The Public Health Challenge of Our Time

April 11, 2019

MGH Institute's Center for Climate Change,
Climate Justice and Health hosts national symposium
addressing the health impacts of global warming.

[Juicebox gallery here]

When torrential rains flooded the Rosebud Indian Reservation in South Dakota, access to health care became treacherous. “Most of the people on the reservation live on dirt roads,” explained Stephanie Sun, a rural health leadership fellow at Massachusetts General Hospital who mentors MGH Institute nurse practitioner students on clinical rotations on the reservation. The flooding, one event in a pattern of increasingly extreme weather events that climate scientists attribute to climate change, turned the dirt roads to mud, stranding people in washed-out roadways. “One patient had to walk more than a mile on a fractured foot after his car got stuck in the mud.”

Sun was one of more than 100 health care professionals who came to the campus of MGH Institute of Health Professions to participate in "Reducing the Impact of Climate Change on Health: The Role of Health Professionals” on April 6. The symposium, hosted by the graduate school’s Center for Climate Change, Climate Justice and Health, served as a call to action for nurses, physicians, and other health professionals to recognize climate change as a serious health threat that ordinary people have the power to change.

The Center is the first-of-its-kind, nurse-led initiative that focuses on addressing ways all health care professionals can respond to the impact of climate change, and help improve such things as ensuring access to safe drinking water, growing a sufficient amount of healthy food, and creating safe, clean environments that can improve ecosystems.

“Climate change is not a Republican issue or a Democrat issue,” said keynote speaker Gina McCarthy. “It’s a people issue.” McCarthy, administrator of the Environmental Protection Agency (EPA) from 2013-2017, kicked off the day urging attendees to frame climate change in human terms. Instead of showing pictures of polar bears and glaciers, she said, it's far more effective to talk about how global warming is affecting people. This includes the increasing incidence of  childhood asthma due to poor air quality and loss of productive work days during extreme heat.

“Change happens at the grassroots level. If you want to make a difference, start with your community,” said the Boston native, who now is director of the Center for Climate, Health and the Global Environment at Harvard University’s T.H. Chan School of Public Health. “People will ignore the problem if they can’t see it or think they can’t fix it.”

As the 13th administrator of the EPA, McCarthy led federal initiatives that cut air pollution, protected water resources, reduced greenhouse gases, and strengthened chemical safety to better protect Americans, especially the most vulnerable, from environmental health hazards. While some of these initiatives are being rolled back, she urged attendees to remain positive. “Don’t mope about what’s going on in Washington D.C.,” she said. “Nothing is more detrimental to progress than thinking you can’t do anything.”

Protecting vulnerable populations

It’s an all-too familiar story--disaster strikes and those with the fewest resources are hit the hardest. Up to 88 percent of the effects of climate change fall on children younger than five years old in the form of malnutrition, diarrhea, asthma, allergies, and vector-borne diseases such as Lyme disease and West Nile virus, all of which have increased in the U.S. and across the globe as weather has grown more extreme. In a breakout session on climate justice and health, Stephanie Chalupka, a professor of nursing at Worcester State University and one of several panelists who spoke throughout the day, detailed these and other long-lasting health impacts of severe heat, air pollution, food shortages, wildfires, and pathogens in the water supply.

Several attendees and presenters also talked about the link between climate change and immigration. Reagan Crowley, a nurse midwife at Lynn Community Health Center, has seen an influx of recent immigrants and refugees in her practice in the past year and half. She attributes at least part of the change to the increase in natural disasters that have forced families to seek refuge in the U.S. “People leave their homes because they don’t have access to food or clean water,” she said. 

Changing planet, changing minds

“It’s critical that health professionals be educated about climate change so they can advocate for their patients’ health and wellness,” said School of Nursing Professor Patrice Nicholas, director of the MGH Institute's climate change center and one of the symposium’s organizers.

However, it’s not easy to motivate health professionals on the issue, acknowledged Assistant Professor of Nursing Suellen Breakey. By way of illustration, she pointed to spikes in emergency department visits during heat waves, which have grown longer and more severe in cities across the country. According to a report by the Natural Resources Defense Council, Boston is one of the top five U.S. cities expected to see an increase in heat-related deaths, which could reach 1,340 in Boston and 29,850 nationwide each year by the end of the century.

“Most health providers treat their individual patients without connecting the dots between climate change and the rising number of patients with heat exhaustion or heat stroke,” said Dr. Breakey, who along with Dr. Nicholas and other IHP faculty authored the textbook "Global Nursing in the 21st Century.” It is one of just a number of publications written by the nursing school's faculty on the subject. “Climate change is real. As clinicians, we need to work together to make sure our colleagues are aware of its impact on patients.”

Catherine O’Connell, a behavioral health professional with UnitedHealth who attended the conference, in part, to hear McCarthy’s keynote address, took a long view. “Gina is saying, make incremental changes. That’s how I think it’s going to happen.” Comparing efforts to combat climate change to treating addiction, O’Connell said “You give people tools for change with the understanding that recovery takes time and work.” Both are urgent issues, and both require patience, persistence and the conviction that change is possible on the part of health providers.

Room for optimism

There’s plenty of room for optimism that the tide of public opinion on climate change has started to turn, as several presenters and participants pointed out. “Nurses have the power to make a difference on this issue,” said Jessica Wolff, U.S. director of climate and health for Health Care Without Harm during an afternoon panel, “Innovative Strategies for Climate Solutions for Health Professionals.” Health Care Without Harm is an international organization of health professionals focused on environmental health and justice. “Nurses are the most trusted health professionals,” she continued. “We’re used to communicating complex information to patients and families.”

Other afternoon panelists who discussed the role of physicians, nurses, and other health professionals in addressing the health consequences of climate change were Renee Salas MD, MPH, MS, the lead co-author on the “2018 Lancet Countdown Report on Climate and Health: US Brief,” spoke about the importance of educating health professionals; Regina LaRocque, MD, MPH, who co-authored (with Caren Solomon, MD) a review article on the roles of health professionals in climate and health in the January 17, 2019 New England Journal of Medicine, discussed the urgent need to address climate-related health issues; Jonathan Slutzman, MD, who leads the Partners HealthCare Sustainability group on climate, discussed the important work that MGH and the Institute can lead; and Amy Collins, MD, discussed Health Care Without Harm’s climate initiatives.

Locally, signs of positive momentum  addressing climate change are also growing. Boston Mayor Marty Walsh has made climate planning a priority for the city and Massachusetts is one of 21 states committed to advancing the goals of the Paris Agreement to reduce greenhouse gas emissions. The city of Boston has moved forward on efforts aimed at fulfilling initiatives described in Climate Ready Boston. Further, the establishment of the Institute’s climate center and other initiatives like it speak to a growing commitment of health professionals to address the issue and ensure a healthier future for all people.

The symposium ended with participants brainstorming ways they could combat climate change both personally and professionally. “I’m the editor of our ANA Massachusetts newsletter,” said IHP nursing Professor Inge Corless. “There’s going to be an article about the health effects of climate change in our next issue.”

Many attendees said they would continue to educate themselves so they could help colleagues and patients understand the link between climate change and current health issues. From revitalizing workplace recycling initiatives and reducing the single-use plastic in their daily lives to adding climate change to health professionals’ educational curricula to getting involved in organizations like Health Care Without Harm, participants left the event with tangible plans to become agents of change.

View: Keynote Speaker Gina McCarthy, Director of C-Change.