Health effects of climate change

I noted in  my Thanksgiving Update that I would turn next to the recent articles in the Lancet that discuss new models that show direct links between health and climate change. As the U.S. Secretary of Health and Human Services, former Governor Kathleen Sebelius (another great Kansan) noted, "As greenhouse gas emissions go down, so do deaths from cardiovascular and respiratory diseases." What is novel about the series of six papers is that it does not just track the increase of infectious disease like Dengue or West Nile, instead it models out what most consider "industrialized nation health issues" like heart attacks.


So what do we know. Climate change promotes environments that mosquitoes love. Thus, we are already seeing dramatic increases of Dengue and Typhoid in the Philippines. From this 2008 article, "changes in cholera, typhoid fever and malaria have been predicted due to the changing pattern of rainy season." In a recent BBC story (video, Nov. 9, 2009), the spread of Dengue is at "almost epidemic levels" in Jakarta as a newly emerging/resurging disease. The sad aspect of the story is that they are fogging insecticide that will have its own health effect on the people of Jakarta.

The World Health Organization began warning the world about the effects of climate change nearly two decades ago. (Overview here by Washington Post; full list of WHO publications) As an American health professional, I can say that the amount of literature used in the U.S. is small and the community isn't aware of most of the literature or issues because most feel that it is an issue for third-world countries. But that is changing.

It is clear that the new Secretary has been pushing the issue of climate change into the American medical community. On November 25, a joint release of the Lancet study lead to a cross-continent launch event of the findings. Generally, the study conducted in industrialized and developing nations, showed that mitigation of greenhouse gas emission improved human health. Focusing on key sectors that produce significant carbon emission, the series of six papers walk through mitigation techniques that benefits human health. These areas are household energy use, urban land transport, electricity generation, food and agriculture, and short-lived green-house pollutants. The most compelling aspect of the studies for me is that I finally have a counter argument that "mitigation is too expensive." Now, this study allows me to say, carbon mitigation decreases the need for costly health care services and enables more citizens to be able bodied laborers. These findings will enable new discussions about cost due to previously unpredicted expensive health outcomes of doing nothing in all countries - including the United States.

Executive summary.

Key findings:

• Replacement of cook stoves in developing countries could significantly reduce air pollution and the risk for acute respiratory tract infections in young children and chronic respiratory and heart disease in adults. An estimated 1 million children are dying globally each year due to respiratory infections induced or exacerbated by inefficient burning of solid fuels. The estimated effect by 2020 of the proposed Indian stove program would cut the above disease prevalence by a sixth in the nation and halve the country's cancer cases.
  
• More foot and bike travel in London could reduce stroke and heart disease by 10-20 percent; breast cancer by 12-13 percent; dementia by 8 percent; and depression by 5 percent.
• The same reduction of oil-based fuel travel in Delhi would reduce heart disease and stroke by 10-25 percent; and diabetes by 6-17 percent.
• In the agriculture sector (did you know beef is the biggest carbon emitter of meats?), the study notes that a 30 percent reduction in livestock production is needed to meet global carbon reduction targets. This would reduce heart disease in the UK by around 15 percent 

In short, the environmental improvements shown here are significant and enough to merit action in and of themselves!

Another study published in the Journal of the American Medical Association shows that the American health care sector accounts for nearly a tenth of the U.S. carbon emissions. The study found (not surprisingly) that hospitals are the number 1 source of carbon emissions. The researchers attributed this to high energy demands for temperature control, ventilation and lighting in large medical buildings. The second largest source was the pharmaceutical industry which the authors attributed the high costs of manufacturing and researching drugs in addition to transportation to distribute prescription drugs. Overall, the study found that the health care sector produces 8 percent of the U.S.' carbon emissions.

In an earlier study, released by the World Health Organization,the energy consumption costs of American health care system adds over $600 million in direct health care cost and more than $5 billion in indirect costs.

One of the groups I pay a great deal of attention to is Practice Green Health which is bringing energy efficient and other sustainability projects to hospitals to decrease carbon outputs. Practice Green Health is a network of "individual hospitals, healthcare systems, businesses in the healthcare community and other like-­‐minded stakeholders engaged in the greening of healthcare to improve the health of patients, healthcare workers, and the environment."

With these studies, it is time for health care leaders to do our part to reduce our consumption of energy. It is time for us to be part of the solution, which in turn makes our patients healthier.