November 15, 2019
The Out-of-Pocket Health News Digest:
Climate Change Special Edition
Below you will find briefs about recent news stories related to climate change and healthcare. With our new special edition, our hope is for students to explore how policy issues outside of healthcare impact public health and the healthcare industry.
This compilation is produced by the HPSA Education Committee: Sharoni Bandyopadhyay, Matthew Dunn, Payton Watt and Courtney Zott.
Climate Change Threatens Global Food Security, Nutritional Content of Foods
Climate change is typically associated with images of drought, unpredictable weather, and increasing temperatures. While these are all very real and devastating parts of climate change, the focus on these few images can make it easy to forget the more subtle, yet urgent consequences of climate change. One of these consequences is food security, defined by the United Nations as, “all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their food preferences and dietary needs for an active and healthy life.”

Climate change places a huge threat on global food systems. Although the United States has encountered similar consequences as lower-income regions ( e.g. North Africa, South and Southeast Asia, the Middle East ), the effects of lower crop yields will affect our most vulnerable populations. In addition, the average American meal contains ingredients from at least five foreign countries . This is particularly important because the global population is expected to rise to 10 billion by 2050, indicating that the global food demand could increase anywhere from 59 to 98% . Simultaneously, it has been estimated that global crop yields could fall 35% by 2100 . 

This decrease in crop yield is due to several factors that have the ability to impact our health directly. Two of the most important are increased pesticide use (due to warmer temperatures), which could cause an increase in biotoxin contamination in food , and a decrease in nutritional content. It has been estimated that if CO2 levels hit their projected 2050 mark, crops could see a 3 t0 17% reduction in protein, iron, and zinc , all of which are essential to overall health and well-being. Therefore, moving forward, it will be incredibly important for both the general population and policymakers to take action. Currently, there are government officials considering policy changes that would minimize disruption to the food system, and there are known actions for individuals to take, such as reducing meat intake and food waste, and buying locally .

Insights from a UM Professor on Disparities in Climate Change Vulnerability
Dr. Koman is a research investigator at the University of Michigan School of Public Health Environmental Health Sciences department. She previously worked for 20 years as a senior environmental scientist at the U.S. Environmental Protection Agency (EPA). Dr. Koman recently led the MiEnvironment study , which investigated patterns of heat vulnerability in Michigan. She also hosts an annual forum on climate change and health in collaboration with the medical school.

CZ: What inspired the MiEnvironment study?

TK: We have been working with a couple of community-based groups in Detroit, and they were especially interested in trying to use climate science…to look at [heat vulnerability] patterns in Michigan. We also wanted to see to what extent vulnerabilities might have equity or equality issues related to them - related to things like income or race.

CZ: Some people may not understand the link between being vulnerable in a community because of heat stress - heat vulnerability - and climate change. Could you explain how those things are tied together?

TK: There [are] going to be a lot of different health effects related to climate change. One that is already happening and will intensify with climate change is that temperature will increase, and that means some of the extreme temperatures in the summer time will also go up. There is evidence from things like the Chicago 1995 heat wave that particularly strong heat can be detrimental to health. It sends people to the hospital and increases mortality, especially among vulnerable groups.

CZ: What are some ways to prepare for and combat heat stress?

TK: You can lower the heat island effect, so think about dark pavement and lack of tree cover. Increasing social cohesion is also another important area. What we learned from the Chicago heat waves is that even though there are certain vulnerable communities, not all of them suffered the same way. Communities that look out for each [other] can help, for example, check in on the elderly to be sure that they are doing OK when they know that there is going to be a heat event coming.

CZ: You mentioned inequities. Why do we see disparities in vulnerability to heat stress in Michigan and elsewhere?

TK: The roots of inequity are deep in our country, and it's hard to give a simple answer to that. One feature of the work that we did was we wanted to look to what extent [heat vulnerability] patterns are equally distributed by a number of factors. Many [factors] are things that we drew from the literature that we know can be areas of inequity in our country, so race is one of them. So what you would want to see is that it doesn't matter what a racial makeup of a community is - that everyone would have an equal exposure essentially. That patterning, from a justice perspective, should not be a factor. What we did find is exactly the opposite, that there is a statistically significant pattern in Michigan, and a lot of that has to do with historic racial inequalities and discrimination, policies that relate to housing and other wealth in our communities. It's especially important I think to consider the inequities because as we are trying to target solutions, we want to start out with the most vulnerable places, and we want to create a situation that doesn't make these situations worse, but in fact makes them better. Oftentimes in the work that I did when I was at the U.S. Environmental Protection Agency, we would have grants, and those grants would be competitively given out. Well, wealthier communities who can hire a person to write grants often do better in those competitions, and that leads to having more resources sent to wealthier communities rather than the communities in the most need, and from a public health perspective, what we want to do is try to bring up the communities that need a little extra help.

CZ: What can public health leaders and policymakers do, in your opinion, to start preparing for heat vulnerability?

TK: I think that the most important thing from my perspective is that we should continue to work on reducing our carbon pollution and greenhouse gas emissions. We can't give up on trying to crack this. The second thing that we need to do is identify vulnerable groups and start our planning process. We also know that local public health is not talking about climate change near as much as they need to be, and if our public health leadership is not talking about climate change and advocating for action on it, then we won't be ready as things are starting to change.

How Can Hospitals Be Better Prepared for Increasingly Frequent Natural Disasters?
A consequence of climate change is an increased frequency of extreme weather events and natural disasters , such as hurricanes, floods, and tornadoes. This impacts public health in many ways, including the burden placed on health care systems. It is unsurprising that within the first few days of a natural disaster, local hospitals will show higher rates of admissions. However, University of Michigan Professor Dr. Sue Anne Bell published a study that found the impacts can be long lasting as well. Following a series of tornadoes across the U.S. southeast in 2011, all-cause hospital admissions for older adults were still 4% greater at 30 days after the disaster. 

Many hospitals are already operating at close to capacity. A sudden influx of patients can overwhelm hospital resources and make it difficult to provide services. The worst-case scenario is if a hospital sustains structural damage from a disaster that completely shuts down operations, leaving a community without health care. There is also concern for the well-being of providers, who may be overworked and experience mental health distress during a crisis.

However, hospitals can take steps to better prepare for extreme weather events. Providing disaster response training to staff is an important component. While 92% of hospitals report training their nurses in disaster response, only 53.1% of hospitals have given this same training to nurse practitioners and physician assistants, and only 49.2% to residents and interns. Some facilities, especially those in locations most threatened, should also consider investing in climate change-resistant infrastructure. For example, the Texas Medical Center in Houston built its own heat and power utility plant at an elevation to withstand flooding. Finally, Dr. Bell points out the need for providers to have access to mental health services, safe spaces to debrief with colleagues, and time to attend to personal well-being. 

U.S. Healthcare's Contributions to Climate Change Largely Overlooked
The U.S. healthcare system will eventually be faced with addressing the public health impact of climate change. However, hospitals currently neglect their own contributions to the climate crisis. The U.S. healthcare system is currently the 7th largest producer of carbon emissions in the world. Hospitals are highly energy intensive due to structural and functional demands required to provide care 24 hours a day, 7 days a week. These energy demands, ranging from sterilization to medical equipment, are currently met with fossil fuel. The impact on the environment is significant: a 2016 study found that the U.S. hospital industry is responsible for 10% of greenhouse gas emissions, 12% of acid rain, and 10% of smog in the country. 

Despite the impact that the healthcare industry has on the environment, the hospital industry has been slow to implement sustainability initiatives.  Climate change impacts public health , and subsequently hospitals will eventually need to respond to the changes in disease burdens and costs. Few hospitals have been proactive about reducing their carbon footprint. In 2014, Gundersen Health System became the first hospital system in the nation to become entirely powered through alternative energy. Similarly, Kaiser Permanente , already one of the top users of solar power in the nation, aims to rely solely on solar power by 2020. However, some argue that hospitals need an external push to become more environmentally friendly. Suggestions include implementing policy interventions that would require sustainability reports or increasing public pressure to reduce hospital’s investment in fossil fuels. Not only would these changes decrease the environmental impact of the U.S. healthcare industry, but also they would also improve public health outcomes and potentially provide a long-term return on investment of $15 billion over the next ten years. As the international commitment to the climate crisis heightens, the pressure falls on private industries, including healthcare, to reflect on their contributions and make necessary changes for the future.

Sources: Commonwealth Fund , Vox