In Virginia, a hospitalist cares for a woman in her fifties who worries how she will pay her bills. She remains hospitalized and debilitated by an acute asthma exacerbation from a pollen season that seems to arrive earlier every year.
In Montana, a physician is increasingly concerned about the risks of wildfire smoke to his patients with pulmonary and cardiovascular disease.
In Georgia, an internist treats a forty-year-old man suffering from heat exhaustion after spending the day hiking with his children on an unseasonably hot, fall day.
As general internists, we have begun to see the effects of climate change on the health of our patients in exam rooms and hospital wards throughout the country. Unfortunately, we may not realize the extent to which climate-related environmental stressors play a role in the health of our patients. After all, the connections between climate change and health are rarely taught in the medical school curriculum. Those who witness the negative impacts on patients may feel ill-equipped to address this risk factor because of time constraints, lack of knowledge about how to mitigate the risks, and concerns about bringing politically charged topics into the exam room.¹
But the science is clear.² Climate change harms the health of Americans in many ways, nationally and regionally.³ Longer and more intense pollen seasons, caused by the earlier onset of spring, later frost, and higher atmospheric carbon dioxide concentrations, exacerbate allergic and pulmonary diseases. Coastal communities are at increasing risk of storm damage, mold contamination, displacement, and disruption such as reduced access to health care. Warming water temperatures increase the risk of waterborne infections from Vibrio species and exposure to harmful algal blooms. Vulnerable patients in cities suffer disproportionately from the heat island effect due to the lack of tree canopy, resulting in greater risks for heat-related illnesses. Wildfires, already burning more acreage with increased intensity, affect thousands directly, and millions more through their smoke plumes.
As physicians on the frontlines of the climate crisis, it is our duty to address the root causes of our patients’ health concerns and to mitigate the associated health disparities and inequities through action beyond the exam room. In a 2016 position paper, the American College of Physicians recommends that the healthcare community “support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change.”¹
As general internists who have worked with other clinicians to create state-level climate health advocacy groups, we share information about how like-minded health professionals can engage in this work in their own communities.
Clinician-led, State-level Climate and Health Advocacy Groups
Virginia Clinicians for Climate Action (VCCA) was founded in 2017 with a mission to build a network of clinician leaders advocating for health through climate change solutions. VCCA works with other local environmental and health groups to advocate for policies that protect the health of our patients and help our communities mitigate the risks posed by climate change. With the passage of the landmark Virginia Clean Economy Act (VCEA) in 2020, Virginia became the first southern state to commit to 100% clean electricity by 2050 and joined the Regional Greenhouse Gas Initiative (RGGI) in 2021.
Another regional success includes the cancellation of the Atlantic Coast Pipeline project. VCCA joined environmental partners to oppose the construction of this natural gas pipeline, limiting new infrastructure for polluting fossil fuels. The cancellation was also a win for environmental justice, as plans for the pipeline included a compressor station in a historically African American community.
VCCA educated fellow clinicians across the state with conferences and webinars, and released a report in 2020 that assessed the health burdens of particulate matter 2.5 (PM2.5) from the transportation sector in Virginia and analyzed potential health benefits for clear car policies by year 2035. This data supports the advocacy for stronger transportation emission controls.
Montana Health Professionals for a Healthy Climate (Montana HPHC), a non-partisan organization, strives to overcome political and other barriers to climate action through education, increased awareness, and advocacy. Montana HPHC was formed in 2019 to give voice to healthcare professionals who are concerned about the threat climate change poses to their families and their patients and want to work for change, especially at the state-level. Montana HPHC members educate the public and elected officials about the implications of climate change and the many ways available to address it. All healthcare professionals, including environmental health professionals, climate scientists, public health officials, and others are welcome.
While many Montana healthcare professionals are concentrated in a few urban centers, a significant portion serve more rural areas. Montana HPHC provides a way for healthcare professionals, many of whom are isolated, to combine their expertise and concerns for their patients relative to climate change and convey those concerns to others. Elected officials, whether it be at the national, state, or local level, may listen to concerns from global or national organizations, but they really listen to matters important to their constituents.
Georgia Clinicians for Climate Action (GCCA) was founded in 2019 by physicians in Georgia with the following goals:
- educating health professionals about the climate risks facing patients throughout urban, rural, and coastal areas of Georgia;
- advocating for climate policies that protect the health of our patients and strengthen climate resiliency in the healthcare sector, and
- developing community partnerships to address climate justice for those most affected by climate change.
GCCA has used collective knowledge to educate local healthcare providers about Georgia-specific climate risks to the health of patients. Additionally, members have penned op-eds for local newspapers informing voters about healthy voting during the COVID-19 crises to elect leaders that will focus on climate and health.
Currently, 22 states across the country have clinician-led, climate and health advocacy organizations—most of which affiliated with the Medical Society Consortium on Climate and Health, a national organization focused on informing the public and policymakers about the harmful health effects of climate change. State groups are working to advance education of the public and healthcare sector while advocating for healthy climate policies within different political environs.
Beyond the care of individual patients, we have the power to educate voters and elected officials about the human health risks of climate change and to advocate for political solutions that protect our patients from the associated health harms. As part of preventive care, it is our responsibility to champion mitigation and adaptation strategies within our communities. State-level climate and health advocacy groups offer internists throughout the country an opportunity to learn more about the climate change-related health risks unique to our practice locations. These groups also allow us to amplify our voices and work within political systems unique to where we live, in order to promote policy change that can protect our patients.
As internists, climate change must be on our problem list. While not a disease, perhaps we should think of it as one given its harm to our patients’ wellbeing. Given our oath to do no harm, should we be quiet about a disease ravaging our patients’ lives, or should we be taking action to address the danger wherever we live and work? As long as the climate crisis affects our patients’ health, this, too, is our lane.
- Crowley RA. Health and Public Policy Committee of the American College of Physicians. Climate Change and Health: A Position Paper of the American College of Physicians. Ann Intern Med. 2016 May 3;164(9): 608-10. doi: 10.7326/M15-2766.
- USGCRP, 2018: Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II [Reidmiller, D.R., C.W. Avery, D.R. Easterling, K.E. Kunkel, K.L.M. Lewis, T.K. Maycock, and B.C. Stewart (eds.)]. U.S. Global Change Research Program, Washington, DC, USA, 1515 pp. doi: 10.7930/NCA4.2018.
- Watts N, Amann M, Arnell N, et al. The 2020 report of The Lancet countdown on health and climate change: responding to converging crises. Lancet. 2020 Dec 2:S0140-6736(20)32290-X. doi: 10.1016/S0140-6736(20)32290-X.
Advocacy, Clinical Practice, Health Policy & Advocacy, Medical Ethics, SGIM, Vulnerable Populations
Dr. Pathak (firstname.lastname@example.org) is an internist and a founding steering committee member of Georgia Clinicians for Climate Action. Dr. Wai (email@example.com) is a hospitalist physician, an associate professor of medicine at the UVA School of Medicine Inova Campus, a founding steering committee member of Virginia Clinicians for Climate Action, and a climate for health ambassador with ecoAmerica and Physicians for Social Responsibility. Dr. Byron (firstname.lastname@example.org) is an internist in rural Montana, a founding member of Montana Health Professionals for a Healthy Climate, and co-chair of the Citizens Climate Lobby Health Action Team.
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