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Thursday Jun 01, 2017

A Changing Climate Threatens Our Health

Climate change is happening now, and this has profound implications not just for the planet, but for our health.

As the continued burning of fossil fuels releases gases into our atmosphere, the planet continues to warm. By trapping solar radiation and preventing it from being reflected back into deep space, these gases function like a greenhouse to warm the planet. Many of these gases comprise just a small fraction of the atmosphere, so even a small change in their concentration has a relatively large impact on the overall climate. For example, carbon dioxide (CO2) accounts for just 0.04 percent of our atmosphere, but that is a 45 percent increase from preindustrial levels and represents a concentration not seen on Earth for the past 800,000 years

The rapid increase in CO2 levels during the past 200 years is being driven by human burning of fossil fuels. After decades of work, 97 percent of the world's climate scientists now agree on this point. Last year was the hottest ever recorded, breaking the record set just one year before. The consequences of this warming are already appearing in the form of more violent storms, droughts, coastal flooding and loss of biodiversity all around the globe.

Until now, these changes (warming, weather variability, severe storms) have largely been viewed through the lens of climate and habitat loss for other species. However, attention is now starting to shift to the human health harms that global warming poses. There are numerous reasons to be concerned about the impact this may have on our well-being and that of our patients. The health threats posed by a changing climate span a variety of illnesses -- some mild, and some severe. Given the scope of the problem, everyone could potentially be affected -- and likely, many of us will be.

These harms include (but are not limited to):

  • Increase in allergens -- Higher atmospheric CO2 and warmer winters are directly associated with an expansion of the allergy season. Ragweed, tree pollen and grass pollen are among the common allergens that will prosper in a warmer climate, both lengthening and exacerbating the allergy season. Patients who suffer from allergic rhinitis or asthma will have to initiate medication sooner and stay on it longer. Patients with asthma will be more prone to exacerbations requiring home medication use and both inpatient and outpatient care.
  • Worsening of heat waves -- Increased frequency and intensity of heat waves may lead to heat stroke, dehydration and even death. Elderly people, outdoor athletes and our pediatric patients will be most susceptible.
  • Rise in vector-borne diseases -- Even as a warming climate threatens the habitat of many creatures (such as polar bears and many amphibians), it also will lead to expanded ranges for many carriers of human disease, chiefly mosquitoes and ticks. West Nile virus infection, Rocky Mountain spotted fever and Lyme disease may become more prevalent and afflict patients for a greater part of the year. The Southern United States may also see a rise in diseases traditionally confined to tropical areas, such as Zika virus infection, yellow fever and malaria.
  • Expansion and exacerbation of lung disease -- Although CO2 is not necessarily directly dangerous to human health, many airborne particulates that are byproducts of burning fossil fuels are. Particulates such as ozone and nitrous oxides are byproducts of industrial processes and are more prevalent in the atmosphere during sunny and warm days. Ozone and nitrous oxides are direct lung irritants and contribute to poor pulmonary health. Patients with asthma or chronic obstructive pulmonary disease are especially vulnerable to these gases, which can cause illness and hospitalization.
  • Hazards to food supply -- The burning of coal results in emission of toxic metals such as lead, mercury and cadmium. These metals contaminate waterways, fish, oysters and other consumables that work their way through our food chain.

What is perhaps most concerning is that these are not hypothetical or future concerns. Climate change is happening now and is already starting to harm us. Increasingly, studies are revealing the numerous ways in which we are all negatively affected by these changes. Therefore, it is important for family physicians to speak out and be active on this issue in the same way we are on a host of other public health concerns, such as access to care, illness prevention and reducing health disparities.

There are already groups that are working to promote awareness and action around climate and human health, including the Medical Society Consortium on Climate and Health, for which I am the director of state programs. The consortium, which was launched March 15 in Washington, D.C., is composed of 12 medical membership societies that represent more than 450,000 clinicians nationwide -- more than half the physicians in the United States. Its mission is to promote awareness among the physician community at both the national and state levels regarding the negative impacts of climate change on human health.

The AAFP, which is a member of the consortium, acknowledges the potential harms a changing planet poses for public health. An article by environmental health expert Cindy Parker, M.D., M.P.H., was published to this effect in American Family Physician in 2011, and AAFP policy (adopted in 1969 and reaffirmed in 2017) recognizes the adverse consequences of air pollution, including greenhouse gases.

Climate change represents a clear and present danger to public health, but it also presents a great opportunity for physicians to advocate for patient health. I encourage you to get involved and lend your voice to this discussion. By making the case for patient welfare and by advocating to accelerate the transition to clean renewable energy, we help our patients, uphold the high standards of our profession, and become champions for cleaner air and water.

Matthew Burke, M.D., is the new physician member of the AAFP Board of Directors.


Anything I can do to help change BACK to a national program? I would volunteer to help your cause as a concerned, retired AAFP member.

Posted by Robert Nicewander on June 02, 2017 at 11:08 AM CDT #

BS. Climate change is real and has been happening for a few billion years. We may or may not be contributing to warming, if that is indeed happening. This is NOT a clear and present danger. We should do what we reasonably can to reduce pollution. I note his use of the term "potential" harms. I resent it when alarmists refuse to consider views other than their own. The seas are not going to rise and polar bears will not be extinct.

Posted by Richard L. Grandjean, MD on June 03, 2017 at 03:42 PM CDT #

The current status of climate change science seems to show a warming trend. There is pretty good science behind this. The current status of climate change politics and ideology suggests that this trend is man made. The science behind this hypothesis is poor at best and mostly relies on consensus among ideologues. This same group also suggests that the net impact on global climate change will be bad. This is where things break down badly. First, there is little to no valid science that comes anywhere close to providing solid enough evidence of this to _act on it_. Second, the idea that a global temperature increase of 2 or 3 degrees will _only_ produce detrimental effects across all populations, ecosystems and species is simply preposterous and probably the prime way to know when you are reading science vs. alarmist ideology. Finally, even if all of this is true there is no science whatsoever to _prove_ that there is anything we can do about it.

So, that being the case, why in the world would the AAFP allow such unscientific, alarmist and inaccurate information to be presented even in an opinion piece?

Well, we all know the answer to that. The AAFP is simply a collection of leftist ideologues rather than an association that looks out for the best interests of its members. This is evident almost daily in blogs like this one and all of the AAFPs interactions with the federal government which can be summed up, simply and accurately, as socialist cheerleading.

As it stands the AAFP represents not much more than a clearinghouse for CME to most of its members and is constantly in ideological conflict with the majority of them. I suspect that if there was any option for easy CME access and tracking (which the AAFP is very good at) then the AAFP would cease to exist overnight. It has already made itself irrelevant for most of us and articles like this one just confirm it.

Posted by George Barron, MD on June 08, 2017 at 07:53 AM CDT #

I wonder why Dr. Burke fails to mention potential benefits from global warming. All of his talking points are speculative even though he characterizes them as "clear and present danger" (which by definition they are most obviously not).

But, if such speculation is admissible as scientific evidence lets make some speculations of our own.

1. Warmer temperatures: Seasonal upper respiratory viruses which take a huge human toll during the colder months will almost certainly become less of a threat as global temperatures rise. This will be a great benefit to older and more frail patients with respiratory issues.

2. Warmer temperatures: As global temps rise there will be less need for heating. This will reduce, across the globe, the burning of fuel oil, wood, peat, propane, natural gas etc etc, thus reducing emissions world wide. The benefits, to any climate change alarmist, are clear here.

3. Warmer Temperatures: As temperatures warm across the colder regions of the planet the growing season for food plants will be extended through enormous regions which will help the world hunger issues.

4. Warmer Temperatures: As the heat increases across the subtropical band across the globe the time range in which non-evergreen trees keep and grow leaves will be extended. This will produce and enormous net gain in tree utilization of CO2 and the return of O2 to the atmosphere.

The list goes on. If you think these are far fetched they are no less speculative than the sky-is-falling examples listed by Dr. Burke.

The measure of climate change alarmism is the idea that the net effect of temprature rise, regardless of its source, will be all bad.

Posted by George Barron, MD on June 08, 2017 at 08:07 AM CDT #

A well written critique of human history beginning thousands of years ago, "Sapiens" by Harari, details how we human beings have created one extinction after another. The species imperative to create more copies of its DNA at the expense of the environment or even its own happiness is leading to our own extinction.

Posted by kurt Lauenstein on June 08, 2017 at 12:20 PM CDT #

Dr. Burke, Thank you for this excellent summary. It is unfortunate that ideology and economic interests have put the US in the caboose in the train of constructive action. When the public in the time of Gallileo and Copernicus resisted findings found unpalatable, at least gravity and the solar system carried on. Now sadly there is little if any chance left to wait for the anti-scientists to come around, or their children and grandchildren to thank them for it.

Posted by Caroline Wellbery on June 18, 2017 at 08:44 AM CDT #

I appreciate Dr. Burke's outline of the health effects of climate change. It is imperative that physicians get involved in mitigating the effects of climate change to protect the lives of our families and patients.

Posted by janet eddy on June 19, 2017 at 06:43 PM CDT #

Mr. Lauenstein, I'm not sure what your point is. Why complain that humans are doing what evolution has developed them to do? Aren't we just another set of DNA doing what DNA does? Aren't we just as much a part of nature as every other species which also tries to perpetuate its genes, usually at the expense of another species?

Or are we above nature? Is there some sort of supernatural (above and outside of nature) imperative that we are bound to follow? If so, where does it come from?

But finally, what evidence do you have to suggest that we are nearing or even preparing the way for extinction? The human population is extraordinarily robust right now and has become this way despite thousands of years of far more vigorous climate change than anyone is predicting as of now.

Maybe your pessimism is unwarranted?

Ms. Wellbery, just who are these anti-scientists? Or is that a strawman? The 'science' that you speak of is extraordinarily weak and yet the ideology attached to it is inordinately strident that extraordinary measures must be taken. So to equate a simplistic medieval church that was in a power struggle with Gallileo has got things exactly backwards. The new religion, which cannot be questioned with out being branded heretical (unscientific) is the climate change pundits and not those who very reasonably and scientifically suspect that its edicts and calls for faithful devotion are misplaced and most definitely fall outside the rigor expected of real science.

Posted by George Barron, MD on June 20, 2017 at 12:52 PM CDT #

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