Treat climate change like the public health crisis it is

Fearful about the climate crisis and furious about the failure to address it, millions of young people across the nation and around the globe went on strike last week to demand action. A United Nations report issued just this week warns that earth is on track for the warmest five-year period on record. To stop a global temperature increase of more than 2 degrees above Celsius (3.6 degrees Fahrenheit) above pre-industrial levels and meet the 2015 Paris climate agreement goals, the report says countries must triple climate emissions cut targets.

Already, 71 U.S. counties have hit the 2-degree Celsius mark, according to news reports. As climate change intensifies, healthcare providers, especially physicians, have a professional responsibility to address its effects on human health.

The nation has seen the acceleration of respiratory, cardiovascular and vector-borne diseases and the growing mental health impacts of climate change. And we know that the healthcare industry is part of the problem: If you were to look at the U.S. health system as a country, it would rank as the 13th-largest greenhouse gas emitter in the world, right ahead of the United Kingdom.

With physicians' decisions accounting for 80 cents of every healthcare dollar spent, our choices—including prescribing, device use and the tests we order—can have a real impact on climate change.

To reduce our collective impact, we offer some steps physicians can take to mitigate climate change and its effects on human health.

Social and economic inequities—where people live, work and play—make certain individuals and communities more vulnerable to climate change's impacts. Physicians can support policies and programs that address the social and environmental determinants of health and ensure the most vulnerable communities have a seat at the table when planning climate policies and related interventions.

For many patients, a convenient alternative to an office visit may be a video or telephone visit with their doctor, which saves time and reduces carbon emissions. Recent studies suggest that telemedicine can reduce the carbon footprint of care delivery by up to 70%, yet only 15% of physicians nationwide currently incorporate telehealth into their practice. Telemedicine also could help with prevention, diagnosis and treatment for approximately 200 million migrants worldwide, whose numbers could grow as climate change advances.

If two drugs/products are equally active and affordable, choose the one that creates less greenhouse gas. For example, many anesthesiologists have switched from desflurane, a potent greenhouse gas that remains in the atmosphere for up to 10 years, to sevoflurane, which lasts just one year. By using a more environmentally friendly anesthesia, the Permanente Medical Group in Northern California reduced greenhouse gas/carbon dioxide emissions by 524 tons from 2016 through 2017, with no impact on patient care or outcomes.

Before opening new equipment and supplies, physicians should ask themselves whether they are likely to need it or not. Where single-use instruments are needed, make agreements with vendors to buy back, recycle and reprocess these instruments to reduce medical waste

Developing rapid-response protocols for climate-induced natural disasters is critical. Each geographic region has extreme weather vulnerabilities that have decimated communities and overwhelmed emergency rooms by lengthening wildfire seasons in the Western states, contributing to epic flooding in the Midwest this past spring and extremely heavy rainfall in the Southern and Eastern states. In mid-September, Tropical Storm Imelda came ashore in the U.S. dropping nearly four feet of rain in parts of Texas. These are likely the new norms.In addition to preparing facilities for an influx of patients, we can educate patients and communities about ways to protect themselves and build resilience to cope with the effects of climate change.

As physicians, we are highly trusted by our patients and our communities. We can serve as powerful role models by advocating for health equity, making climate-smart purchases, reducing waste, planning for climate-related health interventions, and building resilience in the populations we serve.