Caren Solomon, MD, MPH: Health Impacts of Climate Change, Health Care's Contribution - MD Magazine

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

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.

Caren Solomon, MD, MPH

Credit: Harvard Medical School

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 to help healthcare systems decarbonize. The National Academy of Medicine has this big initiative right now focused on healthcare system decarbonization, and there are many ways that can be done. Systems and people in those systems are working on trying to reduce building emissions and trying to have more green buildings and energy-efficient buildings. A big area is reducing anesthetic emissions by moving toward things like IV anesthesia, and a lot of institutions are either developing or have systems to make that transition.

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, trying to reduce single-use disposables and just not be creating so much waste, and then addressing things like employees' commutes. I think docs often don't necessarily think about it, but that factors into these emissions, the amount of business travel that goes on at these institutions. There was certainly a move during the pandemic to switch to much more virtual, not meeting in person all the time. We have since moved back to a great deal of travel, but we learned through the pandemic that in not all, but in many situations, remote 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 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, and one is certainly land use and housing policies that are rooted in structural basis.

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 cited in these communities. There were not a lot of trees or other greenery, which predisposes 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.