As an emergency physician, I have a calling – and an obligation – to serve my patients by improving health, preventing harm and working to create a just society where every patient has an equal opportunity to achieve health. and optimal well-being. Yet I often feel like I’m placing a band-aid over a gunshot wound, temporarily solving my patient’s problem, but never addressing the root cause of his illness.
The burning of fossil fuels – such as gasoline in cars or coal and natural gas for electricity – causes a frighteningly wide range of disease and death, as it pollutes the air and accelerates the climate crisis.
Once, while working a night shift in the emergency department in the spring, I saw a young girl with asthma. It was her third visit that week, and her small chest was heaving up and down as she struggled to breathe. As the treatments began to open up her daughter’s airways, the mother’s eyes began to fill with tears as she shared their recent challenges.
“I did everything the doctors told me – and she’s only getting worse. What am I missing?”
The patient’s pediatrician and pulmonologist had followed the latest medical guidelines, which made me wonder: what did we miss? As I explain later in the New England Journal of Medicine, I looked up my patient’s address and found that her house was very close to a highway. She had breathed air polluted by gas-powered vehicle exhaust during her young life.
Economic injustice and racism explain why some communities have health-protective infrastructure—like parks—and others, like my patient’s, have health-damaging highways and industrial complexes. Research shows that low-income neighborhoods and communities of color were disproportionately exposed to air pollution from almost all emission sources, regardless of factors such as geographic region.
Causality can be considered the holy grail in medicine, and it requires immense scientific evidence. The American Thoracic Society, a leading medical organization, has concluded that there is enough evidence to show that long-term exposure to air pollution causes asthma in children, and it has been estimated that more than one in five children in large cities develop asthma from traffic. associated air pollution.
The harms of air pollution extend far beyond asthmatics. The American Heart Association has found that breathing polluted air causes heart disease and death. Yet, despite knowing it for over a decade, clean air is rarely discussed alongside diet and exercise for improving heart health. Air pollution has also been linked to strokes, autism, cognitive decline, diabetes, and poor pregnancy outcomes like premature birth and low birth weight in infants.
My patient’s skill and exposure to air pollution not only likely contributed to the development of her asthma, but also made it difficult to manage. Yet knowing the cause of a disease allows us to get to the root of the problem and not just treat the symptoms with band-aids. It is true that prevention is the best cure.
As a physician, I see no better prescription for my patients than a just transition to renewable energy sources such as wind or solar. This will not only reduce air pollution and its inequitable adverse health effects in the short term, but it will also minimize the suffering caused by climate change, since the use of fossil fuels is its main driver. The medical community — including major organizations and medical journals — is increasingly recognizing this problem and calling for change. Healthcare professionals are increasingly realizing that their patients are the real face of climate change, not icebergs and polar bears.
The climate crisis is already damaging health widely, creating disease and making it more difficult to deal with existing problems such as heart and lung disease, diabetes and mental health problems. It’s a threat multiplier, which means it underpins other problems and makes them worse – affecting everything we care about in medicine and beyond.
Climate change is increasing the intensity and duration of spring pollen seasons, another reason my patient was having difficulty managing her asthma. It also supercharges extreme heat, deteriorates air quality, compromises food and water supply and security, and alters the patterns of transmission of diseases such as Lyme disease and West Nile through ticks and mosquitoes. Extreme weather events – such as hurricanes, floods and wildfires – are also intensified. And while headlines often only include the immediate toll of injuries and deaths from these disasters, there are also important longer-term impacts – like damage to mental health – that we are only beginning to better understand. . In addition, these events can displace people from their homes and make it more difficult to access health services. Even if the hospital or clinic is still up and running, they may not have electricity or the necessary supplies.
In the United States, 70% of healthcare respondents to a recent survey indicated that climate change is already impacting their organization’s healthcare delivery. In my experience, everyone’s health is already affected by climate change to some extent – even if that impact remains subtle, such as a worsening of allergies due to higher pollen or a passing cough from smoke. a forest fire. But climate change is also contributing to significant illness and death, especially among the most vulnerable people.
The good news is that we already have the solutions we need for a just transition away from fossil fuels. Renewable energy sources are widely available and often cheaper than fossil fuels, especially if governments stop subsidizing fossil fuels. But we need the societal and political will to implement them. Advocating for renewable energy by reaching out to your elected officials is powerful, especially when it comes to a prescription to improve your health and that of your loved ones and neighbors.
My work continues to be guided by the advocacy of my patient’s mother, and it’s a question everyone needs to ask themselves: What am I missing in the environment that’s harming my health? A just transition away from the burning of fossil fuels, root causes of air pollution and climate change, demands of all of us.
We can only do this by working together. My ER bandages aren’t enough.
Editor’s Note: Certain potentially identifiable patient characteristics have been edited to preserve confidentiality. The opinions expressed here are the personal opinions of the author and do not reflect the opinions of his institutions.