Caren Solomon, MD, MPH: Health Impacts of Climate Change, Health Care’s Contribution

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Solomon explains how the health care system contributes to climate change and the direct health impacts seen as a result, based on her session at ACP.

Health care is a major contributor to climate change, but in addition to its notable contributions to the growing climate crisis, 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, discussed 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 provided further insight into the health care system’s impact on climate change, pressing health issues stemming from climate change, and the disproportionate effect on low-income communities and communities of color.

HCPLive: How does the health care system contribute to climate change?

Solomon: It's known that the US healthcare system is responsible for about 8.5% of total greenhouse gas emissions and about 4.5% of total global emissions, so it's an enormous source of emissions contributing to climate change. Those include both direct emissions from healthcare institutions, the electricity and heating and such that are being purchased, and the biggest source is through goods and services that healthcare systems are purchasing and using.

In general, there's definitely an increasing move for healthcare systems to decarbonize. The National Academy of Medicine has a major initiative right now focused on healthcare system decarbonization, and there are many ways that can be done. Examples include moving to greener energy efficient buildings, obtaining electricity from renewable sources, and reducing the use of anesthetic gases such as desflurane, an agent that produces high levels of greenhouse gas emissions, in favor of other anesthetic agents like IV anesthesia. A number of institutions are making such changes.

With respect to the purchase of goods and services, there's a lot that we can work on, like locally sourcing the foods that we serve in our cafeteria. Reducing our waste is a huge one, including trying to reduce the use of single-use disposables. Others include locally sourcing the foods that we serve in our cafeterias and addressing employees' commutes, including considering more remote work as possible. Also relevant is business travel that goes on at these institutions, as plane travel generates a lot of emissions. We learned through the pandemic that in not all, but in many situations, virtual meetings can work very successfully and don't generate these emissions.

HCPLive: What do you consider to be the most pressing issue when it comes to health care and climate change?

Solomon: I think the most pressing issue is that we need to rapidly transition from fossil fuels to renewable energy. Back in 2018, the Intergovernmental Panel on Climate Change had warned that we really needed to decrease our greenhouse gas emissions by 50% from our 2010 levels by 2030, and get to net zero emissions by 2050 so that we could avoid the most devastating climate change impacts for health and for other outcomes.

Despite that warning, we still see that greenhouse gas emissions are rising. We know that fossil fuels account for three-quarters of all greenhouse gas emissions, and they also cause air pollution and chemical pollution, which are major causes of serious illnesses and death, so I would just emphasize that the transition away from fossil fuels has enormous benefits for health, as well as many other outcomes.

HCPLive: How does climate change disproportionately affect marginalized communities and directly translate to negative health impacts?

Solomon: There’s a long list of general adverse effects of climate change on health. Among those are heat-related illnesses, which range from mild illnesses to heat stroke, which can be fatal. There's more respiratory and cardiovascular disease. There are more pregnancy complications like preterm birth and stillbirth. There are more insect and waterborne diseases, there's more kidney dysfunction. There are more mental health conditions or exacerbations of those that we see with climate change.

There are certain groups that are higher risk, including really young people or very old people, those who have pre-existing health conditions, pregnant women and fetuses, but also very, very importantly, low-income communities and communities of color. With respect to those racial inequities, there are a number of reasons why there are these disparities. One is land use and housing policies that are rooted in structural racism.

For example, people will point to the policy of redlining, which goes back to the 1930s and labeled communities of color as ‘high-risk investments,’ and the result was that highways, landfills, and industry were sited in these communities. There were not a lot of trees or other greenery. Together, these predispose people to a greater risk of heat illness because these areas get so much hotter, they're known as urban heat islands.

There's also still a disproportionate placement of pollution-generating fossil fuel infrastructure in communities of color and other low-income communities. Those greater exposures and having fewer resources to address these exposures and the associated health risks obviously end up causing much greater health harm to these communities.

Beyond all the health conditions that I mentioned with respect to climate change, it's also important to note the increasingly intense storms associated with climate change can also affect people's ability to access health care and health care institutions' ability to provide health care, so that's another means by which climate change is causing real health dangers.

Solomon has no relevant disclosures.

Transcript has been edited for clarity.