Environmental Approach to Population Health?

By David Thill

Physician group calls on providers and suppliers to act now in order to mitigate the effects on public health

A major physicians’ group is calling on its members to address a condition that it believes is adversely affecting population health – climate change.

“The evidence for global climate change has been mounting for several decades, but over the past several years we are also seeing the manifestations through untoward health effects,” says Nitin Damle, M.D., MS, FACP, and current president of the American College of Physicians (ACP). “Our members are seeing increased rates of asthma and [Chronic Obstructive Pulmonary Disease] exacerbations, longer and more severe allergy seasons, effects of heat waves on vulnerable populations, and the spread of tick-borne and waterborne disease.

“As an organization that cares deeply about its patients, we felt it was important to make policymakers, patients, and legislators aware of the consequences and mitigation strategies.”

In its April 2016 position paper from the Annals of Internal Medicine, the ACP declared that it “strongly concurs with the finding of the Intergovernmental Panel on Climate Change (IPCC), which has stated that ‘human influence on the climate system is clear.’” Anthropogenic (human-caused) greenhouse gas emissions must be substantially curbed to hold the global average temperature increase under 2 °C (3.6 °F) above preindustrial levels, as established in the 2015 Paris Agreement under the United Nations Framework Convention.

Action needed
Doctors, patients, and suppliers can all play a role in curbing greenhouse gas emissions and avoiding “devastating consequences for public and individual health,” according to the ACP.

For example, physician offices and hospitals can switch to energy efficient building designs, as well as solar and wind-powered energy sources, and reduce fleet emissions. Hospital vehicles can use efficient and alternative fuels. Recycling can help, and doctors can also choose suppliers with efficient or alternate-fuel standards. Patients can become advocates for clean energy and communicate with legislators and policymakers to encourage adoption of mitigation strategies.

Distributors should be aware of efficiency factors in the production and transportation of their products, adds Damle. “Use recycled products and materials, use vehicles with clean emissions, use local suppliers, [and] use waste conservation techniques.”

The ACP ends its position paper by referencing the Lancet Commission on Health and Climate Change, which states that addressing climate change could be the greatest global health opportunity of this century. “The medical profession – by being an objective and trusted source of information about the effect of climate change on health – must be at the fore of this opportunity to make Earth a sustainable home for future generations.”

David Thill is a contributing editor for Repertoire.

(Source: American College of Physicians Annals of Internal Medicine)

Resources for physicians

The American College of Physicians is calling on the healthcare sector to “implement environmentally sustainable and energy-efficient practices and prepare for the impacts of climate change to ensure continued operations during periods of elevated patient demand.”

Repertoire readers can direct their customers to a couple of resources cited by the ACP.

  • My Green Doctor, a website supported by the World Medical Association, the Florida Medical Association, and the Florida Academy of Family Physicians, offers physicians free online materials and suggestions to make their offices, staff, and procedures more environmentally conscious, and encourage patients to do the same. These resources include a series of workbooks focusing on topics ranging from energy efficiency to drug disposal to transportation. There are also several resources, including a “sustainability policy” for offices to adopt, a blog on current events in healthcare and sustainable practices, and educational brochures that physicians can print for patients to read in their waiting rooms. (http://www.mygreendoctor.org)
  • In 2014, the U.S. Department of Health and Human Services released “Primary Protection: Enhancing Health Care Resilience for a Changing Climate,” a tool kit for healthcare facilities with guidelines for how to respond to extreme weather. “Disruptions and losses incurred by the U.S. healthcare sector after recent extreme weather events strongly suggest that specific guidance on managing the new and evolving hazards presented by climate change is necessary,” according to HHS. The document provides background information about climate change and healthcare, as well as a five-element framework for healthcare facilities to follow to become resilient to the effects of climate change:
  1. Multi-hazard assessment – understanding climate risk: Maintain current data on climate hazards and infrastructure vulnerabilities, and prepare infrastructure risk assessments.
  2. Land use planning, building design and regulation: Understand the building regulatory, design, and land use planning context in which the facility is situated.
  3. Infrastructure protection and resilience: Invest, design and construct new sustainable infrastructure in appropriate locations and to a higher standard of hazard and climate resilience to withstand future events.
  4. Protect vital facilities and functions: Understand priority and vulnerable functional needs. (For example, hospitals must be able to provide essential services during and after a disaster.)
  5. Environmental protection and strengthening of ecosystems: Protect ecosystems and natural buffers to mitigate floods, storm surges and other hazards to which the building, campus or city may be vulnerable.

(Source: United States Department of Health and Human Services “Primary Protection: Enhancing Health Care Resilience for a Changing Climate” tool kit: https://toolkit.climate.gov/sites/default/files/SCRHCFI%20Best%20Practices%20Report%20final2%202014%20Web.pdf)

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