How to talk to skeptical allergy, asthma patients about climate change

Key takeaways:

• Providers must understand their own motives for discussing climate change.
• Providers also must recognize where their patients’ views are coming from.
• Consensus may be found by speaking to shared values.

SAN ANTONIO — When patients are skeptical about climate change and its impact on their asthma or allergy, communication is still possible, according to a presentation at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“You won’t be able to change somebody’s point of view in 5 minutes,” Karin A. Pacheco, MD, MSPH, FAAAAI, allergist, division of environmental and occupational health sciences, National Jewish Health, said during her presentation. “But you can plant a seed. You can plant an idea that hopefully will grow.”

Motivations for talking

Before providers discuss climate change with their patients, Pacheco said, they first need to identify why they want to discuss it.

“What is your expectation for why you want to convey this information?” she said before offering several possible reasons.

First, she said, climate change is important for the future.

“You see where things are going, so you need to talk about it,” she said.

Next, she said that providers may be worried that climate change will end in a disaster.

“And the disaster is going to impact especially those who deny that it is actually happening, so you really want to get the word out,” she said.

Pacheco then cited a series of manmade environmental disasters in the 1960s that led to the formation of government agencies including the National Institute for Occupational Safety and Health, the Occupational Safety and Health Administration, and the Environmental Protection Agency.

“People move when there is a disaster and it’s a disaster that you say, ‘Hmm, that could affect me. That could affect my family,’” she said. “I’m not arguing that we want a disaster about climate change. We’re going to get it. We’re getting it. And eventually, it does spur people to action.”

Providers also may want to discuss climate change because it is part of their worldview, Pacheco continued.

“Everybody in this audience basically says, ‘Yeah, climate change is there.’ There’s not a discussion as to whether or not it’s happening,” she said.

Plus, providers may want to be able to discuss why the patient’s allergic diseases are getting worse.

“It’s not because your medications are ineffective. It is because the pollen seasons are longer, and each plant produces higher levels of pollen,” Pacheco said. “Being able to explain why disease is getting worse, I think, is extremely useful.”

Finally, Pacheco said, there is one more reason why providers may feel like they need to talk about climate change.

“The other guy is an idiot, and you need to set him straight,” she said. “There’s a certain amount of that, right? It’s like, ‘How can you not believe that this is happening? How can you come up with some alternative explanation for what’s going on?’”

The other perspective

That is only half of the conversation, Pacheco said.

“The second piece that is really important is that you have to recognize where the other person is coming from,” she said. “What do they think? How are they putting together their worldview? So, you can actually interact with them and present relevant information.”

Pacheco noted that many patients may get their information from cartoons, memes and similar items on the internet criticizing the theories behind global warming as well as the scientists and other people who subscribe to them.

For example, these items may call climate change a hoax because we still have cold and snowy winters. Or, they may say that the lack of a simple explanation for climate change means the science cannot be credible.

“It doesn’t make sense, so it must be nonsense,” Pacheco said.

When these messages are framed in economic terms as well, Pacheco said, these simple and repeated messages have even more resonance. The subtext of many of these messages seems to be that only rich people care about climate change because the proposed solutions will not affect them.

“It’s going to impact the poor people because they can’t continue in their regular jobs, they can’t drive cars, and they can’t go anywhere, so there’s resentment I think about that message,” Pacheco said.

While the Economic Recovery Act may create new jobs in more environmentally friendly industries in the long term, Pacheco said, in the short term, people in fossil fuels may lose their jobs.

“If you turn around and say that they’re part of the problem, you’re not going to get any traction because that’s how they feed their family,” she said. “We need to be aware of that.”

The flip side of this perceived negative economic impact is the idea that climate change activists are making money off their alarmism regardless of how “regular” people are hurt, Pacheco continued.

“Somehow, the implication that academic scientists are making big bucks is just really funny,” Pacheco said.

In addition, climate change skeptics may see themselves as individualists who cannot be duped by scientists, whereas they see those who accept climate change as stupid and blindly believing whatever they are told.

Children in particular, these skeptics may say, are being brainwashed into believing that climate change is real by a liberal media landscape and educational institutions.

Meanwhile, Pacheco said, these messages have economic motives of their own.

“This is the attitude that really has been propagated by scientists employed by the fossil fuel industry to create doubt,” Pacheco said. “If you create enough doubt, then people won’t believe in the argument.”

Identity politics

Both sides of the debate have more in common than they realize, Pacheco said.

“Everyone who watches the Star Wars movies identifies with the Rebels. Nobody says, ‘Well, I’m with Darth Vader on the Death Star,’” Pacheco said. “Each side thinks that they are the Rebels and the other side is brainwashed stormtroopers.”

In her home state of Colorado, Pacheco said, liberals tend to think of conservatives as uneducated people who are being blindly manipulated by the interests of big business.

“I don’t actually disagree with that,” Pacheco said.

Yet conservatives tend to see liberals as blind sheep who are bleating the same message that hurts people’s livelihoods, she continued.

“You need to be aware that you may come across that way, and you probably need to tone down what you have to say in order to be heard,” Pacheco said.

The climate change debate is not a fact-based argument, Pacheco said. The facts already are evident and overwhelming, she said, and adding more facts to the discussion will not change anyone’s minds.

“It has everything to do with identity and ideology. What group do you belong to? What is the groupthink with which you identify?” she said. “If you dispute facts, it will feel like a personal attack.”

When asked why they remain skeptical about climate change, Pacheco said, many people will say that they do not trust the government. Considering the Tuskegee syphilis trial, government research performed on foster children with developmental disabilities, and other experiments, Pacheco conceded that these people may have a point.

“We have to own that, because the government and academic institutions have done some pretty horrible research,” she said. “We need to understand why some people do not trust the government.”

Common ground

So how can providers talk to patients about climate change with patients who are skeptical?

“Start by speaking to your shared values,” Pacheco said. “There are certain things that pretty much everybody agrees on.”

Pacheco suggested that everyone is concerned about their children and the future that they will face. Also, she said, people may share concerns for the less fortunate, particularly those people who will be most affected by climate change.

Stewardship of natural resources is another area where agreement may be found, especially in the West, Pacheco continued. For example, Yellowstone National Park recently celebrated its 150^th anniversary with a conference sponsored by the University of Wyoming.

“Wyoming is one of the most conservative states in the country. But talk was about the effect of climate change on the changing habitat,” Pacheco said. “They’re losing their high alpine forests. And the talk was, how do you manage the habitat for the animals that live there? I think people are willing to see the impacts if it’s something that they really care about.”

However, Pacheco cautioned that fear does not move people to action. Instead, it moves people to avoidance. If the only message is gloom and doom, she said, people will feel like there is nothing they could do to help, so why bother?

But providers also may find their patients asking them what they think, Pacheco said. When that happens, providers should use five rules of evidence communication.

“The important point is you inform, you don’t persuade,” she said.

Providers also should offer balance, but not false balance, including the pros and cons of their positions. Similarly, providers should disclose any uncertainties they may feel as well as the quality of their evidence. Fifth, she said, providers should inoculate their patients against misinformation.

These techniques probably will not change anyone’s minds, Pacheco said, but they do open possibilities for change. And regardless of the outcomes of these conversations, she continued, providers should not give up hope.

“Hope is what inspires,” she said. “Rational hope moves people to action.”

The global response to the COVID-19 epidemic, which involved the scientific world sharing its data in pursuit of a solution, leads Pacheco to believe climate change can be combatted as well.

“It means that we can do this. We are in this together,” she said. “This is an enormous problem. Do I think the solution will be pretty? No. But I do think it is possible. Yes, I think it is.”