When Gaurab Basu saw the news about wildfire smoke from Canada hitting the U.S. earlier this month, one of the first things he did was check his patient chart.
“I was scanning my chart for pregnant patients and thinking about whether we could reschedule or maybe do a televisit and have them stay at home instead of taking a bus to come in,” said Basu, a physician in Boston and health equity fellow at the Harvard T.H. Chan School of Public Health.
It was a prescient concern: One of Basu’s patients who already suffered from asthma had to be hospitalized for an aggressive cough and low oxygen levels, which Basu suspects were related to the air quality. A few hundred miles south in New York City, which saw even worse pollution from the wildfires, there were more than 1,000 asthma-related emergency department visits over the weekend after the smoke event. “It’s been a hard few months for my patients with asthma. I had more conversations about air quality with my patients and colleagues than ever before,” Basu told me.
These conversations are becoming more and more common. Across the country, healthcare providers are watching in real time as climate change affects their patients’ health, from wildfire smoke to particularly bad allergy seasons, extreme heat, and vector-borne diseases like Lyme and dengue fever. In response, clinicians of all stripes are increasingly talking about climate change in their practice — and in effect becoming climate educators.
“Climate change is a huge public health concern, and part of my role as a physician is to highlight awareness,” said Neelu Tummala, an otolaryngologist (an ear, nose, and throat specialist, or what’s colloquially known as an ENT) and co-director of the Climate and Health Institute at George Washington University in Washington, D.C. “It’s not to scare people and say that global warming is going to be the end-all of society, but to make them conscientious of it and maybe inspire them to act on it.”
Healthcare providers occupy a rarefied space in American society. Nurses consistently rank as the most trusted profession in the country in an annual Gallup poll, followed closely by doctors and pharmacists (high school teachers were fourth in the 2023 poll; journalists are distrusted by a plurality of Americans). Patients tend to listen to what their clinicians have to say. That makes them uniquely placed to talk about climate change.
“We make it human,” Basu told me. “There’s a lot of translational work we can do, because emissions and pollutants are confusing and abstract and kind of invisible.”
As climate change increasingly moves from concept to lived reality, bringing it up in the doctor’s office is just a natural progression of the conversation a healthcare provider has with their patient. Take Tummala, whom I first met as a patient myself: I have a history of allergy-induced asthma, and before being taught how to calm my body down I would sneeze and wheeze my way through allergy season. So when I went to Tummala for a consultation this spring, it made sense that she mentioned, as our visit was wrapping up, that climate change was making allergy season worse.
Education has always been part of the job for healthcare providers; they routinely discuss medical science with their patients, whether when discussing individual diagnoses like diabetes or broader public health concerns like, say, COVID-19 or Mpox. But all of the clinicians I spoke with told me that for many patients, their conversation was the first time someone had drawn a connection between climate change and health, and in some instances the first time they’d heard of climate change at all.
The main difference between educating their patients about climate change and other public health concerns, Tummala pointed out, is that the solution to climate change lies not in medical research but in policy. There is no vaccine for climate change; the most a healthcare provider can do to address the problem within the confines of their clinic is give their patients tips for living with the impact of a global issue far beyond their control.
That also means this is new territory for clinicians, some of whom may not even know much about climate change themselves. As Karen Pennar wrote for STAT News in April, there’s a growing, student-led movement to incorporate climate change at medical schools across the country, and some programs, like those at George Washington University and Harvard Medical School, have begun adding climate change to their curricula. But there are already millions of clinicians at work across the country, and reaching them is just as important as training the next generation.
“It’s great to say we’re going to train the next generation of healthcare professionals, but the reality is climate impacts are here,” said Cecilia Sorensen, director of the Global Consortium on Climate and Health Education at Columbia University. “We can’t wait ten years for kids to grow up and start doing their own jobs. We have to train the existing health workforce.”
That means training not just doctors but also nurses and other clinicians who often spend more time with patients than doctors do. Academic initiatives like the Global Consortium are developing workshops, webinars, and other training programs to close the gap, and clinicians are also coming together on the local level: Tummala is on the steering committee for a group called Virginia Clinicians for Climate Action, or VCCA, which organizes educational events for clinicians at hospitals and clinics across the state of Virginia.
“Many of us in practice are figuring this out together and learning together,” said Samantha Ahdoot, a pediatrician and founder of VCCA. “It’s really a whole new field of medicine that’s developing quite quickly.”
As the name would suggest, VCCA goes beyond education. Its members directly advocate for climate policy at the state level, from an annual lobby day in Richmond to testifying on the health impacts of climate change at public hearings. This kind of political organizing is a tricky line to walk: Doctors are pressed for time and energy already, and their involvement in advocacy of any sort is sometimes frowned upon — as illustrated by the recent case of Indiana doctor Caitlin Bernard, who was reprimanded after speaking publicly about an abortion she provided for a 10-year-old girl.
Climate change is just as embroiled in the culture war as COVID-19 and abortion are, and the clinicians I spoke with told me they’re careful to separate any advocacy work they do from their conversations with their patients. Instead, they focus on the patient’s experience of the changing world, as Tummala did with me. That grounds those conversations in the health impacts and makes clear she’s speaking from a perspective of transparent, science-driven healthcare rather than advocacy.
“We have the ability to depoliticize this. We can talk about this as a health issue, not a political issue,” Tummala told me. “You have to meet people where they’re at. If you, for example, try talking to a patient about losing weight, they may think you’re judging them. But if you bring it up in a way that shows it could help their sleep apnea or heart disease, they may be more willing to listen. I think it’s the same with climate change.”
In Cheryl Holder’s experience, those health realities are harder to deny than the high-level concept of climate change. “I get pushback from folks who are not experiencing it like my patients experience it,” said Holder, founder of Florida Clinicians for Climate Action (FCCA) and a physician who primarily treated members of lower-income communities until she retired last December. As part of her advocacy mission with FCCA, she started using Instagram and TikTok to talk about the connection between climate change and health — and she would inevitably see comments from climate deniers.
Her conversations with patients, however, were a different story. Most of them worked outdoors, where they could tell things were changing. “If you work outdoors and you feel the heat, see the grass growing faster and the trees flowering earlier, you know something is happening,” Holder told me. “When I tell them it’s because of pollution from humans, they accept it.”
But just as a patient may decide not to follow a doctor’s advice for treating a medical condition, Basu accepts that sometimes the climate conversation just won’t land. That doesn’t make him any less likely to bring it up, however.
“Hopefully, the patient can trust in a pattern of me making good decisions about their care enough that they believe in [the climate connection],” Basu told me. “I think that’s a critical moment to bring people into the conversation, and to do it with care.”
IEA