Heat waves and health, with Frederick Chen, MD

In collaboration with the PermanenteDocs Chat

. 20 MIN READ

Moving Medicine

Heat waves and health, with Frederick Chen, MD

Oct 4, 2023

Frederick Chen, MD, chief health and science officer at the AMA, discusses the connection between climate change and public health, highlighting the effects of extreme weather events, vector-borne illnesses and implications for patients of all ages. This episode, in collaboration with the PermanenteDocs Chat podcast, is hosted by family physician Alex McDonald, MD.

Speaker

  • Frederick Chen, MD, chief health and science officer, American Medical Association

Host

  • Alex McDonald, MD, family medicine physician and host of PermanenteDocs Chat, Kaiser Permanente

Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.

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Unger: Welcome to Moving Medicine—a podcast by the American Medical Association. Today’s episode was produced in collaboration with the PermanenteDocs Chat podcast, featuring AMA Chief Health and Science Officer Dr. Freddie Chen. He'll discuss the impact of climate change on public health. Leading the conversation is the host of PermanenteDocs Chat, family medicine physician Dr. Alex McDonald.

Dr. McDonald: Hello, everyone. Welcome to this week's PermanenteDocs Chat. Thanks for joining from wherever you may be watching, listening, signing in. I'm your host, Alex McDonald. I practice family and sports medicine here at Fontana, California, as part of the Southern California Permanente Medical Group. Today's chat is another collaboration with the American Medical Association, which I'm very excited about. Today we're discussing health and the climate and the warming climate with Dr. Frederick Chen, who is the Chief Health and Science Officer at the American Medical Association. Welcome, Dr. Chen.

Dr. Chen: Great. Hi, Alex. Call me Freddie.

Dr. McDonald: All right, Freddie.

Dr. Chen: It's great to be here. Thanks so much for having us.

Dr. McDonald: Awesome. Well, if you're listening to this live on the webinar, if you have questions, you can drop them in the Q&A. We'll try to get to as many of those as we can, but this is only a 20-minute discussion, so get your questions in early and we're just going to jump right in. Freddie, tell us who you are and what you do.

Dr. Chen: Yeah. Again, it's great to be here. My name's Freddie Chen. I'm a family physician, trained at UCSF actually, and so a shout-out to some of my colleagues from there. Then came up to Seattle, did my family medicine residency up at the University of Washington, and pretty much stayed there for the last almost 25 years where I was a chief of service at Harborview, which is our county hospital. Then most of my academic work was in health policy, public health with a focus on rural and on physician workforce issues. Then for the last year, I moved over to the American Medical Association. We're based in Chicago, and I'm the chief health and science officer there. I oversee public health, science and ethics for the AMA.

Dr. McDonald: Wonderful. Well, thank you so much for being here. We could go down lots of rabbit holes together regarding health policy and public health and family medicine, but we're going to try to keep this focused on health and the climate today. Just correct me if I go too far off course. Now, there's been lots of weather events in the news recently—the Maui wildfires, the wildfires in Canada as well as Washington, and personally and most recently, the first tropical storm here in Southern California in 80 years. How are these severe weather events affecting people, affecting health and affecting how physicians in the health care infrastructure can respond?

Dr. Chen: Yeah, that's exactly what we're here to talk about today. I'll start by acknowledging all of those extreme weather events that you just mentioned. During the pandemic, I actually served for a time as a medical director for Hawaiian Airlines. The folks I worked with there were particularly impacted by the wildfire in Maui and my thoughts go out to them. The governor there, by the way, is a family physician as well, Dr. Josh Green. He's the only physician governor in the country. He and his team have been super engaged with that. I was just in Chicago yesterday. It was 102 degrees. Came back to Seattle, and there's wildfire smoke here too. I mean, all of those things that you just mentioned, they are top of mind certainly for us at the AMA, KP, but really our patients and our communities as well.

I think one of the main messages we have today is just, as physicians and as leaders in our health care organizations, our attention on climate change and on these health effects is important and valuable. It really helps add to the conversation around it, the attention on these problems, and it really adds that unique medical and health aspect of it that makes it real for people. We talk a lot about the asthma effects, infectious disease effects, cancer mortality effects. There's an element of that that we bring legitimacy to and science to—and we can really help contribute to the national conversation.

Dr. McDonald: Yeah, that's such a good point. There are, I think, a lot of physicians who are very passionate about this and understand the direct link between the weather and the climate and health. I think asthma, respiratory illnesses, heat illness, obviously are the biggest things. There are a lot of physicians who say, "Look, this isn't something we should be focused on. We should be focusing on more traditional issues as physicians within organized medicine." What do you say to those physicians who maybe don't think this is something that we should really be advocating for?

Dr. Chen: Yeah. You know, we used to say that about things like smoking too, right? It is definitely part of our evolution, I would say, as an organization, by the way. I mean, when we went back and looked at AMA's history in environmental health and ... we didn't call it climate change issues back then, but it goes back actually a hundred years plus, so water safety, air safety. It's actually been a longstanding interest, because part of our mission is the betterment of public health. I think that part, there's been a longstanding recognition at the organizational level.

I agree. I think it's the same reason why we had a hard time getting our heads around social determinants of health, but now nobody would argue that racism, housing, education, income and poverty, all have effects on people's health—and climate change is definitely one of those. I would also add that it's not just a small group of your physician colleagues who are engaged in this and interested in it. It's a majority of them, and your patients, as we were just talking about, are really affected by it and I think want to hear what you have to say about it.

Dr. McDonald: Yeah. I've had conversations with colleagues who feel maybe this isn't something we should be delving into over the last several years, and I've seen them definitely shift position over time in understanding—again—as a family physician, my job is to prevent illness. If it's not safe for you to go outside and go for a walk, if the ozone levels are dangerous for people with respiratory issues, how can we ignore that when it's directly impacting their health? I'm glad to hear that, even from your perspective, you think that the majority of physicians understand and want to address this issue. What types of effects? What are some of the main effects you're seeing from your role at the AMA that are the most pertinent health effects that are directly impacting our patients from some of these more severe weather events?

Dr. Chen: I think the most common ... and like CDC's MMWR just today came out with a report around early June and when the wildfire smoke affected East Coast cities, which by the way gets a lot more attention than when it happens on the West Coast.

Dr. McDonald: Right, exactly.

Dr. Chen: The days that were the highest, the worst air quality days, there was like an 80%, almost a doubling of ED visits and asthma visits and that. The respiratory and air quality piece is an easy and most common example. I've been really focused because our purview in public health includes a lot of infectious disease stuff, vector-borne illnesses. We are hearing about malaria cases, dengue cases, zika—so mosquito- and tick-borne illnesses. As the climate shifts, as the temperature shifts, we're going to see more of those. That's going to be a piece of it.

Then as you saw with the wildfires, this is also environmental disaster medicine type stuff. It's not just in the world of emergency medicine, but it's how do you prepare your communities. How can you be better prepared? Then after something happens, where's the access to health care there, and what are those resources available? It really is so broad and far-reaching, in terms of all different aspects of health and health care.

Dr. McDonald: Yeah. No, it is funny you should bring up the vector-borne issue, because as many of you know, I got a whole bunch of rain at my house this past weekend here in Southern California, which is very unusual for this time of year. There was mosquitoes in my house today, actually this morning. My son had a bunch of bug bites, and I found there's some puddles in the backyard. We never have mosquitoes this time of year in the desert here in Southern California. I can speak personally to that one, or more probably, my son can speak personally to that one.

Dr. Chen: Oh, exactly. I mean, yeah. The hurricane, the storm, was exactly it. We just don't have to go very far anymore for examples, and for reasons why we have to be prepared and be able to talk about it and be able to engage in it.

Dr. McDonald: Yeah. Tell us more about heat effects, particularly our elderly and our very young pediatric population, how some of those heat illnesses and heat effects can really become more problematic.

Dr. Chen: Yeah. I think the acute piece of that, of course, are these heat-related illnesses and heat stroke, and what we've seen and continue to see. I mean, there's a heat dome over the Midwest right now, and you just see these tremendous spikes in temperature that are correlated with mortality spikes. It's really helping people think about how to cope with heat and how to prepare for it. What are the resources? I know our clinics, we talk about cooling centers, when those get opened up and then identifying those. That's the clinical level of it, which is how do we manage these heat-related illnesses. I think the bigger picture then is also what are the sequelae of them. What are the other long-term effects of a warming planet?

Dr. McDonald: Yeah. How can physicians better educate themselves to understand some of these impacts of the climate and health, and how can they help their patients and their communities prepare? I think preparedness is obviously a huge component.

Dr. Chen: Yeah. The good news is, because of this increased attention, we're getting better and better resources for teaching physicians about where you can go out and learn. There's the AMA's Ed Hub that has a number of CME materials around climate change that you can look at. We're part of the terrific Medical Society Consortium on Climate and Health, and that group has a great website. We can share it with you, and they've got a ton of information there that you can actually just learn about, and then there's CME opportunities as well to learn about it.

Some of it is, I think as a family doctor, it's not so much you have to learn about the pathophysiology of it. It's really let's talk about what this means for your patients. What's happening at home for them? What are they going to do, and how can they be better prepared? Does that mean they need to go somewhere shelter-wise? Do they need to go somewhere else? Do they need to have those kinds of resources available for them? You and I—we know who our more vulnerable patients are for those kinds of effects. I think that's the kind of thinking that we have to bring to our exam rooms and to our conversations with folks.

Dr. McDonald: Yeah. I think one thing, a lot of patients don't even realize about some of the resources out there. I'm always telling my patients, particularly my older patients, for here in Southern California. I live in a little bit inland where it gets to be 100 degrees regularly and letting them know that there's a discount they can get through their electric company if they need to run their air conditioning more often. I help them fill out the paperwork to apply for those discounts through the electric company.

There were cooling stations set up in my community a couple of weeks ago when there was extreme heat, and just making people more aware of those resources. I think there's just so many different … it feels much like our health care system sometimes, it's this patchwork piece and people just aren't even aware of those parts which don't always communicate. It can be very frustrating for patients and physicians to know what's available in your community.

Is there some specific place? I'm sure it's highly localized and individualized for every community, but is there somewhere where physicians can learn more about these places, and patients can learn more about these places and resources within their local community?

Dr. Chen: Yeah. I've just been starting to see some pretty good resources from CDC at a national level, and then they will actually break out to local resources based on your state and local public health resources, so that's good. Then we're also seeing our state and local medical societies also be really involved with this kind of work too.

Dr. McDonald: Yeah. I know one thing, here at Kaiser Permanente we have a community navigation tool called Thrive Local, at least here in Southern California, where you can go on there. It's a little slow. Just give yourself some time to do it, to find some local community resources for all different kinds of social determinants of health, to get people the resources they need. Just because, again, it's very challenging for some folks to put all these together.

Dr. Chen: Actually—and Alex—before I forget, because you did ask about kids, and certainly the infants, they've got a bunch of thermoregulatory challenges that we've got to be mindful of, but all kids of all ages as they're outside and trying to be active in playing sports, as you know, with the temperature pieces being a really important thing to keep in mind for all of them too.

Dr. McDonald: Absolutely. In my work in sports medicine, especially in August with football players, especially wearing all the pads and the helmet, and the heat can make a big issue. By the way, extra points for using the term thermoregulatory. You sound very smart when you use that term, so I like it.

Dr. Chen: That's right. Well, it is the AMA, so that's good.

Dr. McDonald: That's good. That's good. We have a question here in the chat. We spoke about this a little bit before, but maybe there's more to expand here. The question, "What guidance can physicians give their patients about really preparing for climate events like heat and fires or tropical storms?"

Dr. Chen: Yeah. We have to recognize that, as we saw in Maui, some of this stuff, because of the nature of nature, actually it is about emergency preparedness. Some of the stuff, there's only so much you can do. As we're seeing, we're talking right now about summertime, but in a few months, we'll be talking about extreme cold events as well too. It is an opportunity. It's not an every-visit kind of thing, but as you're doing anticipatory guidance and you're talking to people about what resources they have at home, the same way we do about housing, stable housing or about other things.

It's what resources do you have. How prepared might you be if it's hurricane season, if it's hot season coming up, if it's cold season coming—all those kinds of things. I think we are well positioned to be talking about those things and asking about it. It is a little bit of a stretch for some of us, but I think it's something that unfortunately we're all facing.

Dr. McDonald: Yeah. Yes. I think here in Southern California when I first moved here, I was worried about earthquake preparedness. Here, we're talking about a hurricane. It was a very odd shift. I think that makes a good point, just preparing just in general for anything.

There's a question in the chat here which I think is actually a really good one, and I was going to get to it. Unfortunately, a lot of these public health issues have been politicized for probably bad, but for multiple different reasons. How do we help? "When we have these conversations with patients, how do we prevent it from becoming more political versus about just health and evidence-based medicine?"

Dr. Chen: Well, I think that gets to the nature of our daily work. That is us in the exam room, us in the hospital with patients. We're bringing it from a trusted source. You're addressing something because of their health. You're not addressing it because of politics. We're talking, and that's why we're having this conversation. That's why it was important when the AMA in 2022 declared climate change a public health emergency.

It elevated it at a level that said, "This is not just a political issue. It is a political issue, but it's actually a health issue, and I'm talking with you about it because of your health and because we have a trusting relationship, personal relationship around it." I think that's the fundamental piece of it. That's how you open that door. You pick and choose your time, and you pick and choose your topics and battles with patients, as you know, but as good clinicians, you'll have opportunity to do that. It's something to keep in mind.

Dr. McDonald: I think, again wearing my family medicine, primary care hat, that's where that relationship and that continuity of care comes in. It becomes so much more important. Having taken care of perhaps the kids, the parents, the grandparents for years and years, you build that relationship over time. When you have those maybe more challenging conversations, it comes from a very different place than if you're being seen and right away in the first visit, you start talking about gun violence and gun safety and climate change and vaccines. It can be off-putting for some individuals. I think using our people skills and that continuity is really, really important. That's a great point.

Dr. Chen: I should also add—if you want to get political with it—that's what the AMA is for and that's what your organizations are for too. The other thing I wanted to make sure we say is the role of physicians is not just with your individual patients, but in your communities and in this national debate. The vehicle for that is our hospitals and health systems, which actually everyone understands are contributors to global warming. A lot of our systems on OKP have made a commitment to it. There's a role for doctors to be involved with that and to make change at that level.

And then at our organizations, our professional organizations, these are opportunities for leadership and for being involved in it. If you want to get political about it, there's a place for that too. We recognize that that's the role of AMA. We're here to advocate for doctors on the issues that are important to them. They help tell us what direction. Our members help tell us what direction to go on them. We're on the right side on a lot of these issues, including this one for sure.

Dr. McDonald: Yep, absolutely. I'm very proud to be a part of Kaiser Permanente and have several physicians and leadership participating in the NAM leadership for climate change as an example as well. I think when we're talking to physicians, you think about individual advocacy with your patients in the exam room. You think about in your clinics, in your hospital systems. You think about in your state and then at the national level too. I think, again, that's why I'm a member of AMA and the member of the California Medical Association, is to really advocate at the policy level higher up, which can really affect all the pieces downstream. Again, we'll save that 20-minute conversation or 40-minute conversation for another day.

Dr. Chen: Would love to. Anytime. Anytime.

Dr. McDonald: I do want to wrap up, to keep this pretty high-yield and brief for our listeners. Last question, what makes you most proud to be a physician member of the AMA?

Dr. Chen: Yeah. AMA has a long history, some of it not so great, and you may have heard a lot about that coming up through school. Certainly, that was my experience too. What I've learned about AMA since being there is that the organization has really shifted quite a bit over the last 10 years. We are, like I said, on the correct side of many, many issues now and really fighting for doctors.

What I've been really impressed with is AMA is still the voice for the nation's physicians. When the White House needs to talk to physicians, when the CDC needs to talk to physicians, it's the AMA that they talk to. We're in that great position with all of our specialty societies, with all the state societies, to get that message out. As we've mentioned before, when AMA talks about something, people actually listen and it makes a difference. That's pretty exciting. It's good to be part of that. It's good to be part of an organization that's really looking out for the profession and for the health of the public.

Dr. McDonald: That's a perfect note to end on. Thank you so much, Freddie, for joining us today, sharing your expertise and also all the work that AMA is doing around climate change and health. It's just so important. Thank you.

Dr. Chen: Yeah. It's great to be here. Thanks so much for having me.

Unger: Subscribe to Permamente's Docs Chat podcast so you'll never miss an episode or register to take part in an upcoming live chat. Visit permanente.org/amadocschat.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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