Curing our climate

Why we should shout about environmental changes that are making us sick

Illustration by Greg Clarke

In musing about the impact of global environmental change on the human race, Paul Auerbach , MD, and Jay Lemery , MD, mostly steer clear of politics. They admit they aren’t climate experts. They are, however, experts in treating people who suffer sometimes devastating health outcomes that are caused or exacerbated by global changes in the environment.

Auerbach is a professor of emergency medicine at Stanford and a leading authority on wilderness medicine, and Lemery is an associate professor of emergency medicine and chief of wilderness and environmental medicine at the University of Colorado.

In a new book, Enviromedics: The Impact of Climate Change on Human Health, published by Rowman & Littlefield, they lay out “our inventory of adverse health impacts” of environmental change and call on physicians to undertake a Herculean effort to raise awareness of the problem to help preserve human health.

They evoke climate justice as a means to approach the issue, arguing that negative impacts of climate change on people undermine their rights, as laid out by the United Nations, to a standard of living that is adequate for their health and well-being.

“We should be planning for the future not only as if our lives depended upon it, but knowing full well that the lives of forthcoming generations depend upon it. Medical justice demands this approach,” they write.

The ramifications of environmental events are clear, Lemery and Auerbach say. Floods, for example, account for about half of weather-related disasters, affecting 2.3 billion people worldwide during the past 20 years, while droughts kill more people, accounting for 59.6 percent of deaths caused by extreme weather events.

The authors use fictional stories of composite patients — whose symptoms mirror real ones — to illustrate afflictions people suffer because of environmental factors.

One man spends two weeks at the beach in New Jersey that had been a childhood haven, but this time biting flies and mosquitoes are relentless. Three weeks later, he has a fever, headache and vomiting. After his symptoms worsen, a doctor skilled at detecting diseases formerly considered tropical diagnoses him with malaria.

A 93-year-old woman refuses to leave her apartment when temperatures soar above 90 degrees for 10 days. An electrical brownout knocks out her air-cooling system and she doesn’t want to drink tepid water. So she stops taking her heart medication. Eventually, her heart and nervous system shut down and it is too late to save her.

The authors also point to natural disasters like this year’s hurricanes Harvey, Irma and Maria. The onslaught of rain and wind kills or injures people. Power outages shut down hospitals. People  abandon their homes. Flood waters become a toxic stew of human and chemical waste. Stagnant water near populated areas spreads mosquito-borne diseases. Finally, emotional trauma manifests itself through stress, depression and anxiety for years to come.

In the following excerpt, Auerbach and Lemery advocate for physicians to be ambassadors in making everyone — individuals, lawmakers and industrial leaders — aware that stopping or reversing the negative effects of climate change on human health is an urgent matter.

A doctor’s approach

We are doctors who care for our patients, and the planet that is their home. We wrote this book because we believe that humans are making changes to our environment that soon may become irreversible. We fully understand that the science of climate change is evolving as experts make more observations, perform more research, derive more data and do their best to make reasonable interpretations. The controversy is apparent, but the logic of preserving what we can and trying to avoid depletion of resources and immutable changes to our planet that will affect human health adversely are truths to us. We took a “doctor’s approach” because we believe we are facing a sick patient and we want emphatically to bring human health to the top of the discussion. We presume it is highly likely that humans are altering the environment in a way that causes global warming, widespread pollution, destruction of habitats and everything that comes with these. From that assumption come logical human health implications and you are entitled to know about them.

We care about you. If your chest was hurting, you couldn’t breathe and your pulse was undetectable, we wouldn’t sit still and ponder the situation. We’d do everything possible to make an accurate diagnosis and try to save your life. We’d act fast, because we know that moments count. Should we be any less concerned about our planet? The current situation in Glacier National Park is instructive. In our children’s lifetime, it may need to be renamed Glacier-less National Park. Does that matter? We believe it does.

We rely upon the science of others to understand predictions of global climate change, but we do not need others to explain the health effects that logically would be related because these are conditions we know. We treat them. The composite patients suffering from post-flood diarrhea, wildfire-induced shortness of breath and heatstroke-induced organ failure are the same cases seen every day in emergency departments and medical wards around the globe. Climate change will add to the burden of disease, and sooner or later it will affect people you know, and hundreds of millions you never have met.

Part of the problem to date with science communications on climate change has been failure to identify an immediate health threat. Without that stimulus, the imperative to change the way we live and consume our resources is not sufficient. Lacking a perfectly accurate crystal ball is an impediment for some to become engaged in this issue. We want everyone to form an opinion, and to act on their knowledge and conscience.

If you disagree with our premise, then learn and respond. Throwing up your hands in frustration over the futility of our future will not solve anything. Consider recent events. Fifty years ago, 42 percent of Americans smoked cigarettes. Although tobacco use was widely suspected to cause lung disease, the national per capita cigarette consumption had been on the rise since the 19th century. Medical scientists pointed out the hazards. However, the industry sponsored efforts to suppress the science about detrimental health effects. Such was the state of affairs that some physicians themselves became spokespersons about the benefits of cigarette smoking.

Today, only just over 17 percent of adults in the United States call themselves smokers. How did this change? For one thing, the financial cost of smoking became prohibitive (economics). Tobacco smoking was banned from public places (regulation). A relentless public health media campaign (medical science) made it impossible to ignore the fact that smoking causes major health risks (public opinion). Although this may not be precisely how to affect changing attitudes and behaviors regarding climate change, it clarifies two things. When effects from a behavioral pattern can be determined and linked to a negative economic or health risk profile, public behavior can change. Furthermore, seemingly insurmountable situations that require support of the masses can be overcome.

Throughout the book, Lemery and Auerbach explore health impacts of climate changes they say redefine “normal” with wet places becoming wetter and dry places becoming drier. In the western United States, that can mean longer wildfire seasons.

During peaks, smoke filled with gas and fine particles of building materials, vegetation and chemicals can travel thousands of miles, causing a host of maladies in its path that can linger for months. People in smoky areas commonly experience coughing, shortness of breath, sore throats, irritated eyes, runny noses and sinus pain. Symptoms can be especially severe for those with lung conditions, elderly people and children.

In the following excerpt, the authors tell a story that mirrors stories about recent Northern California fire victims. Tom and Sally live in a log cabin near Bend, Oregon. He had been a volunteer firefighter — they know how to prepare. When dry lightning sparks a blaze 5 miles away, they pack  to leave. Evacuating friends stop to check on them on their own way out. “We’ll be right behind you,” Tom replies. That is the last time their friends see them.

Not a lesser fire

The wall of fire came hard, fast, and unexpectedly from two directions. The inferno burned or melted everything in its path. By the time Tom realized that Sally was not responding to his shouts, she was face down in the backyard, crushed by a fallen tree limb. In less than five minutes, she was burned beyond recognition. In a desperate attempt to save himself, Tom quickly dug a shallow pit in the ground, knelt down and covered up with an old silver “space blanket.” In a lesser fire, this might have saved his life, but this was no lesser fire. The scalding air and flames made quick work of Tom, and destroyed his home and thousands of acres of surrounding forest. It was one of dozens of fires triggered by the same weather system, in a pattern that would be repeated more often as weather and fuel combined to create a perpetual fire hazard.

The authors continue: Extreme weather events are disruptive and almost always hazardous to human health.

From the perspective of those who need to decide whether to take actions that will diminish the likelihood of such events, it is mandatory to understand what they are, how many people they affect and what would be the benefit to humankind if we were able to cause them to be fewer, less intense and of shorter duration.

Knowing how to survive a wildfire or flood is not nearly as good as not having to endure them.