Public Health

Q&A: When fighting climate change, don’t overlook health equity

Sara Berg, MS , News Editor

From heat-related injuries, vector-borne diseases and air pollution from wildfires to worsening seasonal allergies and storm-related illness and injuries, patients are already facing adverse health effects associated with climate change. And like the COVID-19 pandemic, the climate crisis will disproportionately impact the health of historically marginalized communities.

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Medicine doesn’t stand still, and neither do we. AMA members don’t just keep up with medicine—they shape its future.

Jerry Abraham, MD
AMA member Jerry Abraham, MD, MPH, CMQ

That is why AMA member Jerry Abraham, MD, MPH, CMQ—a family physician and director of Kedren Vaccines at Kedren Health in Los Angeles, which is a lead responder for COVID-19 testing, vaccinations and therapeutics, providing more than 450,000 tests and more than 300,000 vaccines—has made it his mission to advocate for climate change.

“Climate change is in everyone’s lane and we’re all going to have to come together, from all sectors,” said Dr. Abraham, “especially from health and health care, where we are not only going to be impacted as individuals and members of society, but as those who are going to have to respond, mitigate, adapt and education people about what to do.”

“I’m doing my role and my little part, but I’m really excited to see the big role that AMA is playing,” he said. “And I hope that in the future the White House and the federal government continues to see how valuable physicians and health professionals are in this work around improving the health of the climate.”

In an interview with the AMA, Dr. Abraham discussed the importance of climate change.   

AMA: Why did you get involved with climate change and why is it important to be involved?

Dr. Abraham: One of the main disciplines in public health is understanding environmental and occupational health. And we know the occupational hazards associated with extreme heat. Imagine for agricultural workers right here in California’s Central Valley—these are truly public health emergencies. And they've been for decades—floods, heat, wildfires, air quality, water quality. They all are so interconnected and related.

It's just now they are becoming so dire, and we are truly starting to feel—in our daily lives—the impact, the economic costs, the public health, the health harms. We're having a different conversation than when I was in middle school or high school.

I'm sad that it's taken us getting so close to the brink for us to really do something. But coming from the public health lens we’re often reviewing things from that 30,000-feet-in-the-air perspective, and so you're really getting a glimpse of the forest. The value of medicine is that you really get to see those individual trees, talk about really caring for Mrs. Jones and being in the exam room and really understanding, in this case, the health harms, the health impacts of climate change.

You're constantly weighing that with the balancing act of the health of the public and the needs of the community. So that's why I love being in family medicine and primary care. We're constantly grappling with that exact tension, the individual in your exam room versus what's best for society. The climate crisis intersects and transcends all of that in ways that many of the issues that we deal with—as important as they are—just can't or don't or won't, and that's just the reality.

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AMA: Does seeing differences in air quality during the “stay home, save lives” early part of the COVID-19 pandemic play a role in more awareness for climate change?

Dr. Abraham: Even during the 2022 AMA Annual Meeting, we were watching in parts of India and Pakistan with excessive, extreme heats. You always hear it framed as once in a lifetime, once in 100 years, once in 10,000-year events, but they're happening so frequently. And yet, we saw during COVID how much our air quality improved and how when we all play our part. We really can change the course of human history.

In this case, it is that existential. We are debating whether our species will survive this ecological disaster—an event no different than that which wiped out dinosaurs from this planet. If we cross over certain thresholds, we will be in points of no return for our species and for many other species and life on this planet.

What is critical, and troubling, is that we have so much control over it. That's what's so hard about trying to help people understand. As I talk to a lot of people, not only to physicians and members at the AMA, within organized medicine here in California and L.A. County, I'm always having to remind people that this isn't just about polar bears and tree planting in wealthy neighborhoods and increasing property values.

This is about whether our children will be able to breathe and live lives free of asthma exacerbations, whether we will have food to eat, whether we will have clean water to drink, whether our seniors will suffer the consequences of heat strokes. Those are very real.

My Black and brown patients do and will suffer the most. We know that low-income countries and middle-income countries have the most to lose. They have voices and we want to elevate their voices. But right now, some of the best things that we can do is stand up, sound that alarm and call attention to it. And that's exactly what we did here at the June House of Delegates meeting where we robustly mobilized our house, we mobilized our delegates, we mobilized members of the AMA to boldly declare the climate crisis a public health emergency.

We know we're going to go a lot further if we can frame it in that way, and I hope that we do that—putting these patients at the heart of that work. There are literally people suffering and dying from these consequences and our inaction is part of the problem.

AMA: What does it mean that the AMA declared climate change a public health crisis?

Dr. Abraham: This is not some fringe topic. This is not a tree hugger or Greenpeace movement to save polar bears. This is literally a fight for our lives and for our habitats and for this planet. By having the AMA adopt such a policy, and for them to be an instrumental player in this movement, not only just to be a player—but to champion it—that really will help move Congress to action and that's so critical.

As we see all the priorities within the Biden administration, they are clearly prioritizing climate crisis and climate change, but we want to make sure that they do so in a way that prioritizes the health harms of climate change, really framing it as a climate health and equity issue. And we believe that by using that lens of public health, we're going to get a lot further.

We saw with the COVID-19 pandemic, the distrust, mistrust, misinformation pandemic. There are many people that the science will never appeal to—the science around vaccines, the science around how COVID-19 spreads, or why masks work or what we can do. That's the same thing in the environmental justice and the environmental health movement.

There's so much questioning of the science and the facts by people in the media, social media, from the lay public, civil society. And we know that that doesn't always resonate or pull on heart strings when we hear it from trusted messengers. That's why bringing the voice of physicians and health care workers to this conversation is so critical. We believe that people will take this more seriously when we're able to really directly link the changing climate to your health outcomes and the health of your community.

This is really not just an existential threat to the planet, but really a direct health impact to the individual, to our patients, to people. That really changes the conversation.

Related Coverage

How physicians can see health care through climate lens

AMA: Your passion really exemplifies why you received the Dr. Debasish Mridha Spirit of Medicine Award.

Dr. Abraham: I'm really thankful for these opportunities, but I really hope—more important than receiving the awards—that people hear the message and that people join together in these struggles. When we think about the struggles for women's rights, for equal rights, for the LGBTQ+ community, Black-and-brown health issues, it's these struggles where we've come together and overcome.

When we can really come together in these struggles, these high-pressure environments, where we are all feeling it, beautiful things will come out of it. It's not me, it's not Dr. Abraham, it's not the AMA, it's everyone. Every person plays a part. Everyone has that value. We are the people, and we together are very strong.

AMA: What can physicians do to help make a difference?

Dr. Abraham: We definitely want to continue to increase the science and the information, the research into the health harms and then how we can better strategize around that. For some of us it's going to be adapting.

Those of us in the Gulf Coast who are in the thick of hurricane season, those living near coastlines with rising sea levels, we're all going to have to adapt in ways. And our health infrastructure's going to have to meet those demands as people are injured, or people are harmed during those events—those natural disasters that are going to happen more and more. And so, we're going to have to increase our public health, our emergency medical, our emergency services and emergency department infrastructure to meet those demands, especially in those zones that'll be the most impacted.

But there's a lot that we can do also in mitigation. That is by doing those inventories, understanding what contributors we are responsible for, and then how can we actually create plans to reduce that reliance on oil or to reduce energy consumption, reduce emissions, reduce waste, reduce plastics. All of these things are connected.

We know that we can also work to electrify. There's still a lot that's being done on understanding what solutions work, but we do believe by replacing combustion engines—like our vehicles with electric vehicles—by removing gas-powered stoves in our homes to those that are electric, all of those things will contribute. Changing our energy from coal and moving toward solar panel, wind technology—all of that's going to help.

Our clinics or hospitals are on those grids and so we're going to have to find ways to continue to adopt and usher in all of these innovative solutions that together all help us take those really important baby steps and giant steps back from the brink of the Doomsday Clock, where we're at a point of no return.

There's no act that's too small. Whether it's on recycling, reducing waste, reducing our use of water, making sure that we replace light bulbs with greener technologies and reduce our electricity consumption in general—those are all very valuable pieces. Those individual pieces are absolutely critical and necessary. ...  

It's really going to be all of it—adaptation, mitigation, educating our workforce, continuing to bring more knowledge and science into this space so that we have more information that can help guide our policies. Then we're going to have to do our part to message and educate to the public when it comes to these issues.