The 30th Annual Alice Hamilton Lecture: Climate Medicine and Occupational and Environmental Health (59:16) - May 11, 2023
Dr. Kari Nadeau is the Chair of the Dept. of Environmental Health at the Harvard School of Public Health (though until recently she was on the faculty at Stanford) and a specialist in adult and pediatric allergy and asthma. She presented a jam-packed lecture on the many impacts of climate change on public health and what a medical practitioner can do in response.
First, in his intro the curator of Grand Rounds Dr. Bob Wachter, Chair of the Department of Medicine at UCSF, noted that UCSF's Division of Occupational and Environmental Medicine was recently renamed the Division of Occupational, Environmental, and Climate Medicine.
Dr. Nadeau starts talking about climate change impacts on public health around 7:12 (after she gallops through the evidence that climate change is real).
I wish I could get a better version of this slide:
"Global Climate Change: Pathways from greenhouse gas emissions to climate medicine"
Dr. Nadeau does a very thorough job reviewing all the major public health issues exacerbated by climate change including (in the order she mentions them):
- Wildfires
She references an epidemiological paper on the connection between asthma and wildfire smoke in 2015 wildfire season, pointing to disproportionate impact on women, the elderly, and the low/middle income communities: Critical Review of Health Impacts of Wildfire Smoke Exposure (Reid, et al. Environ Health Persp, 2016).
I found a 45-slide PPT by Dr. Nadeau "Wildfires and Health" from 2019 from her time at Stanford that
focuses on the California case, landing with the summary line "There is no safe distance from a wildfire." (Download the PPT)
- Dust storms
- Pollens and molds (focusing on the Bay Area - the pollen season has increased by two weeks over the past 17 years and plants are producing more pollens)
- "Thunderstorm asthma" in Australia - something about how the electricity from the storms breaks the pollen into smaller parts, causing asthma in people who previously didn't have it
- Extreme heat
- Flooding, including toxins in water and fungal/bacterial overgrowth
- Waterborne and tickborne diseases
- Air pollution (including wildfire smoke, dust)
- Drought, impacts on water and food supplies, plants becoming less nutritious
- Infectious disease increase and biodiversity loss
Then she backs up and talks about secondary impacts a little.
- Displacement in climate change-related migration
She referenced a new online mapping tool - UNEP's Strata - that models potential displacement from climate change impacts. UNEP explains: "Strata is a geospatial data platform that supports practitioners and policymakers to identify and track environmental and climate stresses potentially driving threats to peace and security."
- Disproportionate impact on women/pregnant people and children
She referenced a new UNICEF report "The Climate Crisis is a Child Rights Crisis" (Aug. 2021).
This report introduces the Children’s Climate Risk Index (CCRI), "which uses data to generate new global evidence on how many children are currently exposed to climate and environmental hazards, shocks and stresses."
- Occupational health issues:
- Wildfire firefighters (10-yr shorter life span than average due to toxic exposure on the job, outside of risks from doing an emergency-related job)
- Farm workers (from heat stress- there are particular kinds of kidney disease associated with farm workers due to dehydration)
- Construction workers (with particular impacts in the U.S. on Hispanic people and people from Mexico, undoubtedly also true for farm workers)
- Workers doing flood clean-up
Then she took one more step back and looked at the "systems" view - concurrent stressors over a person's lifetime add up. I learned a new word here: "exposome" (the totality of internal and external exposures across the lifespan that affect human health). You have to think about climate change in the context of the exposome.
She then (28:10) pivoted to talk about solutions, how doctors can support their patients and give them tools to protect themselves, like, what masks and filters can help against wildfire smoke.
She then (34:38) introduced the topic of climate change x mental health.
She pointed to the article that shows positive returns to cognition from greenery from a study done in Melbourne: Associations of traffic-related air pollution and greenery with academic outcomes among primary schoolchildren (Claesen, et al. Environmental Research, 2021).
She also pointed to a pilot study on biodiversity, the immune system, and microbiota done with children in Finland: Biodiversity intervention enhances immune regulation and health-associated commensal microbiota among daycare children (Roslund, et al. Science Advances, 2020). That study found that immunity was better in children exposed to more green space.
Continuing on with her focus on solutions, she mentioned the new trend of electrifying school buses.
She ended with the potential advocacy role of health care providers - they are seen as a trusted source of information by patients and should feel empowered to talk about the connection between health stressors and climate change when counseling patients.
Dr. Wachter and Dr. Nadeau ended with a little Q&A. She noted the importance of the work of the Governor's Office in California to electrify vehicles in the state and other bright spots on the horizon.