Expert Q&A: Climate at the limit

Are there health effects of climate change that might surprise people?

Heat and heat stress can really affect the body systemically. We often think about heat stroke and acute dehydration — outcomes that are very easy to connect to excessive heat exposure, but what we’re seeing more and more, especially with chronic heat exposure, is that even moderately warm temperatures can affect health.

We’re particularly concerned about conditions that affect the cardiovascular and respiratory systems, because both are under increased stress when temperatures rise. We see impacts of heat on things like heart failure, heart attacks, renal disease, infectious disease and pulmonary conditions such as COPD and asthma.

So it’s really important that people, clinicians and communities understand that chronic health conditions that many people live with, even something as common as hypertension, can be exacerbated during heat events in ways that we can measure. It’s not necessarily as dramatic or acute as someone becoming severely dehydrated or suffering heat stroke, but we can see measurable increases in things like hospitalizations for heart attacks on hotter days.

The projects I work on are mostly focused on older adults, particularly the Medicare population, who we know are a vulnerable group. They often have some of these chronic conditions that can make them more susceptible to heat. 

But these effects can occur across the life course. People with lower adaptive capacity — including young children and people who are pregnant — can also be particularly vulnerable to heat.

How can public health systems prepare for accelerating global warming?

We have to think about ways to increase people’s ability to adapt and their capacity to withstand these exposures. And that happens at both the individual and systemic levels.

Climate and weather should be thought of as exposures that clinicians can help patients prepare for, just as they would for other health risks, in order to prevent some of the exacerbations that can happen during extreme weather events.

Practically, that can mean access to air conditioning, which is a huge issue. It can mean access to medications, particularly if people are unable to go out or are trying to avoid going outside. We also need to think about people’s ability to stay connected to their communities and get the things they need.

And then there are notification systems. In general, people have to seek out air quality forecasts for day-to-day exposures (like checking AirNow or having alerts set up), whereas we have more established systems for heat advisories. I would love to see more centralized notifications about elevated air pollution that cover situations beyond extreme wildfire smoke advisories.

People need to know what’s going on so they can take action. You shouldn’t have to look up at the sky and say, “Oh my God, the sky is orange.” You should be notified before you see it yourself, and you should know what to do when it happens.

We already have a kind of societal intuition about some weather hazards. If there’s going to be a thunderstorm, we know not to go stand on a hill and let lightning hit us. We need to develop that same kind of societal understanding around increasingly common climate-related events, like wildfires. There’s a lot we can do to help people understand these risks and prepare for them.

What’s the biggest misconception you encounter when you talk to people about climate change and health?

I think we tend to see climate change as a series of extreme events or natural disasters. And we think of climate-related health impacts as the emergencies: the deaths, the hospitalizations, the people who become really sick.

But what I think people need to realize is that climate and weather affect the health of all of us, whether the effects are positive or negative. I’d love to see more of an appreciation of that — and more of a sense of ownership as a community that we can all take action to protect ourselves and others.

It’s important to do that now, rather than waiting until there’s an emergency. The old saying “an ounce of prevention is worth a pound of cure,” is really relevant here.

I hope people will start to see climate change, not as something that impacts other people, but as something that impacts them. It doesn’t matter if you’re young and healthy, or older and living with chronic health conditions, we all have a role to play in protecting our own health and the health of the people around us.