Clinician’s Corner

Clinicians are on the front lines of planetary health. They care for individuals already impacted by climate change and other problems generated by burning fossil fuels, such as air pollution.

There are steps clinicians can take to improve the quality of care of their patients through education and providing resources.

Contents

Make health care more sustainable

Health care produces 4.6% of global greenhouse gas emissions, but 8.5% of the emissions produced in the United States, where it also generates 5 million tons of waste each year!

Many clinicians in the United States are engaged in the issue of climate change and sustainability. A 2023 survey of 1001 clinicians indicated that 4 out of 5 American healthcare workers want their employers to act on climate change, and 3 out of 4 wanted to work on the issue both at home and at work. They responded that a majority of healthcare institutions have made strides toward increasing energy efficiency, sustainability, and addressing emissions, or were planning to do so in the next one to three years. As clinicians we can encourage our institutions in those efforts and to follow up on their plans!

Ophthalmology has been a leader (but not alone!) in sustainable health care, particularly in the operating room. Anesthesiologists, for example, have been active in being aware that some of the gases they use for anesthesia are potent greenhouse gases, and there are often alternatives. The podcast series Be the Change from the Global Consortium of Climate Health Education is concerned with medical sustainability and has an excellent episode about the Aravind Eye Care system in India and sustainability. At Aravind they can try strategies that aren’t possible in the west due to the nature of current regulations. However, it is “proof of principle” that there is room for improvements in the carbon footprint in eye surgery that do not negatively impact patient safety and outcomes.

This presentation was given on 9/22/22 through the Global Consortium on Climate Change and Health Education as part of their grand rounds series, available here. They discuss legislative efforts that are relevant to all specialties that perform procedures.

The Medical Society Consortium on Climate Change and Health is comprised of many medical specialty societies and is a great resource.

Health Care Without Harm is about “the global movement for environmentally responsible health care.” Something healthcare professionals could have a voice in.

Practice Greenhealth is a useful site that comes highly recommended, but full access requires a membership. Many institutions are members, so clinicians may be able to access it through their hospital or medical center.

My Green Doctor is designed to help medical office teams, including both clinicians and non-clinician personnel, to get involved in a self-guided program of making the practice green. There are free medical education credits, informational workbooks with links, and brochures for patients. There is a Spanish language version of the website.

Climate Action Nurses is a group out of Australia. They have a quarterly online quarterly zine. Very informative, with an emphasis on sustainable healthcare.

A handout for nurses was developed by Kasey Bellegarde, a registered nurse and graduate student at the University of Minnesota School of Nursing, guided by Dr. Paul West, Senior Scientist at Project Drawdown. It has a lot of information and like the quarterly zine of Climate Action Nurses, it is of interest to all health professionals. The link is to the school’s planetary health page, which has a lot of great material.

A statement with great citations on the global perspective regarding the issue of medical carbon was published in the comment section of Lancet, May 31, 2023: Momentum Builds For Health Care Action (the article is free if you sign in).

The Centers for Medicare and Medicaid Services (CMS) has proposed collecting, monitoring, assessing, and addressing hospital emissions. It will be a voluntary program called the TEAM Decarbonization and Resilience Initiative.

The National Academy of Medicine has resources that are very helpful. They also have an initiative to “accelerate the national climate and health movement.”

Educate yourself and others

On October 25, 2023, 200 medical journals published the editorial “Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency.” It is short and worth reading. You can read it in full on this site as a news post or from the Journal of the American Medical Association.

You do not have to be an expert on environmental issues, but knowledge is power. It is good to have enough information to be helpful.

As a way to get started or review, see the brief discussions on relevant topics on this website and the resources in them for additional information (see our “Summarising the science” section, which has essays on air pollution, infections, heat, and many others)
See the annotated bibliography for relevant materials, specifically this section on planetary health
See websites and groups that interest you and have information you need
See the section on what you can do now
There are many resources throughout this page and in the Additional resources at the bottom of this page.

Upcoming meetings, webinars and short courses:
- In “Washington, DC from March 2-4, 2025, for Our Planet, Our Health: 2025 Climate Action Convention, one of the largest events ever focused on planetary health and climate action…Hosted at the National Academy of Sciences on March 2-3 and the John Hopkins Bloomberg Center on March 4, this pivotal gathering will bring together leaders, experts, and advocates committed to driving progress toward a healthier, more sustainable, and just future. Through a series of dynamic sessions — offered in person and online — we will examine the state of our planet’s health and the necessary steps to achieve a sustainable future. Attendees will gain insights into cutting-edge research on the links between ecological drivers and health outcomes, explore strategies for building resilience and equity in the face of climate challenges, and learn how to meaningfully drive policy change.”
- While this course is over, there is a link to the YouTube videos through this link: Climate Change, Migration, and Health in Latin America and the Caribbean. Global Consortium on Climate and Health Education (GCCHE). Webinar. A five session series that will occur every two months on the first Tuesday, March 5 through November 5, 2024. Spanish and English interpretation. “This webinar series will bring together scholars, practitioners and community organizations to exchange scientific knowledge, share lived experiences and discuss efforts to address myriad health issues facing populations on the move in a changing climate across the Americas.” Register for free.
  The GCCHE has ongoing events and educational opportunities and they make courses available on their website.
- The Global Consortium on Climate Health Education (GCCHE) is presenting a virtual/online course in climate change impacts for nurses: “Nursing on the Frontlines of the Climate Crisis: Education for Action.”
  There will be 10 sessions on Tuesdays 12-1 PM Eastern Time from Oct 1 2024 to December 3 2024.
  “The goal of this course is to equip nurses globally with the knowledge and tools needed to prepare for local and global health-related impacts of a changing climate. This 10-session virtual course is intended for a global audience of nursing practitioners, educators and students. Lectures will be delivered by local and global nursing professionals with expertise in the field. We welcome you to join us!”
  A certificate is available.
  Contact: Haley Campbell Email: hec2141@columbia.edu
  Here is the link to the Website
- The Global Consortium on Climate Health Education (GCCHE) is presenting a virtual/online course on the climate change impact of the health care system “European Climate Resilient Health Systems Course” on Tuesdays, January 28 through April 8, 2025.
  “This course will cover essential topics, including the need to decarbonize healthcare, the effects of climate change on health systems, and examine strategies to protect and support healthcare services and staff and strengthen climate justice. Lectures will be delivered by local and global professionals with expertise in the field. Video recordings will be available for asynchronous viewing.”
  it is a free certificate-based course. For more information contact DM3952@COLUMBIA.EDU
- The Medical Society Consortium on Climate & Health is offering a 6-part climate communications training series on Tuesdays, from June 4, 2024 through August 20, 2024, 3 PM ET. It builds on their series last year, which is available on line. Session recordings can be found here.
- This years offerings:
  Communications 101: How to Make the Case About Climate Change, Health & Equity
  Effective Presentations: Crafting a One, Three or Five Minute Stump Speech on Climate and Health
  2.0 Rules of the Road for Engaging With Policymakers
  Op-ed “Office Hours”
  2.0 Weighing in on Public Discourse: How to Discuss the Impacts of Fossil Fuels on Health
  Coalition Building: Engaging Partners in Your Advocacy.
- The Medical Society Consortium on Climate & Health website maintains a page on upcoming educational opportunities, including webinars and some with continuing medical education credits. Their monthly Climate and Health Equity Webinar Series offers continuing medical education credits. Their 2025 annual meeting is February 28-March 4, 2025. It will be in person and on Zoom, and continuing medical education credits will be available.
- Cafe climate and health out of TH Chan School of Public Health, Harvard and BU School of Public Health have webinars. Their events page has details and is a resource for upcoming events.
- A one hour course with continuing education credit on Climate Change and Vector-Borne Disease: Exploring the Impact on Disease Epidemiology, Emerging Pathogens, and Clinical Preparedness is available on line until January 3, 2025. “This accredited continuing education activity is designed for frontline workers, physicians, nurses, and infection preventionists.”
- The Journal of the American Medical Association started a series on Climate Change And Health and continuing medical education is available.
- The University of Colorado School of Medicine has a 250-hour Diploma in Climate Medicine. It “is designed for healthcare clinicians looking to build expertise at the nexus of climate change and health. Climate Diplomates are change agents prepared to lead climate resilience efforts across organizations, communities, and at state levels. The Diploma consists of five distinct one-week Certificates covering: Foundations in Climate Medicine, Sustainable Healthcare, Disaster Resilience and Response, Community Resilience, and Global Challenges. For detailed course information and enrollment, please click here… We are accepting applications on a rolling basis and are currently enrolling all five Certificates.”
- Project ECHO Climate Change and Human Health has presentations that include CME. They are on hiatus for the summer of 2024 but plan on a new series in the fall. You can get on their email list for updates.
- The Global Consortium on Climate and Health Education is having a free certificate course: ‘Africa Climate And Health Responder Course’ with two sessions each week from September 17, 2024 through October 22, 2024. “All professionals interested in climate and health are welcome!" The GCCHE will make recordings of all sessions available.
- Michigan State University is offering a one hour CME course on PFAS . It is available to view without registering for CME on YouTube.
- Here are some free courses and short presentations about health and climate change, air and plastic pollution geared for clinicians if you want more background. Continuing medical education credits are not available unfortunately, but these may give you the background you need, and help you feel more confident giving presentations and getting involved in other ways,
  
  Human Health and Climate Change from the World Health Organization and the United Nations Institute for Training and Research. It takes about two hours. You can get a certificate if you pass the quiz.
  
  The Health Effects of Climate Change from Harvard University hosted by the site edX. You can audit for free or participate fully and get a certificate for $229.
  Air.gov has modules on the health effects of air pollution for health professionals, including wildfires, particulates and ozone. They also have information you can use as handouts for patients in English and Spanish!
  
  The American Geosciences Institute has a one-hour presentation from October 15, 2024, Plastics in the Environment and Human Health that is available on YouTube.

Give presentations

Healthcare professionals are trusted on these issues and have a potentially large role to play. For an excellent overview see Maibach E, Frumkin H, Ahdoot S, Health professionals and the Climate Crisis: Trusted Voices, Essential Roles. World Medical and Health Policy-Wiley Online Library (2021).

And that trust is increasing:

Presentations can be given to other healthcare professionals (we need more with continuing medical education credits), or government officials (see also presentations).

You can offer a talk designed for patients in your practice or clinic, nursing homes, the local hospital, or community groups, particularly those dedicated to diseases like diabetes, pulmonary or heart disease, that put patients at high risk from heat, poor air quality, or other environmental challenges.

Your expertise and experience can be useful for presentations to policymakers and legislators, or at open hearings where the health impacts of government regulations or legislation are being discussed.

the World Health Organization has a document “Communicating on climate change and health Toolkit for health professionals” you can download.

Incorporate climate into health curricula

If you are involved in medical education, consider giving grand rounds or advocating for planetary health and related topics being included in the medical curriculum. The Climate Resources for Health Education (CRHE) is another valuable resource from the Global Consortium on Climate and Health Education (GCCHE). From the website: “Climate Resources for Health Education ... is a global health professional-led initiative that aims to provide free, publicly accessible, evidence-based resources to accelerate the incorporation of climate change and planetary health information into educational curricula.” The GCCHE also offers monthly “Climate and Planetary Health Office Hours,” consultations if you have questions about incorporating material into your curriculum. “Join us for "Climate and Planetary Health Office Hours" to discuss your practical, administrative, and conceptual challenges to integrating curriculum at your institution, receive personalized support, and grow your collegial network.” You can find the schedule and other opportunities at their “Events and Opportunities” page under “upcoming events” or register here.

See also below under Additional resources at the bottom of this page.

Consider adding specific questions to the medical history or review of systems (ROS) forms you use

There are environmental health questionnaires for patients but they are several pages long and more detailed than most clinicians and their patients can manage. This doesn’t need to be a burden or time consuming, perhaps just add some targeted questions.

You probably already have the patient’s employment history, disease history, mobility issues and medications, and you may have some information about other activities such as sports and outdoor recreation.

Simply asking about these matters points out to patients that they should prepare for heat waves and extreme weather events or wildfires that may occur in their area.

In addition to the usual questions about risk factors that you are already asking about, such as age, depression or other mental health issues, diabetes, cardiovascular and pulmonary disease, allergies and asthma, consider asking (either in person or in a questionnaire):

Are you prepared for very hot days? Would you like to know more?
Do you know how to find out what the air quality is?
Do you work or do other activities (sports, gardening, hiking) outside, in the sun?
Regional factors may be relevant; for example:
In the northeastern United States, the tick that is the disease vector for Lyme disease is now found further north than previously.
In areas of flooding or wildfires, ask if they have an emergency plan, basic supplies and first aid, and having some contact/educational information on hand may be appropriate. A handout can be very useful.
Social and economic factors are important in specific cases.
Where do they live? What is the local environment? For example, in Los Angeles County different parts of the county can vary from cool, breezy and overcast near the ocean to 15 degrees F warmer with glaring sun further inland, at the same time. Add to that the effects of urban heat islands in some areas.
Do they have air conditioning if needed? Can they pay the electric bill?
Where do they work? Is it outside? Are there alternatives on hot days? Do they work with toxins, for example, pesticides? The EPA has a data base with “information on pesticide-related incidents”
What is their commute?
Are there toxic exposures near where they live or work (highways, factories, oil wells or refineries, which have been associated with an increased risk of cancer and other adverse health effects)?
In emergencies such as wildfires, floods and storms, do they have transportation or mobility issues?

On the other hand, these may not be areas a clinician feels qualified to intervene, and may not be something he or she can intervene in.

Where one lives and the type of work one does can be sensitive areas, and can be determined in part by problems like poverty and immigration status, that a clinician can’t make go away.

It is unlikely that telling an individual to move out of an urban heat island will be helpful in a clinic visit. There are many factors that go into where someone lives.

Similarly, someone dependent on commuting for employment and being exposed to more pollution may have no practical choice.

Still, it is important not to discount your ability to help.

We get busy and overwhelmed by pressing issues with our patients, so we need to be efficient. Look out for those who need and want more information and who would like to know what help might be available!

If possible, know what local social services may be available. Having social service and city or county services’ contact information ready as part of a handout on heat, or disaster preparedness, or pollution and disease, could be useful.

There are multiple industrial and other sources of toxic exposures. These can include nearby factories, oil refineries or oil wells (active or not). An example of a common toxin has been gaining in awareness is PFAS “forever chemicals” that have extremely long half lives. The group of PFAS consists of over 12,000 different chemicals, and are found in many products. It was reported in January 2023 that they are found in surprisingly high levels in locally caught freshwater fish in the United States! It would be appropriate to inform patients not to eat locally caught freshwater fish, at least in the continental US, and likely, at least by the Great Lakes, in Canada. PFAS have been associated with increased risk for several cancers, birth defects, lower response to vaccines, thyroid disease, and other health problems. It is unclear what the role for blood testing is, which won’t detect all PFAS, but if a patient has a known exposure risk, for example, a firefighter or anyone in an industry that uses or produces these chemicals, or a pregnant woman who may have more than usual exposures (PFAS pass the placental barrier to the fetus and into breast milk), it may help in giving guidance on avoiding additional exposures. An important point is that blood testing won’t clarify whether the systemic PFAS caused a specific disease in a given patient, whatever the blood levels.

If you have patients at high risk, for example pregnant women or those with high PFAS exposure (workers in fields that use PFAS) or known elevated blood levels, or maybe even if there are infants or young children at home (these chemicals last decades at least in the body and have potential developmental effects) there are home water filters that be effective. Suggestions from Consumer Reports (CR; while behind a paywall CR does have very relevant additional information):

“Most people on municipal water who pay their own bill should receive an annual water quality report called a CCR, or Consumer Confidence Report. If you don’t receive yours, call your local water supplier. And if you rent, contact your landlord

“Systems with 100,000 or more people must also post reports online. You can find them on the Environmental Protection Agency website.

“For questions, call your local supplier or the EPA’s Safe Drinking Water Hotline at 800-426-4791.

“To remove a specific contaminant like PFAS from drinking water, consumers should choose a water filtration device that is independently certified to remove that contaminant by a recognized lab,” says Jim Nanni, associate director of appliance testing at CR.

“Reputable third-party testing organizations include the National Sanitation Foundation (NSF), Water Quality Association (WQA), International Association of Plumbing & Mechanical Officials (IAPMO), UL Solutions, CSA Group, and Intertek (ETL). NSF, WQA, and IAPMO enable you to search for certified products on their websites. Certified products will also bear a seal from the testing organization that identifies which contaminants it’s certified to reduce. For a filter that can remove PFAS, look for one with the code NSF/ANSI 53 (or NSF/ANSI 58 for reverse osmosis systems), followed by the manufacturer’s claim that the product can remove PFAS.”

Be prepared for heat’s effects

We are experiencing unprecedented heat waves, breaking record after record.

The 2003 heat wave in Europe killed an estimated 72,000 people, in large part because Europe was little prepared. Such heat waves just weren’t an issue in Europe before, and so there wasn’t a sufficient plan for what to do, or understanding how insidious the effects may be, and there was relatively little air conditioning.

The 2022 European heat wave set records; in the UK the temperature broke records that have been kept for hundreds of years. Airports were closed because the runways buckled.

It is estimated that there were almost 62,000 deaths in Europe Between May 30 and September 4 2022, predominantly the elderly and in women more than men. (Ballester J et al. Heat-related mortality in Europe during the summer of 2022. Nature Medicine Vol 29:1857-1866, July 2023).

2023 was the hottest year yet, with 2024 being on course to be hotter than 2023. The heat dome in the United States in June 2024 is breaking more records.

This is our present, and it will be worse in the future. These high temperatures are extreme weather events themselves and the driver of other extreme weather events that are more common in this age of climate change.

Keep in mind that heat events that can cause severe problems are not limited to periods of heat advisories!

A simple tool is the CDC Heat Risk Index which has local information by zip code. It is semi-quantitative goes from no risk to extreme. It gives the forecast for a week.

Air quality: poor air quality from air pollution adds to the risk that heat will cause health problem or even result in death. The CDC site for Heat Risk index also has a link for air quality for the zip code. This is especially important for those with heart and lung disease, including asthma, and their families.

A good tool for screening for risk designed for clinicians to go over with patients is the CDC has a questionnaire, called Chill’d Out.

Also see our Heat and Health page in our Science Background section for practical information you can share with patients.

How heat affects the body

Heat-related problems can include cramps, rashes, fatigue, edema (swelling), or more dangerous entities like heat stroke.

Image from https://www.weather.gov/safety/heat-illness That page is a good summary and resource to share.

Peripheral vasodilation as a mechanism to defend against excessive heat (protect the brain by shunting hot blood to the periphery, where it can cool) can cause cardiovascular stress. With dehydration from sweating, this can lead to heat syncope (passing out), and worse, in a vicious negative feedback loop.

“It’s not just the heat, it’s the humidity” is true. If the humidity is high, sweat can’t evaporate so it can’t cool the body. This combined effect of heat and humidity is quantified as the Heat Index, as illustrated in the following chart:

At a body temperature of 100-102 degrees F (38-39 C) there is a risk of heat collapse. At 105 F (41C) heat stroke and death are possible.

Heat sends people to emergency rooms

Emergency room visits and hospitalizations increase during periods of increased heat. These visits can be for the heat problems above, or secondary effects like dehydration, kidney stones, acute or chronic renal failure, and cardiovascular and respiratory diseases.

A study of the records of almost 22 million emergency department visits by adults over 18 from around the United States found that on days of what they considered extreme heat there was an excess of emergency department visits for any cause, heat-related illness, renal disease, and mental illness. These findings were more pronounced in men and in the northeastern United States, but were not limited to the elderly.

There is evidence that direct effects of heat, as well as the compounding problems from some medications used in mental health care (do not stop medications without speaking to your doctor first!), create problems in cognition and emotional resilience.

Here is the data (source: Financial Times) on deaths attributed to heat in Arizona over the last 50 years. Very reminiscent of the Keeling curve of CO2 in the atmosphere, a geometric progression:

One thing to keep in mind, while in heat waves there can be tens of thousands of deaths, that is just the tip of the iceberg of suffering. For example, in 2020 there were 702 deaths in the United States per the CDC, but 67,523 emergency room (ER) visits. What vast resources were used, how many hospitalized, how many would have died, how crowded were the emergency rooms, clinics and hospitals, how much stress on the healthcare system and clinicians? How many individuals weren’t seen, but should have been, with delayed adverse health outcomes that are hard to capture?

Vulnerable people

The sick, the elderly, especially elderly women, those living in cities, particularly in areas where people can’t afford air conditioning (or the electric bill when they have air conditioners), and urban heat islands (where heat is reflected off concrete and glass, and there is little tree cover) are at high risk.

Workers in occupations where they are exposed to heat are at high risk for heat illness as well. The Center for Disease Control, National Institute for Occupational Safety and Health have a free PDF outlining ways to protect workers from heat illness.

Vulnerable groups also include infants and children, pregnant women, certain groups (occupational exposures, and in studies in California and elsewhere, African Americans and Native Americans have historically been hard hit in the United States), and those with diseases that may be impacted by heat.

There is a concern that on very hot days, especially at ambient temperatures over 35 degrees C (95 F), an electric fan can do more harm than good, or at least be of very limited use.

The World Health Organization has suggestions for dealing with extreme heat that can be shared with patients, as does Yale Medicine. The National Weather Service has a one page PDF handout about heat.

There is evidence that mental health problems can be exacerbated by heat events. That may be worth having on the history form. You might ask:

Do you have difficulties with your emotions or thinking when it is very hot?
What medications do you take?

The physiologic response to increased heat can be exacerbated by some psychiatric medications that decrease sweating. Counsel those who are under emotional stress, if you feel that is in your skill set. Otherwise identifying and referring those who need professional assistance for mental health issues exacerbated by heat may be appropriate.

Medications and the ability to physiologically respond to heat

Be sure to review all medications, not just psychiatric medications. Diuretics and alcohol may exacerbate dehydration, and other medications may lower blood pressure, or alter cardiac function, or blunt the response to heat shock, and so can make the patient particularly susceptible to the more severe impacts of increased heat. These are already likely part of your medical history forms, but are good to remember to consider in this context.

The CDC has helpful information guiding clinicians about the effects of medication and heat. This has a list of medications and includes comments on the physiologic/pathologic mechanisms of how medications affect patients’ ability to deal physiologically with the effects of extreme heat. It was updated April, 2024

How heat affects medications

Also keep in mind that medications might be affected by heat or light, a particular concern in there are power outages due to increased electricity use for air conditioning during heatwaves.

Additional considerations: pollution and natural disasters

Pollution

Taking care to discuss air quality, particularly with people at risk (with lung or heart disease, children, the elderly), can be useful. This includes both indoor and outdoor pollution. Patients can access air quality measures (see below under additional resources) and adjust their activities accordingly.

Big picture, millions of pediatric asthma attacks could be prevented by switching to clean energy and electric vehicles.

The costs of pollution from fossil fuel use have been estimated by the International Monetary Fund . They believe that besides saving money from avoiding pollution caused (or exacerbated) illnesses, measures to decrease fossil fuel subsidies would save millions of lives: “Full fuel price reform also reduces global air pollution deaths from fossil fuel combustion by 50 percent below baseline levels in 2030, or 1.6 million a year.”

The effect on human health from closing a polluting coke plant can be seen over just a few years. Closing the Shenango Coke Works near Pittsburgh resulted in “a 90 percent drop in sulfur pollution near the plant and an immediate 42 percent decrease in emergency room visits for cardiovascular disease among nearby residents. And over three years, those ER visits dropped even further – 61 percent compared with past years.” Note that “The Shenango plant was closed by DTE Energy after years of protest from neighboring communities.”

It has become clear that stoves using natural gas are a risk for worsening asthma, especially in children. Some gas can leak even when the stove is not in use. Making sure the kitchen is well ventilated, especially when cooking, and using an efficient air purifier may help, but it may be best to switch to an electric stove when possible rather than expose children with asthma to the emissions from a natural gas stove.

Globally, solid fuels used for cooking are a source of indoor pollution.

Other suggestions a clinician might make:

Secondhand smoke is an important indoor pollutant. This can come from tobacco products, fireplaces, and wood stoves.

Be careful and sparing with cleaning materials and similar chemicals. Ventilate well when cleaning, painting, varnishing and other times volatile materials are used.

Carbon monoxide detectors for the home are available.

Maintain gas furnaces, stoves and gas hot water heaters. Testing for leaks in natural gas pipes can be considered. Furnace filters should be changed regularly.

Air purifiers, including portable models meant to filter a single room, can remove many, but not all pollutants. HEPA filters can be considered for removing particulate matter. They are effective for allergens and even particulates way smaller than PM2.5 (as small as 0.3 microns).

Wear KN95 masks if near large concentrations of particulate pollution such as wildfires.

The effects of human pollution on human health are extensive and go beyond indoor and outdoor air pollution. Some recent examples:

PFAS (“forever chemicals”) were discussed above in the section on asking about toxic exposures on your review of systems, incluiding infromation about PFAS in local water and home water filters.

Plastics are a form of pollution that go beyond their impact on the environment. Plastic chemicals were linked to $249 billion in US healthcare costs even back in 2018! A detailed report was published by the Journal of the Endocrine Society (Journal of the Endocrine Society, Volume 8, Issue 2, February 2024)

In addition, over 900 chemicals have been associated with breast cancer. (Published in The Journal Environmental of Health Perspectives).

Natural disasters

It may be appropriate for clinicians to counsel patients about special concerns in a natural disaster, in additional to general advice about preparing for disasters. This is particularly important in an area likely to be impacted by wildfires (high risk for exacerbating pulmonary and cardiovascular disease), floods, severe storms and hurricanes, or extreme heat, now all more common or more powerful due to climate change.

The following groups recommend some practical ways to prepare that are relevant to all individuals with chronic disease when facing a natural disaster, especially when evacuation may be necessary at a moment’s notice or community services may be curtailed for some time.

The Centers for Disease Control has a website page on how to manage your chronic disease during a disaster, including PDFs that can be printed out as handouts for patients.

The American Cancer Society has advice for cancer patients on preparing for a weather emergency for cancer patients, including what to do after a natural disaster. The American Kidney Fund, and The Arthritis Foundation have information for patients about preparing for disasters as well. The Diabetes Disaster Response Coalition has a handout for diabetics.

Some examples of the advice given:

Have a plan and checklist ready ahead of time.

Patients should make sure family and friends know of their status and whereabouts and ways to communicate and meet up if possible.

Patients will need at least a 3-day supply of medications either at home if sheltering in place or to bring if evacuating (and know if they need to be refrigerated; if so, have a small portable cooler and ice or equivalent).

If they are on a special diet, they might want to have several meals prepared and frozen in advance.

Patients need to know how to handle medical devices (for example, oxygen tanks in the context of a wildfire, blood sugar monitoring kit if diabetic, what to do if they are on home dialysis and the power goes out).

Patients need alternatives for reaching you or other health practitioners during the emergency, and if evacuating should bring insurance cards with them, and have a brief written summary of their diagnoses and treatment with contact information for you.

If they are at particular risk for infections, they need to make sure they have a mask and sanitizer if they have to go to a public shelter.

Medical offices and clinics should consider having a plan as well.

Additional resources

There are many commercial handouts and pamphlets available about heat and air pollution to give to patients. A web search will find many of them; I won’t list them here because clinicians know what is best for their practice. Another source is professional groups relevant to your practice.

Climate change handout from the American College of Physicians (ACP) for patients as part their climate change toolkit.

Additional patient care handouts are available as a Google doc file from Clinician’s for Planetary Health (C4PH), under “seedbox” on their website. This group is part of the Planetary Health Alliance.

The World Health Organization has material on climate change and health.

Medicine for a Changing Planet is a website supported by the Stanford Center for Innovation in Global Health and the University of Washington that centers on climate relevant clinical case studies. They do a very complete presentation about topics directly to climate change, such as the effects of extreme heat and changes in zoonoses, but also related topics such as pollution, refugee health and ecoanxiety. They also have a great list of additional resources.

The New England Journal of Medicine has an online section on climate change and health.

The Journal of the American Medical Association started a series on Climate Change And Health in January 2024.

the World Health Organization has a document “Communicating on climate change and health Toolkit for health professionals” you can download.

Air pollution

The American Lung Association has materials about clean air. There are sections about air at home, work, school, and outdoors, and even about climate change, and emergencies and natural disasters that you can suggest to patients. It includes videos.

As a health professional you might need to counsel about activities to curtail when air pollution is bad. Here is an example of a set of guidelines from the US government site, www.airnow.gov

If you want to know the local air quality for yourself or your patients, you can check local air quality by zip code on the same site: https://www.airnow.gov

The EPA “My Environment” site has more than most patients will want, but for those looking for more information, it is fascinating. It includes air quality and much more, both current and historical. Try it.

Posters about climate change and air quality are available from UCSF Sustainability.

Keswani A et al. Health and Clinical Impacts of Air Pollution and Linkages with Climate Change. NEJM 6/15/22. Part of the 9/15/22 New England Journal of Medicine issue with a group of articles on climate change, pollution and health.

The EPA Introduction to Indoor Air Quality, a good summary of indoor air quality and pollution with internal EPA links to related topics.