The Impact of Global Climate Change in Health Care

Author, M. Snyder, BSMIS; Co-author, Arshad-Snyder, Siti, Ed.D., CPHIMS | ☀

Abstract – The irrefutable evidence surrounding human-derived global climate change has been accumulating over many decades. In August of 2021, the Intergovernmental Panel on Climate Change (IPCC) released its 3,949 page report on climate change entitled; “Climate Change 2021: The Physical Science Basis (AR6)^-[**][∞].” One-hundred sixteen (116) climate experts (scientists) from around the world^-[*] examined historical climate data, assessed its implications, and added new evidence to that already gathered in the IPCC’s 2013 and 2019 climate reports—which is the underlying subject and premise of this case study. The multinational panel concluded that human activities, particularly with respect to greenhouse gas (GHG) emissions, have put the planet and its nearly 8 billion inhabitants in significant peril. What is also evident, as well as potentially foreseeable, are the impacts global climate change will have on global health and its administration and management. The combined effects of deteriorating air and water quality globally along with the climatic catastrophes brought about by floods, more intense storms, sea level rise, heatwaves, wildfires, and drought will most likely impact food supply chains, create suitable breeding grounds for human pathogens, and unleash a plethora of interconnected health related issues due to the mass migration of climate refugees. Therefore, it is critical to understand the mechanisms driving global climate change and how those might impact health care services and its effective management or administration.

^-[*]42 countries-Algeria, Argentina, Argentina, Australia, Bangladesh, Belgium, Brazil, Canada, Chile, China, Colombia, Denmark, France, Germany, India, Indonesia, Ireland, Italy, Jamaica, Japan, Madagascar, Morocco, Mozambique, Nepal, Norway, Pakistan, Philippines, Poland, Portugal, Republic of Korea, Russian Federation, Senegal, South Africa, Spain, Sri Lanka, Sweden, Switzerland, The Netherlands, Ukraine, United Kingdom, United States of America, Vietnam

^-[**](AR6) Assessment Report 6

^-[∞](AR6) Synthesis Report 6 (update)

Top ten oil producing nations in the world: 1) Russia – 10.58 million BPD; 2) Saudi Arabia – 10.13 million BPD; 3) United States – 9.352 million BPD; 4) Iran – 4.469 million BPD; 5) Iraq – 4.454 million BPD; 6) Canada – 3.977 million BPD; 7) China – 3.383 million BPD; 8) United Arab Emirates – 3.174 million BPD; 9) Kuwait – 2.753 million BPD; 10) Brazil – 2.622 million BPD [citation 12]

Introduction
This case study on climate change and its impact on health and healthcare management overlaps a number of scientific disciplines and is grounded in research that has been collected and analyzed for over a century. In 1896, Swedish scientist Svante Arrhenius proposed the hypothesis of whether burning fossil fuels, such as coal, could potentially increase the levels of carbon dioxide (CO₂) gas in the atmosphere and thereby raise the planet’s average temperature [citation 10]. While this “greenhouse effect” was one of many plausible causes, it wasn’t until the 1960s that global climate change was discovered to be of concern. Dr. Charles Keeling kept extensive atmospheric carbon dioxide measurements that would later be used to not only understand the planet’s carbon cycle, but to also serve as “…a valuable benchmark for testing our understanding of the response of land ecosystems to climate change [citation 11, Exhibit 1].” While the plausibility of climate change may be passionately debated within the scientific community and the world’s legislative bodies, dismissing it completely out of hand and projecting it through the lens of Occam’s Razor–rather than viewing it as a complex and dynamic problem–may be a bit myopic. This case study, therefore, should not be viewed as a position paper, or as provocation for scientific or political debate, but rather as an opportunity to add perspective to the subject of climate change and its potential impact on health and healthcare management. Moreover, it should be used as a way to direct thoughtful discussion toward a more informed perspective on climate change and to prepare for the what ifs surrounding it. According to the Lancet-UCL, “Climate change is the biggest global health threat of the 21st century [citation 8].”

Climate Change Defined
According to the Intergovernmental Panel on Climate Change (IPCC); “Human activities are estimated to have caused 1.0ºC (1.8ºF) of global warming¹ above pre-industrial levels, with a likely range of 0.8ºC (1.44ºF) to 1.2ºC (2.16ºF). Global warming is likely to reach 1.5ºC (2.7ºF) between 2030 and 2052 if it continues to increase at the current rate (high confidence)” [citation 3]. Climate change is, therefore, a phenomenon that is primarily and broadly characterized as a) happening now; b) being driven primarily by human activity (anthropogenic); and c) capable of being ameliorated in terms of its impact and progression [citation 4]. Climate change differs from the natural patterns of weather, climate, and climate variability in terms of the degree to which it interferes with those natural patterns. The disruptions to global weather patterns are determined by use of “…statistical tests to determine the probability that changes in the climate are within the range of natural variability” [citation 4].

In a nutshell, global climate change is the result of over 200 years of industrial emissions of greenhouse gases into the earth’s atmosphere. These gases, over time, have begun to interfere with the earth’s natural mechanism of regulating atmospheric heat. Greenhouse gas emissions form a thick covering (blanket) that traps heat in the earth’s troposphere rather than allowing it to escape into space, thus interfering with the earth’s thermal regulation and energy balance [citation 6]. The gas emissions that are known to be primarily responsible for climate change are composed of carbon dioxide (CO₂); methane (CH₄); nitrous oxide (N₂O); black carbon (i.e., soot; particulates from wildfires, wood stoves, etc.); and fluorinated gases (hydrofluorocarbons (HFCs), perfluorocarbons (PFCs), sulfur hexafluoride (SF6), and nitrogen trifluoride (NF3)). Other global warming potential (High GWP) gases such as chlorofluorocarbons, hydrochlorofluorocarbons, and halons are referred to as ozone-depleting substances and are emissions that typically occur in smaller quantities [citations 4 & 5].

Of all the gases emitted into the earth’s atmosphere, atmospheric carbon dioxide (CO₂) is the most consequential and concerning. Furthermore, it has been determined that atmospheric carbon dioxide is the greatest contributor to climate change and its associated effects. Removing or reducing the short-lived climate pollutants (SLCPs), such as methane, black carbon, and fluorinated gases, will only “buy time” as the transition from fossil or carbon-based energy/fuels to zero-emission or renewable sources of energy² progresses [citation 4]. Given what we know about the earth’s atmospheric chemistry, it is clear that GHGs have altered that chemistry and are causing five critical global environmental changes: 1) warming temperatures of the earth’s surface and the oceans by 0.13ºC (2.34ºF) per decade since 1957); 2) changing the global water cycle (i.e., hydrologic cycle – annual precipitation has been disrupted globally over the past century); 3) shrinking glaciers and snowpack (i.e., globally, glaciers have receded in area, volume, and mass, and diminishing ice and snowmelt has impacted watersheds across the globe); 4) causing sea level rise (i.e., due to warmer and expanding water as well as melting glaciers); 5) triggering ocean acidification (i.e., 25% of emitted CO₂ is absorbed by the earth’s oceans, which is leading to a lower PH/higher acidity level) [citation 4].

[Graphic: citation 3]
Source: https://www.ipcc.ch/site/assets/uploads/sites/2/2019/05/SR15_SPM_version_report_LR.pdf

These changes in atmospheric chemistry have given rise to greater variability in terms of weather that produces “wetter wets”, “drier dries” and “hotter hots.” This all translates into “more frequent and severe extreme heat events; more severe droughts; more intense precipitation, such as severe rains, winter storms, and hurricanes; higher average temperatures and longer frost-free seasons; longer wildfire seasons and worse wildfires; loss of snowpack and earlier spring runoff; recurrent coastal flooding with high tides and storm surges; more frequent and severe floods due to intense precipitation and spring snowmelt; worsening air quality (higher temperatures increase production of ozone–a key contributor to smog–and pollen, as well as increasing risk of wildfires); and longer pollen seasons and more pollen production” [citation 4]. Given all that we know about global climate change and its mechanisms, researchers continue to gather climate data so that climate models can be updated and revised to determine if progress is or is not being made. In any event, global climate change will greatly influence how health care systems plan and respond to its effect on human populations in the United States and around the world. Given its global effect, human migration (i.e., climate change refugees) may one day end-up at America’s doorstep seeking refuge and relief from extreme weather events, sea rise, and food shortages. Our ability to respond may require considerable pre-planning to meet that challenge.

Impacts From A Health Care & Health Care Services Perspective
The effects of global climate change are beginning to be profoundly felt now more than ever before. Unprecedented heat waves, droughts, wildfires, severe weather, flooding, and sea-level rise have all acutely impacted the planet in ways that have been immensely damaging and catastrophic. For example, disruptions in the world’s food supply chain can occur on many levels, whether from damage caused to infrastructure; to agricultural lands; to fresh or saltwater fisheries; or to carbon-absorbing forests, the world’s supporting sources of nutrition that are regarded as essential in warding off malnutrition, as well as those health issues related to it, are becoming a growing concern [citation 1]. In addition, climate change can bring about a host of social infrastructure impairments that can have injurious consequences in terms of serious economic and social disruptions [citation 2]. These infrastructure impairments that are characterized by heat-waves, extended periods of drought, severe weather, floods, fires, poor air quality, etc., can lead not only to malnutrition from supply chain disruptions, but also to injury, increased stress, disease, and mortality [citation 2]. To lessen the impact of those infrastructure impairment brought about by climate change it is essential to remain proactive: According to the 2014 IPCC’s Working Group II’s Assessment Report 5:

“The negative effects of climate change on health may be reduced by improved health services, better disaster management, and poverty alleviation, although the cost and effort may be considerable“
[citation 2]

The IPCC’s Assessment Report also identified three ways that climate change affects health: “1) directly, such as the mortality and morbidity (including “heat exhaustion”) due to extreme heat events, floods, and other extreme weather events in which climate-change may play a role; 2) indirect impacts from environmental and ecosystem changes, such as shifts in patterns of disease-carrying mosquitoes and ticks, or increases in waterborne diseases due to warmer conditions and increased precipitation and runoff; and 3) indirect impacts mediated through societal systems, such as undernutrition and mental illness from altered agricultural production and food insecurity, stress, and violent conflict caused by population displacement; economic losses due to widespread “heat exhaustion” impacts on workforce; or other environmental stressors, and damage to health care systems by extreme weather events” [citation 2].

In the United States, the health care system could very likely confront an increased incidence of heat-related medical conditions such as heat rash, heat cramps, heat exhaustion, or heat stroke. In addition, as global temperatures rise air quality may become compromised by noxious air pollutants released through photochemical reactions that increase the concentrations of ground-level ozone, airborne allergens, and harmful airborne pollutants or particulates. The combined effects of excessive heat and poor air quality could potentially give rise to higher rates of respiratory tract diseases such as asthma and rhinitis as well as aggravate existing respiratory conditions. Eye and skin disorders such as conjunctivitis, dermatitis, and eczema may also become more prevalent. Conversely, just as climate change can cause heat waves and droughts, it can also cause some geographical areas to receive excessive amounts of rain that can produce flooding and long periods of standing water [citation 2]. The consequences of flooding increase the likelihood and spread of waterborne diseases by creating a suitable breeding ground for disease carrying insects and by releasing harmful contaminants or chemical toxins into the flood water (i.e., sewage, wastewater, chemical runoff, etc.). Human contact with insect pathogens and poisonous water contaminants after a catastrophic flood event, will most likely be a more common scenario for health care to plan for should climate change worsen [citation 2].

Along with the environmental impact of climate change on human health and its associated effect on air and water quality, there is also the health impact from extreme weather events such as flooding, tornados, and hurricanes. These dangerous weather and geophysical events not only destroy essential infrastructure, but can also cause serious injury to human life. Disruptions to critical infrastructure such as power, water, and communications can limit, or gravely impact, a health care system’s ability to respond and provide the vital care essential in saving lives and in caring for the wide-ranging health care needs of a community. Disaster planning is essential to ensure that adequate back-up for critical health care infrastructure is available in the event of a catastrophic weather event.

Impacts From A Health Care Management Perspective
When we think of the many interconnected components of a health care system, we may think first of the individual health care providers who diagnose, treat, and care for patients in a variety of health care settings. Beyond the individual level, however, is the public dimension of health care that operates at the community and environmental levels [citation 9]. As climate change continues to impact and affect ecosystems, economies, and human health, health care managers must understand and confront the challenges climate change presents. Understanding the core challenges of climate change beyond its health care implications is within the purview of healthcare managers whose chief focus is on the access, quality, and cost of health care [Exhibit 2]. These core challenges have already had an impact on access to health care. From 2000 to 2017, nearly 75 percent of the 158 hospital evacuations were a result of “climate-sensitive events”; more than 50 percent required 100 patients or more to evacuate from a healthcare facility. In California, wildfire prevention measures–instituted either directly or indirectly to climate change related events–caused nearly 250 hospitals to simultaneously lose power; moreover, it is expected that wildfire related power outages will become more frequent [citation 7].

Disruption to a health care system after an extreme weather event can be costly, can reduce the quality of care, and can lead to worse patient outcomes. For example, a study conducted after Hurricane Maria slammed into Puerto Rico discovered that the mortality rate was 62 percent higher than the previous year. Ten other climate-sensitive events from 2012 were studied and it was found “…that associated hospital admissions, emergency department and outpatient visits, home health care, and medication use totaled $1.5 billion” [citation 7]. The aforementioned examples are expected to continue well into the future, even as the decarbonization of greenhouse gasses picks-up pace.

When we consider the cost of current and future climate-related impacts on health care infrastructure, we can’t ignore the meager investments that are being made to ameliorate its impact. As of 2016, “only 5 percent of all US climate resilience investments went to the health care sector [citation 7].” If public health funding continues to remain a low budgetary priority, it can be expected that preventable climate-related morbidity and mortality will be affected negatively. Therefore, it is important that more resources (i.e., funding, infrastructure improvements, staffing, emergency medical supplies, etc.) be expended in the public health care domain so as to bolster the sort of infrastructure resilience that can respond to any human health care crisis related to climate change.

As previously mentioned, sufficient funding support to establish a more durable health care infrastructure is a necessary component to address the issues of healthcare access, cost, and quality in the era of global climate change. Without the appropriate health care infrastructure needed to respond to climate sensitive events it may be difficult, if not impossible, for a health care system to provide the capacity or resilience necessary to achieve favorable patient outcomes. A very good primer with respect to the discussion of climate change and health care policy is Salas, Friend, Bernstein, and Jha’s commentary published in 2020—“Adding A Climate Lens To Health Policy In the United States [citation 7].” The authors’ concise assessment of the key vulnerabilities within the healthcare system call attention to how climate change will make healthcare delivery more problematic.

To confront these key vulnerabilities, the authors made the following policy suggestions with regard to public health infrastructure: A data driven approach, national surveillance for climate-related health risks, and coordinated resilience planning; and with regard to health care delivery: Health care system decarbonization, resilient infrastructure and supply chains, interoperable information flow, and climate-ready workforce; and with regard to payers: Medicare and Medicaid risk mitigation and incentives for decarbonization [citation 7]. The commentary also identified key knowledge gaps requiring further research if the climate lens is to have “greater clarity [citation 7].” For instance, more study is needed with respect to determining which populations are the most vulnerable to climate related exposures and what characteristics play a key role in those exposures. Understanding more comprehensively how climate change will affect the healthcare system systemically will tie-in to better risk-benefit calculations and how to deploy resources more effectively. This, along with other data, will guide “…strategic investments and policy [citation 7].”

While this case study can only begin to scratch the surface of how climate change can or will affect healthcare management, it should provide a good jumping-off point with which to explore its implications further and to begin to more fully grasp and appreciate the challenges climate change will pose to health care managers, health care workers, and the health care community as whole. It is suggested that a review of the prominent citations buttressing this case study be done to gain further context of the relevant points presented herein.

Footnotes
1 Present level of global warming is defined as the average of a 30-year period centred on 2017 assuming the recent rate of warming continues.
2 Solar, wind, hydroelectric, biomass, geothermal, tidal and wave energy sources.

Citations
https://www.ipcc.ch/srccl/chapter/chapter-5/ -[1]
https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap11_FINAL.pdf -[2]
https://www.ipcc.ch/site/assets/uploads/sites/2/2019/05/SR15_SPM_version_report_HR.pdf -[3]
https://climatehealthconnect.org/wp-content/uploads/2016/09/Climate101.pdf -[4]
https://www.epa.gov/ghgemissions/overview-greenhouse-gases -[5]
https://scied.ucar.edu/learning-zone/atmosphere/layers-earths-atmosphere -[6]
https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2020.01352 -[7]
https://climateandhealthalliance.org/wp-content/uploads/2018/02/UCL-Lancet-Managing-the-Health-Effects-of-Climate-Change.pdf -[8]
https://www.apha.org/-/media/files/pdf/topics/climate/hc_vs_ph_factsheet.ashx -[9]
https://www.scientificamerican.com/article/discovery-of-global-warming/ -[10]
https://scrippsco2.ucsd.edu/history_legacy/charles_david_keeling_biography.html -[11]
https://worldpopulationreview.com/country-rankings/oil-producing-countries -[12]
https://www.sealevel.info/co2.html -[13]