Caren Solomon, MD, MPH: How The Health Care System Can Combat Climate Change

Health care is a major contributor to climate change, contributing approximately 5% of total greenhouse gas emissions and similar fractions of toxic air emissions. However, the health care system is also greatly impacted by changing climatic conditions, a topic Caren Solomon, MD, MPH, associate professor of medicine at Harvard Medical School and physician at Brigham and Women's Hospital, highlighted during her session at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston.

In a post-conference Q&A with the editorial team of HCPLive, Solomon gave an overview of key topics discussed during her session and discussed what the health care system can be doing to help fight climate change, physicians’ and patients’ willingness to discuss climate change, and how this concept has evolved in recent years as well as progress she would like to see made in the future.

HCPLive: What responsibility falls on physicians and other key stakeholders when it comes to climate change mitigation and adaptation? What can they be doing in their own communities?

Solomon: In terms of reducing their own carbon footprint, physicians and health care professionals should work with their clinics and healthcare systems to reduce their carbon footprint, for example by encouraging their institutions to use (and generate) renewable energy where possible, reduce waste (include reducing the use of plastics and single-use devices where possible), and take other approaches as mentioned above.

To protect patients’ health in the setting of climate change, we can (and should) educate our patients, especially our higher-risk patients and caregivers, regarding strategies to reduce risks of harms from extreme heat and air pollution, including checking the heat index and air quality index and staying indoors as possible when exposure levels dangerously high; educating regarding signs of heat illness, the need to keep hydrated, and to have access to cooling; discussing the use of air filters and N95 masks when air quality poor, as in setting of wildfire smoke.

There are some great resources that patients and clinicians can use to guide responses to such climate change-related risks as extreme heat, wildfires, and flooding. For example, this excellent toolkit was created through a collaboration between Americares and the Harvard TH Chan School of Public Health: https://www.americares.org/what-we-do/community-health/climate-resilient-health-clinics/#toolkit

As trusted voices, health professionals can play an important role in legislative advocacy by contacting their representatives or providing testimony and writing op-eds or letters to the editor, making clear the health harms of fossil fuels and the health benefits of proposed legislation to transition to clean energy and reduce greenhouse gas emissions. Working in partnership with frontline communities, health care professionals can amplify the voices of those who are disproportionately harmed by fossil fuel pollution and climate change in order to prioritize their needs.

HCPLive: Do you find the climate change conversation is a conversation physicians are more willing to have because they see firsthand some of the direct health impacts, or is there still pushback? What about patients?

Solomon: I think it is important for health professionals to remember that it should not be political to protect the health of our patients and that doing so includes their recognizing the health risks of climate change, such as extreme heat, worse air quality, more allergens, and more insect-borne diseases, and how they can protect themselves. This can be addressed by explaining to patients (particularly those at higher risk) that we are experiencing, for example, more days of extreme heat, more local insect-borne diseases like Lyme disease (and outside what was traditionally thought of as the season during which these occurred), and then explaining briefly ways to keep safe. Resources like the ones mentioned above can be helpful for managing extreme heat or other climate hazards.

In my experience, patients generally respond well to information about such risks, and I do mention their relation to climate change. My sense is that more physicians are beginning to have these conversations for the reasons you note, but it is still not the norm among physicians or across visits. Challenges include potential discomfort in how to bring this up with patients and uncertainty on the part of many clinicians about what needs to be covered and effective ways to do so. In this regard, more education can help and is increasingly being incorporated into med school and post-graduate curricula. Another major challenge is the time pressures inherent in clinic visits in which multiple other issues also need to be addressed.

One other important point clinicians can make in speaking with patients is that certain lifestyle changes that reduce greenhouse gas emissions, like reducing or eliminating meat intake in favor of a plant-based diet, or walking or biking when possible instead of driving, also have major health benefits, such as facilitating weight loss and reducing risks for metabolic disorders and cardiovascular disease.

HCPLive: How far has this conversation come in recent years as climate change has grown into a much larger discussion? Where would you like to see it go/continue in the future?

Solomon: As you indicate, the conversation has expanded substantially in recent years. We are seeing increasing attention to health as a critical reason for rapidly transitioning from fossil fuels to clean sources of energy. I would like to see the health community become increasingly active in climate action, including in educating patients, communities, and legislators about how climate change and fossil fuel pollution harm health, and the substantial health benefits of rapidly transitioning away from fossil fuels. If people realize that their health, and especially their children’s health, is at stake if we do not act soon, that can be a powerful motivator for action.

We are also seeing more recognition of the role of the fossil fuel industry in causing the climate crisis (as well as air and other pollution) and in impeding the action we need to protect our patients’ health. We know that fossil fuel industry scientists projected decades ago the harms of their products with respect to global warming and that the industry responded to this information by sowing false skepticism and hindering the passage of needed climate legislation. A new alliance of health organizations called Fossil Free for Health is focused on bringing attention to these issues and supporting policies that end fossil fuel use and promote environmental justice.

Solomon has no relevant disclosures.

Transcript has been edited for clarity.