When Hurricane Harvey hit Texas in 2017, emergency rooms were overwhelmed by patients with burns, cuts, bruises and broken bones. Other types of health problems showed up later on, says Dr. Adlia M. Ebeid, director of pharmacy services at San Jose Clinic in Houston, a “safety-net clinic” that helps underserved patients in the community access care.
After the storm, the clinic’s staff checked on families in the small town of Rosenberg, Texas. With up to two feet of water sitting in their houses, they’d started to develop mold and respiratory disorders. In response, the clinic sent in hundreds of inhalers. “I personally was surprised they did not realize the impact this [flooding] could have on them, their children and their health,” Ebied says.
The most obvious health effects of natural disasters are the immediate deaths, injuries and acute trauma addressed through emergency relief efforts. But climate change is making extreme weather events more frequent and intense. One consequence of this new normal is health complications, including respiratory, autoimmune and cardiovascular disorders that emerge after flood waters recede and wildfires fan out.
To help get ahead of and manage these lingering health issues, an expert-led movement wants to bring climate change into the exam room. The push is for doctors and other types of clinicians to start screening for climate change–related health risks during appointments, making sure that patients explicitly understand the role climate change plays in their health. “The stunning thing for me is that in 2021, we don’t have any guidelines for these clinics on how to keep their patients safe,” says Dr. Aaron Bernstein, interim director of the Center for Climate, Health and the Global Environment at the Harvard T.H. Chan School of Public Health. “That was not particularly OK in the past, but it’s certainly not OK now.”
Sick planet, sick people?
Natural disasters aren’t a new threat. But extreme weather events are becoming more frequent and severe. While numerous factors might contribute to a singular event, climate change is the driving force behind the larger pattern of supercharged wildfires, floods and heat waves. The “why” always comes back to rising temperatures. The earth’s surfaces (air and ocean) are getting warmer because fuel emissions are trapping more heat in the atmosphere. This phenomenon creates ideal conditions for extreme weather in numerous ways. Warmer air traps more moisture, priming hurricanes and other storms to produce heavier rain. Meanwhile, higher average temperatures fuel longer, more intense wildfire seasons in the Western U.S., including causing winter snow to melt sooner and leaving forests and soils drier, perfect for kindling.
Experts are working in real time to understand how extreme weather events cause a variety of long-term health impacts. The connection is clearer for some issues than others, says Mariel Fonteyn, associate director of emergency preparedness at Americares. Some lingering health consequences that can stem from a few types of extreme weather include:
- Extreme heat: A new study says around 5 million people die each year from exposure to abnormal temperatures caused by global warming. While more people still die from the cold, the study found cold-related deaths have decreased, while heat-related deaths have risen. Extreme heat can trigger symptom flare-ups for many chronic conditions, like multiple sclerosis and asthma. It can also cause dangerous short-term illnesses like heatstroke, which can result in long-term complications such as muscle damage and kidney and liver problems.
- Hurricanes: Post-storm environmental damage, such as water contamination and air pollution, can cause long-term impacts, including chronic illnesses like cardiovascular and respiratory diseases.
- Floods: As a side effect of heavy rainfall, hurricanes and tropical storms, floods are the most common natural disaster. Flooding can cause respiratory disorders, gastrointestinal and other bacterial infections, and diseases transmitted from rodents. It can also exacerbate chronic conditions, like asthma.
- Wildfires: Smoke from wildfires can be highly toxic, and can travel long distances. (Just this July, smoke from Oregon fires made its way all the way to Manhattan.) One 2018 fire produced smoke equivalent to “eight to 10 cigarettes.” Particles found in the smoke can exacerbate respiratory issues like asthma and chronic obstructive pulmonary disease. Inhaling these particles can increase your risk of a heart attack or stroke down the line. Research also suggests exposure for pregnant people could contribute to gestational diabetes and premature birth.
The psychological toll of extreme weather is well-documented. Just over half of adults and 45 percent of children experience depression after being in a natural disaster, according to the American Public Health Association; studies on specific storms support and flesh out these statistics. Merely thinking about the possibility of a climate emergency can cause distress; therapists say they’re seeing “pre-traumatic stress” more often.
Some climate change–related health issues aren’t necessarily tied to extreme weather events. Even short of bonafide heat waves, rising average temperatures can worsen air quality and increase the levels of pollen and other allergens in the air. As a result, people with asthma and allergies are prone to more intense flare-ups, and people who’ve never had allergies in the past might develop them.
Rising temperatures also help infectious mosquitos, ticks and other disease vectors thrive in previously inhospitable environments. The Wildlife Conservation Society warned climate change could worsen the spread of 12 diseases including yellow fever, bird flu and cholera.
Historically, nonemergency clinicians haven’t been overly involved in addressing health issues during and after natural disasters. Public health officials are in charge at disaster sites; they set up cooling and storm shelters, bring in mental health support and figure out how to get essential supplies like food, medical equipment and water to communities. Health-related emergency relief organizations, like Americares, which brings medical supplies to disaster zones, support these public health disaster relief responses.
“Emergency planning tends to focus on things like hurricanes and tornadoes, the big things that are on the news,” Fonteyn says. “We aren’t necessarily thinking about things like the increase in heart attacks due to heat waves.”
Our public health system focuses on health at the community and population levels. But climate change isn’t only a scourge on our collective well-being; it can also threaten our personal health. Bernstein thinks local clinicians are in a unique position to ensure the ongoing safety and well-being of individual patients. (FEMA, which is in charge of much of federal disaster preparedness, has even said that it needs help from private citizens and small communities in combating the health impacts of natural disasters.) As we deal with more and more extreme weather events, clinicians can monitor patients’ health issues throughout the year. In the case of something like a heat wave, they can call to check on patients long after pop-up cooling centers have been shut down.
However, clinicians aren’t necessarily trained to discuss climate change with patients. Even the suggestion that the topic falls under their purview is fairly new. In 2019, the American Medical Association called for climate change education in all medical schools, and just this year, a team of medical school professors proposed the first-ever set of climate curriculum guidelines.
“Clinicians spend our days working with individual patients, and we’ve heard little discussion of the implications of the climate crisis for our daily practice,” Dr. Renee N. Salas wrote in a 2020 op-ed in the New England Journal of Medicine.
A climate conundrum
Guidelines exist for most things that doctors do in the exam room, but if they want to incorporate climate-change education into care, they’re largely on their own. To fill this gap, Bernstein and his team at Harvard are creating resources based on the needs of the San Jose Clinic through a pilot project focused on climate resiliency.
For this project, researchers are also talking to clinics in other disaster-prone areas. All the clinics are federally qualified health centers, which receive government funding to deliver high-quality care to underserved communities. “The providers at these clinics are just really, really busy,” Fonteyn says. “A lot of them haven’t had the opportunity to sit down and consider that these issues that they’re seeing are related to climate change and where those connections are.”
Ideas for helpful resources are still “on the sketch pad,” but researchers have already noticed a few areas for improvement, Bernstein says. The team hopes to curate screening checklists to assess patients’ vulnerability to extreme weather events, as well as disease management plans for patients and healthcare providers ahead of events.
For clinicians in underserved, disaster-prone communities, helping patients manage chronic illnesses like diabetes, hypertension and high cholesterol is often top of mind. Abeid says conversations about preventive care are really important for these patients, who might also need to keep certain medications on hand in case of emergency. “If these patients go untreated for a certain period of time, they will most likely end up in the hospital with a heart attack or a stroke,” she says.
The pandemic has also made technology a regular part of routine care, and the Harvard team thinks it can be a useful tool for clinicians ahead of natural disasters. For example, if a doctor sees a heat wave on the horizon, they could virtually alert their patients to take certain precautions based on their health histories.
Just as the pandemic changed healthcare as we know it, Bernstein and his team are confident that climate change is already testing our limits. Once the Climate Resilience Project wraps up, they hope to apply their findings to other healthcare centers around the country.
“When no one has touched an area, there’s a great opportunity to make a difference,” Bernstein says. “I don’t know if we will make a difference, but we at least have to try.”