, access to water, biodiversity, and livable air quality; that is to say, the well-being and survival of all things. Dealing with disasters proactively by putting response systems into place is at best temporary. Our failure to prevent the continued rise of CO2 emissions is a planetary calamity of a different order altogether.
Many thanks to Marc Barbiere, Director of Georgetown’s Office of Emergency Management for information on campus preparedness, and to Dr. Stefan Wheat UC Health Emergency Care University of Colorado School of Medicine for his thoughts on this topic and this resource.
Dr. Wellbery is interested in climate change and health in medical education. She prepares the next generation of health professionals to advance climate change solutions through patient education and advocacy.