Health care providers must join fight to combat climate change
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Key takeaways:
- Increasing air pollution and higher temperatures are associated with increased risks for diabetes and adverse pregnancy outcomes.
- Changes must occur at individual and institutional levels to slow climate change.
CHICAGO — Health care providers, institutions and facilities all have roles in reducing global warming and reversing effects of climate change, according to two plenary speakers at ENDO 2023.
Caren G. Solomon, MD, MPH, deputy editor at The New England Journal of Medicine, associate professor at Harvard Medical School and physician at Brigham and Women’s Hospital, and Jodi Sherman, MD, associate professor of anesthesiology at Yale School of Medicine, discussed how climate change has had several endocrine-related impacts on people and how health care as a field contributes to greenhouse gases and the carbon footprint.
“Pollution prevention is the new patient safety movement,” Sherman said during the presentation.
Air pollution increases diabetes, pregnancy risks
Air pollution and rising temperatures have had a major impact on human health, according to Solomon. Citing smoke from Canadian wildfires seen in much of the eastern U.S. in June, Solomon said people are being exposed to air particulates that could negatively affect health outcomes. In a meta-analysis published in 2020, exposure to air pollutants was associated with an increased risk for incident type 2 diabetes. Another meta-analysis published in JAMA Network Open in 2020 found greater exposure to air pollution was associated with a higher risks for preterm birth, stillbirth and low birth weight.
Higher temperatures also have a negative impact on health. A 2019 study found increased temperatures were associated with more hospital admissions, including diabetes-related hospitalizations. The meta-analysis published in JAMA Network Open also found associations between higher temperatures and higher risks for preterm birth, stillbirth and low birth weight.
Solomon said the “world is behind” with trying to tackle climate change, but added some progress has been made, with the cost of renewable energy dropping and many states passing renewable energy bills.
Some of the progress is due to an increasing concern from the public about climate change. Data from the Yale University program on climate change communication revealed 53% of people said they were alarmed or concerned about climate change in 2022, an increase from 38% in 2012.
“Most importantly in driving the action that has occurred so far, we know that increasing numbers of people are worried,” Solomon said.
Health care’s contribution to pollution, climate change
Health care as an industry contributes to pollution and climate change, according to Sherman. Hospitals run 24 hours a day, 7 days per week, and they mandate unique infection prevention requirements and utilize resources in a wasteful way due to regulatory complexities and business models, Sherman said.
She noted 5.2% of greenhouse gas emissions are attributable to the health care industry. This number is even larger in the U.S., where health care emits 8.5% of greenhouses gases.
“The U.S. is a big contributor [of greenhouse gas emissions],” Sherman said. “The U.S. has the highest per-capita greenhouse gas emission.”
The majority of health care greenhouse gas emissions comes from the supply chain, including pharmaceuticals and chemicals, medical devices and supplies, and food for hospital staff, patients and visitors.
Other contributors to pollution are single-use disposable devices, drug waste and inefficiency. Excessive use of disposable devices is driven in part from an effort to prevent health care-acquired infections, according to Sherman. Matching supply and demand and avoiding inappropriate care are necessary to reduce the number of resources used, she said.
“[The purpose of health care] is preventing disease to begin with,” Sherman said. “[We can reduce] demand for health care by promoting disease prevention and addressing social determinants of health.”
Ways to fight climate change
Solomon highlighted several actions health care providers can take to support a more sustainable world. She encouraged providers to educate patients, students and trainees about the ways climate change negatively affects health. Patients can also be counseled on how to avoid exposure when air pollution is high and to avoid outdoor activities on hot days.
“We’ve seen fracking bans in multiple states owing to actions from health professionals from multiple other groups,” Solomon said. “Multiple states have committed to 100% renewable energy, and nearly 1,600 institutions at this point have committed to divestment from fossil fuels.”
Sherman said providers can ensure appropriate care while being conscious of the environmental impact. Adherence to clinical practice guidelines and advocating for universal access to health care can reduce impacts on a larger scale. Sherman added that coordinating care to avoid duplication and implementing institutional structures to promote best practices can help reduce waste on the institutional level.
Individually, Sherman said, providers should adhere to guidelines and avoid inappropriate tests for patients and engage in shared decision-making. Being more efficient with resources can not only improve the value of care, but can have a positive effect on the impact health care has on the environment, according to Sherman.
“By reducing financial costs, we are also reducing environmental and social costs,” Sherman said.
References:
- Bekkar B, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.8243.
- Vaidyanathan A, et al. Proc Natl Acad Sci U S A. 2019;doi:10.1073/pnas.1806393116.
- Yang BY, et al. Environ Res. 2020;doi:10.1016/j.envres.2019.108817.
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Solomon CG, et al. PL-01. Presented at: ENDO annual meeting; June 15-18, 2023; Chicago.
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