Climate change is making it harder for me to do my job as a doctor – which is to improve health, prevent harm, address equity, and save lives.

Rene Salas, MD, MPH, MS
Department of Emergency Medicine
Massachusetts General Hospital 

Renee Salas, MD, MPH, MS, is an attending physician in the Massachusetts General Hospital (MGH) Emergency Department and a researcher studying climate change and its effects on human health and health care. She is lead author of the 2020 Lancet Countdown U.S. Brief which tracks the relationship between climate change and health across a number of key indicators. The Brief also analyses adaptation and mitigation tactics as well as socioeconomic, public and political engagement strategies to combat climate change. Salas also is the keynote speaker for the MGH Center for Environment and Health’s virtual Climate Change Symposium: Our Health Care System, Our Patients and You on Wednesday, May 27.  

Can you briefly summarize the findings of the 2020 Lancet Countdown on Health and Climate?

The 2020 Lancet Countdown on Health and Climate Change Global Report reveals the most concerning outlook for human health since its inception five years ago. Climate change induced shocks are harming health, taking lives, disrupting health systems and threatening livelihoods in all parts of the world and U.S. right now. No country – whether rich or poor – or any person in the U.S., is immune from the health impacts of climate change.

However, as our 2020 Lancet Countdown U.S. Brief outlines, certain individuals in the U.S. bear the greatest burden of harm due to age (e.g., children and older adults) or underlying health inequities from systemic racism (e.g., Blacks, Latinos, Indigenous, and other people of color). COVID-19 has acutely exposed these deep equity divides in this country, which have already been playing out with climate change on a longer timescale. Unless urgent action is taken, the health impacts and inequities of climate change are set to worsen – with our health systems at risk of becoming overwhelmed and unprepared for this future.

In addition, we show how climate change is intricately connected to air pollution because they both come from the same root cause – the production and use of fossil fuels. Thus, reducing our use of fossil fuels will also have near-term health benefits as air pollution improves.

A holistic response to the converging crises of COVID-19 and climate change, both compounding the unaddressed health inequities from systemic racism, can deliver a quadruple win: improved health, a more equitable society, a sustainable economy and a stable climate. We recommend six key prescriptions for better health and equity in the following areas: agriculture, fossil fuel subsidies, electricity, transportation, public health, and our recovery from the pandemic.

What relationship does climate change have to human health?

Climate change harms health through a frighteningly broad suite of pathways that result in direct and indirect harms to health and disruptions to health care systems, as outlined in our Interactive Perspective published in The New England Journal of Medicine. The exposures that harm health vary depending on where you live. For example, in the Northeast, we are experiencing more extreme heat, intensification of extreme weather, longer and more forceful pollen seasons, worsening of vector-borne illnesses like Lyme disease, and an ocean environment more suitable for water-borne illnesses caused by bacteria like Vibrio.

Climate change is a “metaproblem,” meaning it underlies other problems, and is a “threat multiplier,” making existing problems worse. I believe that our true understanding of how climate change is harming health is still in its infancy. For example, it has been found that rising temperatures are associated with increased bacterial resistance to antibiotics (2018 Lancet Countdown U.S. Brief). We can’t optimally prepare for what we don’t fully understand, and this stresses the critical need to urgently increase the research funding in this space.

As a physician, have you seen these effects first-hand? If so, how?

Climate change is making it harder for me to do my job as a doctor – which is to improve health, prevent harm, address equity, and save lives. For example, it is impacting the diseases my patients are experiencing as it exacerbates heart and lung conditions; how I counsel my patients about medication that may make them more at risk for heat illness, or their ability to protect themselves from harm during power outages.

While I may have the knowledge needed to treat my patients, I also need the right tools to provide optimal care. And our ability to deliver health care is being increasingly disrupted through destroyed health care infrastructure, power outages and fragmented supply chains. For example, following the category 5 Hurricane Maria in 2017, there was an intravenous saline shortage that even reached MGH. We had to ration IV fluids and instead give patients who didn’t meet a certain severity criteria a bottle of Gatorade. This story is just one of the many that highlight the far-reaching health implications of cascading failures.

How did you become interested in the intersection of health and climate change?

I first learned about climate change and health a few months after finishing my emergency medicine residency. I couldn’t believe that I hadn’t learned about this during medical school or residency, and I clearly saw that this was the greatest threat to achieving optimal health, health care delivery, and equity. It was a pivotal moment for me, as I truly felt a calling to redirect my career path to focus solely on this.

My practice as an emergency medicine doctor remains synergistic to my work on climate change, as the patients I see put a face and story to the data. For many of my patients harmed by climate change, I often feel as if I am putting a bandage on a bullet wound as I may be able to improve their immediate symptoms, but then I send them out my doors without having gone upstream to the root of the problem. This larger work allows me to target the root cause problems.

What can health care leaders and institutions do to combat the effects of climate change on patients?

While there are many important ways for health care leaders and institutions to get involved, I will highlight three. First off, it is important for the health care sector to amplify the message that climate action is a prescription for improving health, preventing harm, and addressing inequities. We need to ensure that health and equity are placed as the central drivers for climate action. Secondly, unprecedented challenges mandate unprecedented collaboration. The impacts of climate change, just like the pandemic, don’t affect just one health system in isolation. Institutions need to work together, and silos have to be broken down. Third, there is an immense urgency to act boldly on all levers of action. This includes adapting clinical practice to improve patient outcomes and strengthening health care system resiliency. It also means reducing health care’s own contribution to the problem through charting a course that reduces its own greenhouse gas emissions and air pollution.

You were a founding member of the MGH Sustainability Committee and now serve as an advisor for the newly launched Center for the Environment and Health. Can you briefly talk about why this work is important?

As health care increasingly internalizes and amplifies the message that climate action is a prescription for improved health and equity – it must also ensure that its actions are not fueling current and future harm to its own patients and making the jobs of clinicians harder. The new center seeks to ensure that a culture of sustainability is infused into all operations at MGH.

There is nothing harder for me than having a patient in front me that I don’t have a treatment for. Thankfully we have the treatments we need here – the solutions to reduce greenhouse gas emissions to as close to zero as possible, often called “net zero.” We just need the collective will to do it. We save a patient’s life in my emergency department by working as a team, and that is exactly how we need to tackle this – together. 

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