by Victoria Leytin, MD
Assistant Professor of Emergency Medicine, Clinical Educator
As emergency physicians, we are expected to expertly treat anyone that walks, stumbles or is wheeled through our doors. We are trained to expect the unexpected and resuscitate the sick, and fix the broken. Because we stand on the from lines of the healthcare system, we must be prepared to manage the evolving distributions of disease and injury brought on by climate change. Emergency physicians are uniquely positioned to be advocates for our patients and our planet.
Climate change is truly the existential crisis of our time. The planet is already 1º warmer than pre-industrial levels. The past four years have been the hottest on record, with 2019 having been the second hottest year ever recorded. Rhode Island bears the unfortunate distinction of being the first U.S. state to reach 2ºC of warming (though our New England neighbors are not far behind.) Rhode Island’s heat waves have become longer and hotter each year, our winters too warm to kill the ever present ticks, our levels of pollutants, allergens and particulate concentrations in the air are rising. According to recent reports from the Lancet, as well as the IPCC and US Climate Assessment, we know that climate change has directly resulted in human suffering and death. This is our reality. Our current reality, not a nebulous and dystopian future. Climate change is displacing communities, destroying homes and infrastructure, harming public health, and burdening our economy. Climate refugees are exponentially increasing in numbers. The 11 foot rise in sea level predicted by 2100 will wipe out our coastal communities and resources that Rhode Islanders depend on for life and livelihood.
It would impossible to be a practicing physician in Rhode Island without treating “bad air day” illnesses such as asthma and COPD, heat exhaustion, MI, or stroke. A study out of Brown University from 2015 found that Emergency Department visits increase significantly as temperature rises. The WHO (World Health Organization) has called pollution “the invisible killer”, estimating that it is responsible for more than a quarter of heart attacks and more than a Many vector borne diseases are spreading well beyond their historical areas of distribution. Particulate matter has been implicated in increased rates of neurodegenerative diseases, chronic renal failure, obesity, psychiatric disease and all cause mortality. These health risks posed by climate change are not evenly distributed among the population: age, economic resources, race, and location determine risk exposure, exacerbating already existing health inequities.
As the planet warms causing the climate to destabilize, what had previously been seen as hundred-year events have become commonplace, affecting huge swaths of our densely packed population. The past decades have seen a staggering rise in the number and force of storms and the tendency toward temperature extremes, putting many geographic areas at risk and making others uninhabitable. The current fires in Australia have killed more than 800 million animals (excluding insects, bats and frogs) and burned areas the size of New Hampshire and Vermont. In Rhode Island we have felt the force of storm and flood, heat and frost, and through luck alone, have avoided a direct hit by a superstorm such as Sandy.
To be a physician means to be an advocate for health and wellbeing, to cure illness when we are able, and to prevent or mitigate that which we cannot cure. The recent IPCC report emphasizes that emissions must be cut in half by 2030 if we have any hope of keeping warming below 1.5ºC. Instead last year we saw global fossil fuel emissions rise once more, continuing our frenzied path toward a catastrophic 4ºC rise by 2100. Neither the general public, nor medical professionals can afford to wait any longer. The health costs of climate change are rising exponentially and will be felt by all, with communities of color and low income populations being disproportionately affected.
The healthcare industry bears a great deal of responsibility as one of the top drivers of worldwide climate change. According to a 2019 report from Healthcare Without Harm, if the healthcare sector were a country, it would be the 5th largest emitter of greenhouse gases in the world, and the United States is the world’s largest emitter of healthcare greenhouse gases. Therefore it falls to us as American healthcare professionals to take action on this issue within our respective workplaces, healthcare systems, and states. Organizations such as Healthcare Without Harm and Practice Greenhealth, Physicians for Social Responsibility, and the Medical Society Consortium on Climate Changes are focused on sustainability within the medical system.
The image of climate change is no longer a starving polar bear on a melting iceberg; instead it is a child struggling to breathe in the Emergency Department resuscitation bay. Though individual actions to reduce one’s carbon footprint, such as reducing consumption of red meat or limiting airplane travel, are wide ranging and important they cannot achieve the necessary results without societal action and aggressive policy change. As trusted messengers, physicians must take up the call and advocate for laws and policies that move us away from an economy driven by fossil fuels to one sustained by clean and renewable energy. Already three times as many Americans work in clean energy jobs than in the fossil fuel industry. Still, we are burning massive amounts of these polluting sources of energy, and even allowing our lawmakers in Washington D.C. to remove protections of our water and air.
Despite having the natural resources and workforce to be able to lead in the fight against climate change, Rhode Island has been lagging behind neighboring states. This month the Act on Climate bill (H7399 and S2165) was introduced in the legislature, with the goal of setting enforceable and aggressive emission reducing targets throughout the entire economy – including the health care industry. We must be present as a sea of white coats at climate events and to support legislation such as the Act on Climate bill which promotes keeping fossil fuels in the ground and reducing carbon emissions. We must voice support for sustainability efforts and stand with those individuals who are working to bring such changes forward on both a local and national scale. We call on you, the front line providers of Rhode Island, to join us in standing up to this crisis together.
 IPCC. 2018 Global warming of 1.5C. An IPCC Special Report on the impacts of global warming of 1.5C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change. World Meteorological organziation, Geneva, Switzerland.
 US Global Change Research Program Fourth National Climate Assessment
 Wellenius G et al. Heath-related morbidity and mortality in New England: evidence for local policy. Environ Research 2017;156:845-853
 Chuang et al. 2018 Particulate air pollution and neurological diseases: The role of tauopathies. Environ Dis 2018;3:4-7
 Chan et al. Long-term Exposure to Ambient Fine Particulate Matter and Chronic Kidney Disease: A Cohort Study. Environ Health Pers 2018:126:10
 IPCC. 2018 Global warming of 1.5C. An IPCC Special Report on the impacts of global warming of 1.5C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change. World Meteorological organziation, Geneva, Switzerland
 Karliner, J and Slotterback, S. Health Care’ Climate Footprint: How the health decontrol contributes to the global climate crisis and opportunities for action. Health Care Without Harm 2019 https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf