Part 1: Climate change is a determinant of health

Beth Malow:
Hi, I’m Dr Beth Malow. I am a neurologist at Vanderbilt Medical Center in Nashville, Tennessee, and I’m here with my colleague, Dr Ali Saad. We did a session this morning on climate change and health, and tried to fill in our colleagues at the American Academy of Neurology meeting on what’s going on with climate change and also what they can do to make a difference. And Ali did a lovely job basically reviewing in about 15 minutes all the highlights of where climate change and health is currently at. So I’m going to let Ali share for you a little bit of what he shared with our audience today.

Ali Saad:
Thank you, Dr Mallow. So I’m Ali Saad. I’m also a neurologist. I live in Denver in Colorado and I practice here. I specialize in stroke, and I’m affiliate faculty at the University of Colorado’s Climate and Health program. So when it comes to climate and health, there are two main ways that climate change interacts with health. One is through pollution. Pollution, through greenhouse gases, is the main driver of climate change but now it’s also being recognized as a social determinant of health. So things like air pollution, extreme heat, they cause direct health problems through mechanisms like dehydration, inflammation, and trigger people who already are predisposed to things like stroke, heart attack, migraines, epilepsy, cognitive impairment like dementia, it can be the trigger and an exacerbating factor for having clinical manifestations of those diseases.
The other way that climate change interacts with health is by affecting the social determinants of health. So extreme weather events like droughts, wildfires, flooding… these things destroy infrastructure, they destroy housing, and they affect crop yields and people’s access to food. So just by affecting those social determinants of health, especially people living in low wealth countries, low wealth communities, people that are under-resourced, they are at especially high risk, but no one is spared. We’re seeing it across all countries and across all demographics.

Beth Malow:
And I want to add that it’s also across all specialties or subspecialties of neurology. I’m a neurologist who specializes in sleep disorders and even there, for example, if it’s too hot, it’s harder for people to sleep at night and not everybody can crank up the AC. Some people have economic challenges and they just don’t have the money to put into air conditioning in the summer in the sweltering heat. So I think it’s really important to recognize that this issue really it cuts across subspecialties and neurology.

Ali Saad:
Yeah. And we do have the greatest data for two particular areas of neurology: stroke and dementia. We know that air pollution specifically accounts for anywhere from 13 to 25% of global stroke risk. The World Stroke Organization quotes 20%. And for dementia, it accounts from anywhere from 2 to 6% of dementia cases. And we just had a publication in the Neurology Journal from the American Academy of Neurology earlier this week, or sorry, last week, I should say, where they found that there were an excess of over 500,000 deaths worldwide from extreme temperatures as a result of climate change, specifically deaths from stroke.

Part 2: What can neurologists do about climate change?

Beth Malow:
There are many things you can do, and we always start out by saying neurologists should recognize that climate change is not a political issue, but a health issue, that it’s truly in our lane. Climate change is something that is linked, for example, to air pollution and has, as Ali said so eloquently, all sorts of neurological consequences, including stroke and dementia. We really believe that there are ways neurologists can effectively talk with their patients, and it’s truly in our lane. It’s very central to health, climate change, and some of the things that we talked about this morning that we continue to emphasize are joining some sort of group. It can be extremely helpful. It might be a group at your university or your medical center. It could focus on sustainability. It could focus on cutting carbon emissions in your medical center. It can also be something like, for me, it was joining one of the one of the national climate groups. There are Citizens’ Climate Lobby. There’s other groups that are out there that you can make a difference in.

And then we formed a group called NICHE: Neurologists Interested in Climate, Health and Education. And the focus of our group is really to get neurologists deployed and get them excited and enthusiastic. And as part of that, we’ve set up a website. We’ve made some recommendations to the American Academy of Neurology that we would love for them to adopt, and they’re actually actively considering them right now, which is very exciting to us. So, for example, there’s a medical society consortium on Climate and Health that you can join as an individual or organizations can join. And we would love for the American Academy of Neurology to consider joining that. We also really applaud the AAN for including our session as part of the annual programing this year. And you had a session last year, if I’m remembering correctly. So we really appreciate that and we’d love to see more programing over the years. We’d love to expand our session if possible.
And then also when you look at the publications, for example, the Green Journal, Neurology, there have been many, or I should say there have been several publications in the last year or two on climate change and health, and we would like to see even more, because that’s where neurologists go for their information. And when they read about not only what’s going on, but how they can make a difference, it can really spawn lots of effective action.

Ali Saad:
And of course, the organizations we mentioned are free to join. And we’re not just seeing publications in Neurology, but other mainstream neurological journals like Stroke, like The Lancet…

Beth Malow:
Sleep Medicine.

Ali Saad:
Yeah, yeah, a lot of the big ones. Another thing I’d like to highlight is when we talk about advocacy, what people usually think of is forming committees or subcommittees, talking to their members of Congress, um, maybe even going to the Hill and protesting. And doctors have been involved in these issues for years, whether it comes to reproductive rights or disarming new nuclear missiles. But I think what’s unique about climate and health advocacy is you can do all of those things focusing on decarbonizing, working with your health care system, working with your city… but there is a modality that’s accessible to not only neurologists, but any health care professional that has a huge impact on climate chang and that’s our food. Because when you look at this one resource we presented this morning, Project Drawdown, it ranks personal behaviors based on how impactful they are at reducing carbon emissions and the top two were reducing food waste and incorporating more plants into our diet, without necessarily being vegetarian or vegan, just more plants. And that’s something that I think all doctors can get on board with. Addressing food insecurity and getting people to eat healthier, even without directly being involved in climate change. This is a very powerful form of climate advocacy that all doctors should be doing primarily for health with excellent climate co-benefits.

Beth Malow:
Yeah, very well said.

Part 3: The future of climate change and health

Beth Malow:
The action plan is for any neurologist to think about what they can do, where they are. It may be legislation, it may be going and talking with your members of Congress, but it may also be cutting back on the meat you eat and really adopting some vegan or vegetarian habits. Not necessarily becoming a full blown vegetarian, but considering putting more plant based foods in your diet. It might be talking to people at your medical center about sustainability efforts, cutting down on emissions that your institution is doing. It might be getting more education out to your trainees. Medical students, the next generation really getting them involved. It may be doing and promoting more research into the impact of climate change in health. My passion is climate change communication and teaching others how they can communicate with their friends, their colleagues, their patients to really get that ripple effect going, where you can make a difference in how you communicate with someone, and then they start communicating with the people in their circles. And then before you know it, everybody’s talking up about climate change and the need to move forward on that issue.

Ali Saad:
There have been surveys showing that medical students want to learn about it, at least in the US, but it’s lacking in terms of how well it’s integrated into the curriculum, largely because it’s not a requirement for a medical school to become certified. It’s not one of the, um, the core learning objectives. But now we’re seeing that climate change is a social determinant of health. And as we’re recognizing other social determinants of health, I think it’s just a matter of time before major organizations like the American Medical Association, the AAMC, will hopefully issue recommendations that medical schools have to start teaching about these things. There are so many things medical students already have to learn and if it’s not going to be on a test and if it’s not required for a certification for that medical school, it’s going to be really hard to integrate that into the curriculum. But I think it’s just a matter of time before it is.

Beth Malow:
And I think the good news is the generation behind us, the younger generation, really cares about climate change. I mean, we have young conservatives, young republicans are extremely passionate about climate change and it’s a very important area to our young people. And that includes our young people in medical school and residency. So I think if we can give them those opportunities, they’re going to grab them and jump on them and be really active in their world, whether it be research or education or advocacy.

Ali Saad:
And we’ve already seen this with other things like DEI, diversity, equity and inclusion. Medical students were asking for it. Undergraduate students were asking for it. It became part of the Dean’s agenda. And once it becomes part of the institutional agenda at a university or a medical school, it trickles down to the other departments and it influences the rest of society and the rest of the educational system.

Beth Malow:
Yeah, absolutely. I mean, medical students have told me that they will decide where to go for their residency based on how active a university is related to climate and sustainability, it means a lot to them. It meant a lot to my son when he made his decisions about college, knowing where the college stood and what their values were related to climate and the environment.

Part 4: The role of medical societies

Beth Malow:
So the EPA… you spoke about that. Why don’t you start with that?

Ali Saad:
Yeah. So, our colleagues in climate medicine have been researching and publishing the effects of pollution and climate change on health. And one of the things they found is one of the major components of air pollution, PM2.5, or particulate matter 2.5, is one of the components of air pollution that has the strongest data for poor health outcomes, and by demonstrating that here in the US, the Environmental Protection Agency recognized that data and now lowered what it considers the safe level of exposure for that component of air pollution. So I think more research is critical at influencing public policy. And in order to encourage more research, we need major medical societies like the American Academy of Neurology, like the World Stroke Organization, like the American Medical Association, to issue positions saying, we recognize that climate change is a social determinant of health. We recognize that it impacts these specific diseases, and we realize that it’s modifiable and there’s stuff that we can do about it. And by having those positions, it incentivizes grants. It incentivizes research, and it aligns with what policymakers will see as something valuable, something mainstream, recognized by our main medical societies and authoritative sources.

Beth Malow:
Very well said. I mean, I think that a neurologist listening to your broadcast, there’s so many different ways that they can get involved. They can get involved in doing the research. They can get involved in the advocacy, taking the research and communicating it to legislators. They can do it by encouraging medical students and other trainees to get involved in research and education and advocacy. So there’s so many different ways to get involved.

Ali Saad:
And as you said, Dr Malow, it’s you know, people ask us this question all the time, how can I get involved? They want to do something. And what it really comes down to is what are you passionate about and where is your sphere of influence? So if you’re a medical educator, great, integrate into the curriculum. Please visit our website. We can provide resources and give you the right connections. If you are a department head, you can change your departments institution. If you’re on the medical executive council for your hospital or you’re a board member, that’s another sphere of influence for your researcher. So it all depends on what you’re able to do and what you love doing.

Beth Malow:
One of the things we did this morning in our course is we specifically asked people to talk to their neighbor at their table and come up with action plans, and there was a lot of enthusiasm for it. I really believe that AAN and its members can change the needle on climate change and health.

Ali Saad:
I would just end by saying that this is well within our lane as clinicians, because it is something that affects health, and I think physicians should feel empowered. And more specifically, neurologists should feel empowered that there is data out there. And we are the authoritative source on what is good for our brain health. And we need to speak up and use that power and authority.

Beth Malow:
And I’ll just add that poll after poll shows that physicians are considered to be trusted messengers. People trust us more than other people, like politicians. People really trust their doctors and health care providers. So it’s squarely in our lane, especially when we add in health. It’s apolitical to talk about health because everybody cares about health. So I would really encourage neurologists to speak up.