Should we be talking about the health impacts of climate change with our patients in the emergency department (ED)? Admittedly, this is a question I hadn’t considered until recently. Maybe I was being overly optimistic, but I always imagined entering into clinical practice and finding ways to discuss climate and health with my future patients. As I prepare to begin my residency at Henry Ford Wyandotte Hospital in metropolitan Detroit in July, the prospect of having these conversations in the busy ED seems almost jarring. However, behind the acute problems we encounter in the ED lie a set of chronic conditions and social determinants we should be addressing – and the health impacts of climate change are among them.
A Unique Challenge
In many ways the health impacts of climate change are elusive. We recognize patients who have diabetes or COPD, but generally only see these people in the ED when their symptoms become severe. Symptoms of chronic disease develop gradually, and major lifestyle changes are needed to prevent the disease from progressing. Unfortunately, the ED is not the place to manage these chronic conditions. Rather, it is where people are treated for an acute exacerbation of their chronic disease, then advised to follow up with their primary care physician. As a result, the discussions on how to manage or prevent these conditions is brief of non-existent.
So how can we find time to address the bigger picture? Climate change is an omnipresent influence, often unrecognizable to the untrained eye. It’s difficult to discern how to increase public awareness and understanding of this important environmental determinant of health because our time is already limited. In the ED, we give medications and suture lacerations, we order X-rays and blood tests, and we work with multiple patients simultaneously while awaiting the arrival of our next patients. Amidst all this, we do make time to have discussions, albeit brief, about the importance of self-care. For patients who are marginalized, or who lack access to regular healthcare or resources, we may even help them to find the services they need. So if we can make time for or recruit others to have these conversations with our patients, why can’t we also discuss the health impacts of climate change?
Making a Start
Maybe it’s time for us to think about climate change differently. Perhaps we should consider regarding the acute events precipitated by climate change, such as asthma exacerbations related to air pollution or heat stroke associated with rising temperatures, as integral to emergency care. If we do, it may be possible to have those brief conversations that inspire patients to start thinking about how the changing environment is directly (or indirectly) affecting their health.
As idealistic as all this sounds, there may be practical ways to go about it. A few emergency physicians I have spoken with have had success discussing the environmental impact of food choices or the role of air pollution in worsening asthma. While sharing information with their patients about the reduced cardiovascular disease risk associated with consuming less red meat, these physicians will also emphasize the benefits of a healthier diet on the natural environment through emissions reduction. Connecting our patients’ behaviors with the environment may be the most reasonable means for introducing the topic of climate change in the ED.
Given the time constraints experienced by most emergency physicians, there’s likely no practical way to sit down and have long conversations about the climate, or even discuss all of the ways that climate change is impacting health. Therefore, we must not forget that we can also have an important impact outside of the emergency department. We can easily raise awareness of environmental sustainability by promoting recycling and reducing waste. Many hospitals have “green teams” specifically charged with this task, and organizations like Practice Greenhealth partner with healthcare systems across the United States to encourage environmental stewardship through environmentally-conscious healthcare practices. These practices have been shown to reduce costs for the hospital while also lessening healthcare’s already substantial environmental impact. And increased awareness of and support for sustainability in hospitals may prompt the surrounding communities to adopt these behaviors as well.
As climate and health leaders we must share our knowledge with our colleagues. We must raise awareness of the rapidly changing climate by discussing the specific health impacts of climate change. As I prepare to enter medical residency, I hope to share my knowledge with my co-residents, my attending physicians, and the rest of the health care team. I hope to partner with my hospital’s green team to advance sustainable practices within the hospital. Most of all, I hope to develop ways to discuss the health impacts of climate change with my patients. I recognize that this will not be an easy task, but I am entering residency with the energy and the determination to make it happen.
Editor's Note: Climate for Health's "Let's Talk Health and Climate" guide provides helpful strategies for getting conversations going in clinical settings. Health care providers may also find our one-page climate and health Fact Sheets useful for this purpose. Written in collaboration with the American Public Health Association and supporting partners, they summarize the information presented in our 2016 "Making the Connection: Climate Changes Health" webinar series.
You may also be interested in reading the book Global Climate Change and Human Health, co-edited by our Leadership Circle member Jay Lemery. Dr. Lemery is an associate professor of emergency medicine at the University of Colorado; read his profile here.
Former Climate for Health intern Matthew Mueller graduated from Des Moines University Medical School in Iowa, where he received Doctor of Osteopathic Medicine (DO) and Master of Public Health (MPH) degrees. He will soon begin a residency in emergency medicine at Henry Ford Wyandotte Hospital in metropolitan Detroit, MI. In his spare time, he enjoys distance running.
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