Climate change is shifting how we live across the globe, impacting some communities far more than others, and forcing us to continue working to mitigate the damage and adapt to a new and changing environment. Nowhere is this need more important than in healthcare. Join us as we learn from Dr. Robert McLean (rheumatologist, advocate for climate justice, former ACP President) and Dr. Erika Moseson  (pulmonary and critical care physician, founder of Air Health Our Health) about the impact of climate on health and the ways we can work toward climate justice.

​Click here to obtain CME/MOC credit for listening to the episode!

Show Notes
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Learning Objectives:
Part 1:
  1. Explore the intersection between health, healthcare disparities, and climate change.
  2. Describe the breadth of the impact of climate change on historically marginalized and disinvested communities and individuals.
  3. Understand the various strategies to respond to climate change being adopted at the community level, frontline, and systems level in two different areas in the United States.

[0:00-2:05] Welcome and Introductions
  • Introduction of co-hosts, guests, and episode topic

[2:05-4:42] Introduction to Guests: Dr. Robert McLean and Dr. Erika Moseson
  • Dr. McLean
    • Internal medicine and rheumatology at New Haven
    • Past president of ACP
    • Associate Clinical Professor of Medicine at the Yale School of Medicine
    • Immediate past Chair of the Medical Society Consortium on Climate and Health Steering Committee
    • Member of National Academy of Medicine's Action Collaborative on Decarbonizing the U.S. Health Sector
  • Dr. Moseson
    • Pulmonary critical care physician with Legacy Medical Group of Oregon
    • Member of the American Thoracic Society's Environmental Health Policy Committee
    • American Lung Association Health Professional for Clean Air and Climate Action
    • Serves on the board of the American Lung Association of Oregon
    • Founder of Air Health Our Health podcast
    • Worked with the Oregon Medical Association to promote healthy climate action

[4:42-13:04] “Be the Change” Segment
  • Dr. Moseson
    • Dr. Moseson’s interest in climate health began while working with Oregon Thoracic Society and understanding the impact legislation has on the health of patients
    • Using legislation and connecting with lawmakers is a tool to make patient and physician voices heard
    • Air is invisible: lawmakers do not see the impact of tobacco, air pollution, unregulated diesel emissions, for example, however physicians are in a position to see these effects
    • Dr. Moseson also started a bilingual podcast regarding pollution and lung health to empower people with knowledge 
  • Dr. McLean
    • Dr. McLean's involvement in climate health began with ACP Advocacy work, recognizing the impact he had as a physician when working with legislators and policymakers
    • The ACP Policy paper in 2016 put climate health on the radar
    • Becoming the Chair of the Medical Society Consortium on Climate and Health’s initial Steering Committee helped grow his passion of advocating for climate solutions

[13:04-    15:33] Marianne’s Anecdotes about Intersection Between Climate and Health
  • Marianne’s experience working with a local health cooperative in El Salvador
    • Many young, healthy farmers were being diagnosed with chronic kidney disease
    • Dr. Ramón García-Trabanino, a nephrologist, would later describe this as Mesoamerican nephropathy
      • Mesoamerican nephropathy is an epidemic of kidney disease across Central America, primarily in young male farmers without other risk factors for chronic kidney disease
      • There’s a movement to promote preventive measures such as safe drinking water, adequate hydration, and reduced exposure to toxins
  • Marianne’s anecdote involving Portland’s heat dome event in 2021 
    • The heat dome event brought temperatures up to 116 degrees Fahrenheit 
    • A patient died in the hospital from a heat stroke due to a lack of air conditioning in her room 


[15:33-    21:00] How Do You Define Climate Justice in Healthcare?
  • Dr. Moseson
    • Climate justice means everyone being in the same boat in terms of having access to resources that can protect them from heat-related illnesses and being able to use paid leave when it’s unsafe to work outdoors in hot weather
    • We must work to ensure that everyone has access to clear air and decrease the health risks of those who are exposed to poor air quality
    • We need to address areas where there are limitations on resiliency
  • Dr. McLean
    • There are also global inequities where countries that aren’t contributing to pollution are still suffering from it
    • According to the Lancet Countdown report, there are developing countries who are suffering from more frequent flooding and other significant weather events 
    • The U.S. and other major countries are contributing to fossil fuel pollution, but we’re not experiencing the brunt of the impact it has on the world’s climate
    • We need more awareness of local and global climate injustices


[21:00-    30:52] Effects of Climate Change that Impact People and Communities the Most
  • Dr. McLean
    • Neighborhoods that live at or near interstate intersections experience much different air quality than neighborhoods who live farther away from interstate intersections 
    • Every time an individual hits the brakes of their vehicle, there’s an increased emission of particulate matter and thus, more air pollution
    • Local laws can mitigate the difference in air quality of these neighborhoods
  • Dr. Moseson
    • Freeway intersections are generally localized in communities with lower socioeconomic resources and often in historically redlined communities
      • A study in California found that Hispanic children are more likely to live close to freeways and be exposed to traffic pollution compared to non-Hispanic white children
      • Also, Hispanic children with indigenous ancestry were even more likely to live close to freeways
  • Wildfires are increasing particulate matter emissions and the particulate matter can cause disease 
  • A warming climate has led to infectious diseases spreading further and longer pollen seasons with pollen that’s more intense and allergenic
  • The warming climate and increased particulate matter emissions have also increased ozone exposure and formation
  • Massive climate events, such as floods and hurricanes, are costly and are happening more frequently, so we need to invest in addressing the issue now


[30:52-31:26] Closing
This is the end of Climate Change, Climate Justice, and Healthcare: A Beginner’s Primer, Part 1. Stay tuned for Part 2!

[31:26-32:17] Outro 

Credits:
Guests: Dr. Robert McLean, Dr. Erika Moseson
Co-Hosts: Dr. Marianne Parshley, Dr. Elisa Choi
Executive Producer: Dr. Tammy Lin
Co-Executive Producers: Dr. Pooja Jaeel, Dr. Maggie Kozman
Associate Producer: Dr. Candace Sprott
Senior Producer: Dr. DJ Gaines
Editor/Assistant Producer: Joanna Jain, Sanika Walimbe
Production Assistants: Leyna Nguyen, Dr. Erynn Beeson
Website/Art Design: Ann Truong
Music: Chris Dingman https://www.chrisdingman.com


References 

Guests’ Mentions
Dr. Moseson’s podcast and website:
https://airhealthourhealth.org/category/indoor-air-quality/
https://www.thoracic.org/patients/patient-resources/resources/climate-change-health-effects.pdf

Dr. McLean:
https://medsocietiesforclimatehealth.org/
https://www.climatechangecommunication.org/
https://nam.edu/programs/climate-change-and-human-health/
https://acpinternist.org/archives/2021/09/pollution-hurts-health-may-pose-pandemic-risk.html
https://climateforhealth.org/


Climate Justice and Health Equity
After COP26 — Putting Health and Equity at the Center of the Climate Movement
John M. Balbus, M.D., M.P.H., C. Joseph McCannon, A.B., Arsenio Mataka, J.D., and Rachel L. Levine, M.D.,April 7, 2022,N Engl J Med 2022; 386:1295-1297, https://www.nejm.org/doi/full/10.1056/NEJMp2118259?query=TOC
Air pollution (PM 2.5 particulates)

Rajagopalan S, Landrigan PJ.,  Pollution and the heart. N Engl J Med. 2021;385:1881-92. [PMID: 34758254] doi:10.1056/NEJMra2030281
Alexeeff SE, Deosaransingh K, Van Den Eeden S, Schwartz J, Liao NS, Sidney S. Association of Long-term Exposure to Particulate Air Pollution With Cardiovascular Events in California. JAMA Netw Open.2023;6(2):e230561. doi:10.1001/jamanetworkopen.2023.0561
Anondo Mukherjee, Michael C. McCarthy, Steven G. Brown, ShihMing Huang, Karin Landsberg, Douglas S. Eisinger, Influence of roadway emissions on near-road PM2.5: Monitoring data analysis and implications, Transportation Research Part D: Transport and Environment, Volume 86, 2020, 102442, ISSN 1361-9209,
https://doi.org/10.1016/j.trd.2020.102442
  • Brook RD, Rajagopalan S, Pope CA, et al; American Heart Association Council on Epidemiology and Prevention, Council on the Kidney in Cardiovascular Disease, and Council on Nutrition, Physical Activity and Metabolism. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121:2331-78. [PMID: 20458016] doi:10.1161/CIR.0b013e3181dbece1
  • Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med. 2019;381:705-15. [PMID: 31433918] doi:10.1056/NEJMoa1817364
  • Aguilera R, Corringham T, Gershunov A, et al. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nat Commun. 2021;12:1493. [PMID: 33674571] doi:10.1038/s41467-021-21708-0
  • D’Amato G, Chong-Neto HJ, Monge Ortega OP, et al. The effects of climate change on respiratory allergy and asthma induced by pollen and mold allergens. Allergy. 2020;75:2219-28. [PMID: 32589303] doi:10.1111/all.14476
  • Air Pollution and Mortality in the Medicare Population; Qian Di, M.S., Yan Wang, M.S., Antonella Zanobetti, Ph.D., Yun Wang, Ph.D., Petros Koutrakis, Ph.D., Christine Choirat, Ph.D., Francesca Dominici, Ph.D., Joel D. Schwartz, Ph.D.; June 29, 2017 N Engl J Med 2017; 376:2513-2522
  • Yu Z, Bellander T, Bergström A, et al; BAMSE COVID-19 Study Group. Association of short-term air pollution exposure with SARS-CoV-2 infection among young adults in Sweden. JAMA Netw Open. 2022;5:e228109. [PMID: 35442452] doi:10.1001/jamanetworkopen.2022.8109
  • Johnson, N.M., Hoffmann, A.R., Behlen, J.C. et al. Air pollution and children’s health—a review of adverse effects associated with prenatal exposure from fine to ultrafine particulate matter. Environ Health Prev Med 26, 72 (2021). https://doi.org/10.1186/s12199-021-00995-5
  • Mikati I, Benson AF, Luben TJ, et al. Disparities in distribution of particulate matter emission sources by race and poverty status. Am J Public Health. 2018;108:480-5. [PMID: 29470121] doi:10.2105/AJPH.2017.304297

Heat Related Illnesses and Injuries
  • Trabanino RG, Aguilar R, Silva CR, Mercado MO, Merino RL. [End-stage renal disease among patients in a referral hospital in El Salvador]. Revista Panamericana de Salud Publica = Pan American Journal of Public Health. 2002 Sep;12(3):202-206. 
  • Sanchez Polo V, Garcia-Trabanino R, Rodriguez G, Madero M. Mesoamerican Nephropathy (MeN): What We Know so Far. Int J Nephrol Renovasc Dis. 2020 Oct 22;13:261-272. doi: 10.2147/IJNRD.S270709. PMID: 33116757; PMCID: PMC7588276.https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-022-02861-0
  • Wesseling, Catharina,Newman, Lee S.; Chronic Kidney Disease of Unknown Cause in Agricultural Communities; 2019;New England Journal of Medicine;PG 1843-1852;V380-19;New England Journal of Medicine May 9, 2019 380(19):1843 https://www.nejm.org/doi/full/10.1056/NEJMra1813869
  • Johnson, Richard J., Wesseling, Catharina,Newman, Lee S.; Chronic Kidney Disease of Unknown Cause in Agricultural Communities; 2019; New England Journal of Medicine May 9, 2019 380(19):1843;  https://www.nejm.org/doi/full/10.1056/NEJMra1813869

Advocacy and Governmental actions around Climate and Health​
Tools for Advocating
Healthcare Sector Contributions
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Instagram and Twitter: @TheDEIshift
Email: [email protected]
Website: www.thedeishift.com

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Disclaimer: 
The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with. 

Season 5 of The DEI Shift podcast is proudly sponsored by the American College of Physicians Southern California Region III Chapter.  

​The DEI Shift theme music is by Chris Dingman. Learn more at www.chrisdingman.com. 

Contact us: [email protected], @thedeishift, thedeishift.com

Disclaimer

.The DEI Shift podcast and its guests provide general information and entertainment, but not medical advice. Before making any changes to your medical treatment or execution of your treatment plan, please consult with your doctor or personal medical team. Reference to any specific product or entity does not constitute an endorsement or recommendation by The DEI Shift. The views expressed by guests are their own, and their appearance on the podcast does not imply an endorsement of them or any entity they represent. Views and opinions expressed by The DEI Shift team are those of each individual, and do not necessarily reflect the views or opinions of The DEI Shift team and its guests, employers, sponsors, or organizations we are affiliated with.