The World Is Ablaze: What Can Physicians Do?

— Five steps to help address climate change

by
Leong Koh, MD, and Colin Cave, MD

August 11, 2023

Record-breaking heatwaves in the U.S., Europe, and China are all too common, and there’s a 20% chance that 2023 will be the hottest year on record, according to the National Oceanic and Atmospheric Administration. Such conditions exacerbate the hot, dry conditions fueling fires now raging in multiple locations across the planet. At this very moment, our hearts go out to the people of Maui, who are our patients, colleagues, family members, and friends, as the ongoing tragedy in Hawaii continues to unfold.

Climate change is happening now, and physicians are increasingly on the front lines of the crisis as ozone, smog, and particulate pollution from wildfires inflame lungs, exacerbate asthma symptoms, and worsen many health problems, such as diabetes, heart disease, and lung disease.

The American healthcare sector also contributes to climate change, as it accounts for about 8.5% of all greenhouse gas emissions in the U.S. Hospitals contribute the bulk of the emissions and generate an enormous amount of non-recyclable trash from single-use items that end up in landfills or incinerators. The sheer volume of emissions fueled by patient care is staggering. The gasses emitted by one hour of anesthetic use is equivalent to driving a gasoline-powered car 250 miles and some anesthetic gasses, including nitrous oxide, can survive in the atmosphere for more than 100 years.

Several recent studies indicate that incidences of health threats — including pandemics — will accelerate along with global warming.

One survey found that extreme weather connected to climate change has aggravated 58% of 375 known infectious diseases. Another study predicts that by 2070, changes in climate and land use will spread novel viruses between mammals, including humans, an estimated 4,000 times. While not necessarily causing a pandemic, each viral transmission could affect animal health and make the leap to human hosts. Other studies have suggested that climate change may have played a key role in the evolution or transmission of SARS-CoV-1 and SARS-CoV-2.

As business leaders and trusted advisors, we have a responsibility to reduce the climate impacts of the healthcare sector, including those of us who provide care. Physicians, clinicians, and healthcare delivery systems are well-positioned to help mitigate climate change. They can make business decisions that help reduce their organization’s carbon footprint. During visits with patients, clinicians can signal that it is acceptable to talk about climate change, so patients feel comfortable bringing up climate-related concerns. Now is the time to engage in such conversations.

To mitigate climate change and its effects on human health, we recommend five steps physicians can take, including lessons learned from the pandemic:

Increase the primary care workforce. Our country is facing a dearth of primary care physicians at a time when they’re most needed. These physicians act as the first line of defense against the spread of disease by triaging, testing, educating, and coordinating patient care. As a result, they are also well-positioned to influence the choices individuals make, such as riding a bicycle or walking rather than driving short distances. Unfortunately, in part because of that front-line role, and especially in the aftermath of the COVID-19 pandemic, many are burned out. It’s critical to advocate for policies that increase the primary care physician workforce and improve their well-being.

Move more care into the home. Innovations like telehealth and remote patient monitoring can help us reach climate goals while delivering other societal benefits. Delivering care — including acute care — in the home can eliminate the CO₂ emissions that occur when caring for a patient in a hospital.

Rethink supply chains. The pandemic disrupted the global supply of masks and personal protective equipment from other countries, highlighting the need for supply-chain redundancy. Investing in alternative supply chains contributes to the resilience of local economies and communities, while potentially reducing overall emissions. Such investments can also provide stopgaps when natural disasters disrupt distant suppliers and distribution channels.

Make prudent use of medical supplies. Our health system’s “Wait Don’t Waste” program allows single-use surgical equipment to be opened only when needed and standardizes surgical trays and case cards. The program eliminated 14 metric tons of CO₂ emissions in its first full year of implementation. Our National Product Council, which provides clinical oversight for the quality of products that Kaiser Permanente purchases, has made environmental impact a required, significant factor in purchasing contract decisions. Purchases are a major part of Scope 3 emissions, which include indirect emissions of the external parties that source, produce, and transport the medications, equipment, and supplies that we use. Other health systems should institute similar models and protocols.

Ensure vulnerable communities are represented when planning climate policies. Climate change will disproportionately affect the health of people in marginalized communities. Physicians can take a leadership role by supporting policies that ensure marginalized populations are represented in planning decisions that affect community health, including infrastructure proposals, plans for landfills and toxic waste facilities, and land use. Health systems should start by pledging to reduce greenhouse gas emissions and increasing their climate resilience.

Polls and studies have found that an individual’s own physician is the most trusted advisor when it comes to health-related information and decisions. Let’s use that influence for positive change. Let’s also leverage the power of our industry to share lessons learned during the pandemic about innovation, patient education, waste reduction, and health equity to reduce our carbon footprint, advance climate justice, and encourage behaviors that improve the lives of our patients and our planet.

Leong Koh, MD, is president and CEO of Northwest Permanente. Colin Cave, MD, is medical director of External Affairs, Government Relations, and Community Health for Northwest Permanente.