She had walked into the office the last time I’d seen her. Now, she entered in a wheelchair. Her cane dangled dejectedly off the side. Gaudy gemstones and Frozen stickers crowded every square inch, evidence of her daughter’s industrious attempt to bedazzle her Momma’s new “accessory.” She was 30, a mother of two, and trying desperately to protect her girls from her personal reckoning with newfound disability. So her girls decorated her cane and they named it “Olaf” and they didn’t talk too much about the multiple sclerosis. Then, during a particularly hot summer, her symptoms recurred and she started having trouble walking with Olaf alone. The heat persisted and she struggled to regain the ability to walk. The spasticity in her legs eventually became too painful to function in her everyday life. She was referred to neurosurgery for intervention: a surgery to implant a pump system in her spine to deliver spasticity-relieving medication to her legs. And while the surgery would potentially improve her spasms, she understood that it might not help her to walk again and came with the risk of significant complications. Feeling she had few options at this stage in her disease process, she proceeded with surgery, hopeful that her young children could learn to adapt to yet another “accessory.”
For weeks, his eyesight would go out on one side before spontaneously recovering. It wasn’t painful so he didn’t pay it much attention. His construction job was in full swing, making it hard to take time off anyways. In the preceding days, he’d been on the job for long hours in an industrial park: an area known for poor air quality and elevated air pollution levels from fossil fuel burning processes. In fact, over the years in his line of work, he’d often spent long days outside regardless of air quality and pollution levels. Then, one day, his vision went out like a shade coming down over the world. And it didn’t come back. He finished his work day before heading to the emergency room, worried that he wouldn’t get paid. The workup showed a severely narrowed carotid artery in his neck from an atherosclerotic plaque. The plaque was showering his brain with tiny clots, causing strokes from blood flood disruption, including in the artery to his eye. Forty-two and he was permanently blind on one side now. What’s more, the neurosurgeon told him he needed surgery to remove the plaque from his carotid artery, restore blood flow, and prevent further strokes. With his new visual impairment, he couldn’t keep his job. His partner didn’t make enough money to cover their mortgage, car payment, and now medical bills. Forty-two and he felt like he was starting all over.
These are just a few examples of neurosurgical patients whose lives have been forever altered from climate-related changes. More and more, we’re seeing global changes that impact neurosurgical conditions. There is general consensus in the scientific community that greenhouse gas (GHG) emissions from human activity-related fossil fuel combustion are causing the global warming crisis. (1) Global warming is not only causing dangerously increased surface temperatures, it’s also increasing frequency and intensity of extreme weather such as hurricanes and heat waves with implications for the health of human populations. Multiple sclerosis (MS) is an auto-immune disease in which a patient’s immune system mistakenly attacks the protective sheath surrounding nerve cells, thereby causing nerve misfiring and dysfunction. MS predominantly affects women in their 20s-50s, with resultant disability from symptoms including fatigue, double vision, muscle weakness, sensory changes, and spasticity. Sixty-80% of patients experience heat stress-induced exacerbations and/or triggering of their symptoms. (2) Several studies have demonstrated connections between worsening MS symptomatology, anomalous warm days, and increases in temperature by as little as a few degrees Fahrenheit. (3) As global warming causes increased heat waves and weather fluctuations, MS patients may experience greater difficulty controlling their symptoms, with the potential for more patients requiring neurosurgical interventions for disabling disease.
In addition to worsening heat waves, fossil fuel burning has a devastating impact on cardiovascular and cerebrovascular health. Fossil fuel combustion is the major cause of worsening air quality and increasing air pollution because its combustion releases tiny particles, called PM2.5. This particulate matter penetrates deep into the lungs when inhaled, passes into the blood stream, and enters into the brain. (4–7) Both long and short-term exposure have been linked to premature death from heart, lung, and neurologic disease, to name a few. (5–8) Recently, in 2020, over 1.6 million deaths were attributed fossil fuel combustion-related PM2.5 exposure. (9) Studies also show that PM2.5 increases the risk of atherosclerosis and stroke. Scientists believe that this is due to the body’s pro-inflammatory response to particulate matter in the brain’s blood vessels, which results in accelerated plaque build-up. (10,11) To make matters worse, the risk of PM2.5 exposure and subsequent chronic disease disproportionately impacts marginalized populations who are already at increased risk of suffering from poor health. These vulnerable populations include racial/ethnic minorities, the elderly, indigenous peoples, children, and communities with low socioeconomic status. (12–16) Thus, these communities are subjected to higher rates of PM2.5 exposure which, in the setting of pre-existing health disparities, result in our most vulnerable patients suffering a disproportionate burden of illness without recourse. (17)
Neurosurgeons frequently perform surgeries to treat the cerebrovascular disease that results from PM2.5 exposure. We implant spinal cord pumps to alleviate the painful spasticity associated with MS. We remove plaque from the carotid arteries in the neck to prevent stroke. We perform emergency surgeries to extract ruptured plaques lodged in the brain’s major vessels to restore blood flow and reverse strokes. And, unfortunately, we often operate on young patients whose strokes are so devastating that the diseased brain swells beyond the confines of their skull. While these interventions may benefit our individual patients, the warming climate and persistent reliance on fossil fuels will continue contributing to diseases that neurosurgeons are called upon to treat.
Neurosurgery is just one example of climate change’s impact on subspecialty healthcare – climate change is the most consequential public health crisis of our time. Engaging in climate solutions – communicating with patients, colleagues, and policy-makers – is essential to drive the systemic change we need to protect the health of our patients.
About the Author
Rebecca Achey, MD is a neurosurgery resident and a Climate and Health Science Policy Fellow at the University of Colorado. She is currently at the Cleveland Clinic where she is in training to become a neurosurgeon with subspecialty interest in cerebrovascular and endovascular techniques. She is actively trying to bring the climate change and human health fight to surgical specialties with a particular interest in climate change’s disproportionate impact on cerebrovascular diseases in our most vulnerable communities.
- Mukherji, A. et al. SYNTHESIS REPORT OF THE IPCC SIXTH ASSESSMENT REPORT (AR6).
- Chacko, G., Patel, S., Galor, A. & Kumar, N. Heat Exposure and Multiple Sclerosis—A Regional and Temporal Analysis. Int. J. Environ. Res. Public. Health 18, 5962 (2021).
- Louis, S. et al. Impacts of Climate Change and Air Pollution on Neurologic Health, Disease, and Practice: A Scoping Review. Neurology 10.1212/WNL.0000000000201630 (2022) doi:10.1212/WNL.0000000000201630.
- Manisalidis, I., Stavropoulou, E., Stavropoulos, A. & Bezirtzoglou, E. Environmental and Health Impacts of Air Pollution: A Review. Front. Public Health 8, 14 (2020).
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- Miller, K. A. et al. Long-Term Exposure to Air Pollution and Incidence of Cardiovascular Events in Women. N. Engl. J. Med. 356, 447–458 (2007).
- Wei, Y. et al. Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study. BMJ 367, l6258 (2019).
- Romanello, M. et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. The Lancet 0, (2022).
- Lin, H. et al. Ambient PM2.5 and Stroke. Stroke 48, 1191–1197 (2017).
- Chen, Z., Liu, P., Xia, X., Wang, L. & Li, X. The underlying mechanism of PM2.5-induced ischemic stroke. Environ. Pollut. Barking Essex 1987 310, 119827 (2022).
- Khraishah, H. et al. Climate change and cardiovascular disease: implications for global health. Nat. Rev. Cardiol. 19, 798–812 (2022).
- Tessum, C. W. et al. PM2.5 polluters disproportionately and systemically affect people of color in the United States. Sci. Adv. 7, eabf4491 (2021).
- Motairek, I. et al. Historical Neighborhood Redlining and Contemporary Cardiometabolic Risk. J. Am. Coll. Cardiol. 80, 171–175 (2022).
- Mohai, P. & Saha, R. Which came first, people or pollution? A review of theory and evidence from longitudinal environmental justice studies. Environ. Res. Lett. 10, 125011 (2015).
- Brender, J. D., Maantay, J. A. & Chakraborty, J. Residential proximity to environmental hazards and adverse health outcomes. Am. J. Public Health 101 Suppl 1, S37-52 (2011).
- Hajat, A., Hsia, C. & O’Neill, M. S. Socioeconomic Disparities and Air Pollution Exposure: a Global Review. Curr. Environ. Health Rep. 2, 440–450 (2015).
“Don’t go outside without bug spray! Mosquito-borne illnesses can cause bad diseases like West-Nile encephalitis and other brain infections. What’s worse, we’re seeing mosquitos spread farther and stick around longer these days because of the warming climate. You can learn more about how to protect your health in a changing climate by scanning this badge.”
“We’re seeing more and more patients come in with brain attacks (strokes) during heat waves because of how extreme heat impacts brain vessel health. Climate change is making heat waves more common so you want to stay on top of your hydration and be sure to check the weather regularly! You can learn more about how to protect your health in a changing climate by scanning this badge.”
“I recently had a patient in their forties come to the hospital with a major stroke, leaving them with severe, life-long disabilities. It turns out, their neighborhood is right next to an industrial complex whose processes run on fossil fuels. The air pollution released from these plants when they burn fossil fuels is worsening air quality in that patient’s neighborhood and other surrounding areas. Like in my patient, the fossil fuel-related air pollution and poor air quality cause major health problems such as asthma attacks, heart attacks, and even strokes. As we continue to burn fossil fuel, and the climate continues to change as a result, we’ll see more neighborhoods, like my patient’s, with severe air pollution, poor air quality, and resultant debilitating diseases. You can learn more about how to protect your health in a changing climate by scanning this badge.”
“Climate change is negatively impacting human health in surprising ways. For instance, increasing CO2 levels and the subsequent warming climate are decreasing the nutritional content in our foods. Researchers at Harvard found that staple foods such as wheat, corn, rice, and soy lose 5-10% of their zinc, iron, and protein when grown in elevated CO2 environments. That means less zinc to support a healthy immune system, less iron for sufficient red blood cell production, and less protein for muscle-building. That means it’s even more important nowadays to pay attention to what you’re eating. You can learn more about how to protect your health in a changing climate by scanning this badge.”