As the California Camp fire spread in Nov 2018, the University of California, Davis, Burn Center received a call that nearby Feather City Hospital was on fire and patients were being urgently transferred. The Professor and chief of the Burn Division, UC Davis Department of Surgery recalls was when the chaos began. Within the next Forty eight hours, with fires raging, Twenty new burn patients were rushed to his facility (which usually admits one or two patients in a given day). The most severely injured man had burns on over half his body, with exposed bone and tendon; a month later, he and two other patients remained hospitalized, facing repeated surgeries. However, these were the patients fortunate enough to have made it to the hospital. At least Ninty five people died and nearly 20000 homes were lost in what is the largest California wildfire on record.
As physicians, we have an individual responsibility to safeguard the health and alleviate suffering. Working to curtail greenhouse gas emissions rapidly is part of the healing mission. The United Nations Intergovernmental Panel on Climate Change concluded that we need to cut global greenhouse gas emissions in half by 2030 and entirely by 2040 to avoid the most catastrophic effects of climate change. These emissions hit a record high towards 2018. Rapid but equitable changes in energy, transportation, and other economic sectors are needed if we are even to begin to meet the critical emissions-reduction targets. Handling this challenge may feel impossible, but physicians are well placed and, we believe, morally bound to take a lead role in confronting climate change with the urgency that it demands.
Individual lifestyle actions like walking and cycling and driving smoke emitting large SUV's, eating less meat, reducing food waste, and conserving energy are the easiest for us to undertake, offer many benefits for personal wellness, and allow us health-promoting behaviors as we reduce our environmental footprint. Individual actions are not effective to address the challenges we collectively face. The financial interests of organizations vested in the fossil fuel industry, a federal administration that disavows climate science and its responsibility to act, and inertia are powerful countervailing forces. Changing our institutions and society will therefore require an organized, and active effort.
Institutionally, a first step is for the U.S. health care system to recognize that we are part of the problem. The health care sector accounts for nearly 10% of the U.S. greenhouse gas emissions and reportedly would rank seventh in the number of such emissions internationally if it were its own country.
Health care professionals, therefore, have an ethical obligation to insist on a transformation of the way our hospitals and clinics operate. Kaiser Permanente, Partners HealthCare, and Boston Medical Center are examples of health systems that are showing leadership by cutting their greenhouse gas emissions and working toward carbon neutrality. Others have achieved energy independence several years ago and produces more energy than it consumes, using wind power, solar power, and methane from a local landfill. However, there is still much more to do to make health care “climate-smart,” we also need to ensure that our health care institutions are resilient to the effects of extreme weather and climate change.
Most Americans perceive climate change as a distant problem that will not affect them personally. Others feel powerless. Physicians can educate our colleagues, patients, and students about the health effects of climate change and the need for rapid reductions in fossil fuel use. We can help motivate people to act by clarifying the links between environmental degradation and real problems, such as air pollution, insect-borne diseases, and heatstroke. We can also emphasize the health benefits that we will achieve as we move to alternative sources of energy.
Beyond serving as educators, physicians and health institutions can engage in legislative advocacy, with a focus on the health imperative of addressing climate change. At one end of the support, the spectrum is directly contacting lawmakers to weigh in on the health implications of climate and energy policy. In our vast experience, personal contact from a physician attracts special attention and takes little time. For those who are open to more active involvement, testifying at public hearings and meeting directly with legislators is useful. Advocacy skills are increasingly included in the medical school curriculum, and most hospital systems have professionals devoted to government relations; talk about climate change should be part of their mission. Joining an advocacy organization, such as Physicians for Social Responsibility (of which we are members) or the Health Care without Harm Physician Network, can provide physicians guidance on promoting legislative action.
Financial divestment, with support from physicians, has been a useful instrument in other health movements, including efforts to thwart the tobacco industry. Much like the tobacco industry, fossil fuel companies have used their vast resources to sow disinformation and influence policymakers against the public interest. The American Medical Association and the Royal College of General Practitioners passed resolutions in 2018 asking for financial divestment from fossil fuel companies, joining other medical organizations, including the Canadian Medical Association. These actions set an example for other health care organizations, medical schools, and individual physicians, who can place together with their financial power with their mission of protecting health by divesting their retirement portfolios and endowments from the fossil fuel industry.
Some doctors may be willing to take more direct action in protest of policies that harm health. On this question, we agree with Charles van der Horst, who was arrested for protesting his state’s failure to expand Medicaid, that “In the face of great danger to our patient-remaining silent is not an option.”
We are frightened by the unfolding climate crisis, with its vast implications for the health of our communities and the future of our children. Rather than being paralyzed by despair, we should choose to focus our efforts on areas where our voices are most influential — for example, by working with medical students on climate action, supporting the undergraduate movement, joining forces with like-minded health professionals, and speaking with our legislators. There are currently more than a million Doctors in the United States and our actions matter. When will the next generation asks us, “What did you do about climate change?” we want to have the right answer.
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