Public Health

For Oregon doctors, climate change’s health impact is self-evident

Marc Zarefsky , Contributing News Writer

In 2020, wildfires intensified by warm, dry weather burned more than 1 million acres of land across Oregon. The next year, temperatures reached 116 degrees in Portland and about 800 people in Oregon, Washington and British Columbia died from record-breaking heat.

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The cause of these catastrophes is climate change, according to Colin Cave, MD, medical director of external affairs, government relations and community health for Northwest Permanente, a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Northwest Permanente is the medical group for Kaiser Permanente Northwest in Portland, Oregon. And from Dr. Cave’s perspective, climate change should be talked about and treated as a public health crisis.

"It's important that we focus on how climate change disproportionately affects certain communities, and those communities typically are communities of color," he said. "Climate change disproportionately affects people who are socioeconomically disadvantaged."

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Dr. Cave represents the Oregon Medical Association in the AMA House of Delegates, which in June adopted new policy declaring climate change a public health crisis.

He talked about climate change and how health professionals can help mitigate its impact during a recent video interview with the AMA.



Dr. Cave heard about climate change concerns for years, but he was struck by how quickly, and how damaging changes have been. Those most impacted have been individuals who live in "heat sinks," areas Dr. Cave described as having no trees and large amounts of concrete.

"When we look at the disease burden that is carried, the effects of climate change increase illnesses like myocardial infarction, strokes and asthma," he said.

Dr. Cave said Northwest Permanente sees a 5% to 25% increase in emergency room visits and hospitalizations every time there is a fire in the Pacific Northwest. He added that mental health is also of growing concern, for example, as people deal with the realities of losing their homes to fire.

Find out how Kaiser Permanente manages at the burning edge of climate change.

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How physicians can see health care through climate lens

There are actions health systems can take to try and mitigate the impact of climate change, Dr. Cave said.

The health care sector is responsible for 8.5% of greenhouse-gas emissions in the U.S. Kaiser Permanente was certified as carbon neutral in 2020 and earlier this year committed to a 50% cut in emissions by 2030 and getting to net zero by 2050.

At Permanente Northwest, Dr. Cave and his colleagues have monitored their amount of virtual visits since 2015. From 2015–2019, in-person visits rose by about 1.5% while virtual visits increased by nearly 40%. In 2020, with the onset of the COVID-19 pandemic, in-clinic visits dropped by 46%, while virtual visits increased by 108%.

A study based on that data was co-written by Dr. Cave and colleagues and published in The Journal of Climate Change and Health. The researchers found that telehealth can cut the carbon footprint from outpatients in half.

“It basically eliminated 9,000 metric tons of CO2 from being put out into the air in the Pacific Northwest," Dr. Cave said.

While such steps are encouraging, Dr. Cave said that more needs to be done.

"As hopeful as we are, and as much as we really want global warming to decrease, we're also realists," he said. "We want to be able to continue our role in mitigating climate change and mitigating our effect on climate change. We also understand that we need to be prepared to work and meet our mission of improving the health of our members and our communities in a climate-changed world."

Read this Q&A with AMA member Jerry Abraham, MD, MPH, CMQ, to learn why health equity shouldn’t be overlooked in the climate change fight.