by Laalitha Surapaneni, MD, MPH
Most medical societies around the world and in the United States have published statements outlining the effects of climate change on human health. In its December 2017 issue, the American Medical Association Journal of Ethics discussed whether it is ethical for physicians to engage in advocacy around climate change. The articles cover a broad range of topics from global public health to discussions with individual patients in the office. The journal also discusses the role of physicians in mitigating health effects of climate change, sustainability efforts in health care organizations, individual patient choices of fertility in the context of climate change and the ethics of genetic modification to make our species more adaptable to climate change.
Catastrophic images of climate change are ubiquitous in popular culture. Images depicting submerged cities because of rising sea levels are familiar to many. However, in reality, effects of climate change on populations are much more insidious. An article discusses the case study of gradual displacement over the past two decades of citizens of Tuvalu to New Zealand. Chronic flooding of neighborhoods, destruction of freshwater supply, drought and spread of waterborne diseases are some of the main issues prompting displacement. If climate change continues to affect humans as predicted, physicians all over the world will need to equip themselves to care and advocate for a new generation of climate refugees. The article concludes that it is ethical for the physicians in island nations and the international community at large to educate the public about the effects of climate change on health and advocate for these vulnerable patients’ best interests. However, the authors also emphasize the need for a non-paternalistic, culturally sensitive and tailored approach.
Divestment from fossil fuels is a trend that is strengthening. Many educational institutions - and recently, New York City - have moved their investments from fossil fuels, citing ethical reasons. An article by Zaidi describes how energy poverty necessitated investment in cheap fossil fuels in the past. He points out however that “the residual benefit after subtracting the public health costs of polluting energy from the public health benefits of energy poverty reduction - came paired with global climate losses." The article recognizes that with cheap renewable energy on the rise, global health and climate health are now synergistic goals.
Zooming in from a global perspective to an office setting, a case study discusses a hypothetical situation of how clinicians can communicate climate change to their patients. The discussion acknowledges the highly politicized nature of climate change. It talks through several fears physicians might have about the need to maintain a politically neutral position with their patients. The article also cautions physicians that they need to distinguish between their roles as a health expert and as a private civic-engaged citizen. Finally, the authors give clinicians a practical example of how to communicate with patients. They discuss the possibility of a letter to the patients in the practice or a pamphlet in the waiting room that would detail the health effects of climate change.
Dr. Andrew Jameton, from Minnesota PSR, outlines concrete steps for physicians on climate change advocacy as well, including expanding medical school curricula on climate and global change and promoting physician awareness of this topic. He also urged the AMA to create a sustainability division with a climate sustainability expert at the helm.
Finally, an article by Dr. McPherson proposes a framework that outlines why physicians should advocate for climate change. They identify expertise, effectiveness, proximity, uniqueness, low-risk or cost, severity and public trust as the seven criteria in the framework. In a powerful statement, the authors state, “Physicians’ silent acceptance of ongoing rates of greenhouse gas emissions risks undermining their ability to uphold public trust." The authors call upon physicians from the U.S. to join their British colleagues in engaging with climate change activism. The authors conclude that physicians have a responsibility to educate about health impacts of climate change and to advocate for solutions. Advocacy by physicians that is evidence-based will not only serve the public interest but will also counterbalance politicization of the topic.
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Dr. Surapaneni is a board member of Chesapeake PSR.