Every climate solution is a health solution — both are badly needed

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“My allergies are getting worse, and this medication ain’t cheap.”

“It’s so hot where I work, and I can’t take the time to rest because we’re behind schedule.”

“No, I don’t have A/C and if I did, I couldn’t pay the bill — no way.”

These are common refrains I hear when I ask my patients about their daily lives.  For the past 34 years, I have served low-wealth, Black and Brown Miami-Dade communities with names like Opa Locka, Little Haiti, Perrine and Overtown. The people I treat are already feeling the effects of our rapidly warming world. Most of my patients are immigrants, documented and undocumented, working at the lowest tiers of South Florida’s thriving agriculture, construction, hospitality and health care industries. As an internist, I see patients with common chronic diseases such as COPD, asthma, congestive heart failure and kidney disease.

Research into the social determinants of health teaches us that health outcomes are more likely determined not by our DNA, but by our zip code.  Only 10 percent of our health outcomes are determined by our genes and biology.  Physical environment, health behaviors, as well as social and economic factors have a much bigger influence on our health. The poor patients I care for bear the brunt of the worst diseases because they live, work, play and love in oppressive environments shaped by policies that limit their access to opportunity, money and power.

The wise Robert Bullard, Ph.D. — whose self-described “kick-ass sociology” has led to his being dubbed “the father of environmental justice”  —  encourages us to look closely at maps, and see that the United States’ stroke belt, diabetes belt and heart disease belt all track very neatly with both the most polluted environments and higher concentrations of minority populations. Pollution places extra burdens on the health of Black and Brown people living in high-risk communities because of policies like redlining, where banks and government outlined “good” and “bad” neighborhoods and put highways, manufacturing, and other polluting facilities in the “bad” — i.e., non-white — communities.

Study after study points to the toll this takes on communities of color. For example, a review of dozens of studies shows a link between increasing heat and pollution associated with climate change, and babies who are premature, underweight or stillborn. Black mothers are 2.4 times more likely than white mothers to have low-birthweight babies. Black Americans are 40 percent more likely to have asthma than white Americans, and they are almost three times more likely to die from it. The rate of heat-related deaths for Black Americans is 150 to 200 times greater than heat-related death rates for white Americans.

Fossil fuel pollution is bad for our health. Mercury and lead target brain functions, and have serious neurological consequences, including stroke and loss of intellectual capacity. Particulate matter, sulfur dioxide and nitrogen oxides contribute to cancer, COPD, asthma, congestive heart failure, heart attacks and cardiovascular disease, which is the leading cause of death, in the United States. 

As our society ignored the impact of fossil fuel pollutants on vulnerable populations, the data mounted showing its byproduct gasses warmed our planet and changed our climate. The poor Black and Brown people are serving as the canaries in the coal mine, feeling its impacts first and warning us about the future. This warming has led to wildfires, drought, extremely intense hurricanes and tornadoes, infections like Zika and dengue in unexpected places, sea level rise and extreme heat.  According to the Union of Concerned Scientists, Miami will go from having just one day per year with a heat index of 105 degrees to having 59 days per year that “feel like” 105 degrees heat by midcentury. 

For the U.S. Latinx population, 55 percent live in three states — Florida, California and Texas — which are already experiencing serious effects related to climate change. They are also more likely to work in agriculture and construction, with higher exposure to rising outdoor temperatures. At a heat index of 90 degrees, outdoor workers become more susceptible to heat-related illness. At a heat index of 105 degrees, anyone could be at risk of heat-related illness — or even death — if they stay outside too long.

Scientists see these trends in the data, but as a doctor, I see them up close. My 2016 “aha” moment: A patient came in for an early refill on her breathing medicines made worse by heat, ground-level ozone, mold and mildew. She asked me to sign a form asking the power company not to cut her off for lack of payment, because if she didn’t run her air conditioner, she could not breathe. Now I see patients with the similar problems nearly every week. 

My patients inspired me to co-found Florida Clinicians for Climate Action to engage more doctors, nurses, and other health professionals to learn about climate, talk about climate, and act on climate. As clinicians, we hold power. A 2020 Gallup poll rated nurses and doctors at the top of the list for the “most trusted professionals.” I call on my fellow clinicians to use their power to obtain health as defined by the World Health Organization — a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity — for all. This can only occur if we speak out and support a rapid and equitable transition to clean energy, address the warming already baked into our planet’s system, and prepare our patients for the changes to come. 

Every climate solution is a health solution. For example, when we make homes more efficient with energy-efficient air conditioners, we help families lower their bills, improve indoor air quality and reduce pollution. But whatever policies we consider, we must ensure that poor communities are centered. We need urgent solutions to stop the pain and save lives. We must act now to protect the Earth — and every one of us.

Dr. Cheryl Holder is an associate professor and interim associate dean for Diversity, Equity, Inclusivity and Community Initiatives at the Florida International University Herbert Wertheim College of Medicine. She co-founded Florida Clinicians for Climate Action, which engages health professionals to learn about the health harms of climate change and advocate for equitable solutions.

Tags Cheryl Holder Climate change extreme weather Public health

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