As an emergency medicine doctor, I have a calling-and obligation-to serve my patients by improving health, preventing harm, and working to create a just society where every patient has an equal opportunity to achieve optimal health and well-being. Yet I often feel as if I am placing a Band-Aid on a bullet wound-temporarily fixing my patient’s problem but never getting to the root cause of their illness.
The burning of fossil fuels – such as gasoline in cars, or coal and natural gas for electricity – is the root cause of a frighteningly broad range of illness and death as it pollutes the air and drives the accelerating climate crisis.
Once, while working an overnight shift in the emergency department during the spring, I saw a young girl with asthma. It was her third visit that week, and her small chest was heaving up and down as she struggled to breathe. As treatments began to open her daughter’s airways, the mother’s eyes began to fill with tears as she shared their recent challenges.
“I have done everything the doctors have told me – and she just keeps getting worse. What am I missing? ”
The patient’s pediatrician and lung specialist had been following the latest medical guidelines, which left me asking: What have we been missing? As I outline further in The New England Journal of Medicine, I looked up my patient’s address and found that her home was in very close proximity to a highway. She had been breathing in air polluted by the exhaust of gasoline-burning vehicles during her young life.
Economic injustice and racism are behind why some communities have health-protective infrastructure-such as parks-and others, like my patient’s, have health-harming highways and industrial complexes. Research shows that low-income neighborhoods and communities of color have been disproportionately exposed to air pollution from nearly every emission source, independent of factors like geographic region.
Causality can be viewed as the holy grail in medicine, and it requires immense scientific evidence. The American Thoracic Society, a leading medical organization, concluded there is enough evidence to show that long-term exposure to air pollution causes asthma in children, and it has been estimated that more than 1 in 5 children in major cities develop asthma from traffic- related air pollution.
The harms of air pollution extend well beyond those with asthma. The American Heart Association has found that breathing in polluted air causes heart disease and death. Yet despite knowing this for over a decade, clean air is rarely discussed alongside diet and exercise for improving heart health. Air pollution also has been linked to stroke, autism, cognitive decline, diabetes, and poor pregnancy outcomes like preterm birth and low birth weight for infants.
My patient’s address, and her exposure to air pollution, not only likely contributed to her development of asthma, but it was also making its management challenging. Still, knowing the cause of a disease enables us to get to the root of the problem and not just treat the symptoms with Band-Aids. It is true that prevention is the best medicine.
As a doctor, I can think of no greater prescription for my patients than a just transition toward renewable energy sources such as wind or solar. This will not only reduce air pollution and its inequitable health harms in the near term, but it will also minimize the suffering from climate change, since the use of fossil fuels is its primary driver. The medical community – including major organizations and medical journals – is increasingly recognizing this problem and calling for change. Health professionals are realizing more and more that their patients are the true face of climate change, not icebergs and polar bears.
The climate crisis is already widely harming health, creating illness and making it harder to manage existing problems like heart and lung disease, diabetes and mental health conditions. It is a threat multiplier, meaning it underlies other problems and makes them worse – touching everything we deeply care about in medicine and beyond.
Climate change is increasing the intensity and duration of spring pollen seasons, yet another reason my patient was struggling to manage her asthma. It is also supercharging extreme heat, worsening air quality, impairing the supply and safety of food and water, and changing the patterns in which ticks and mosquitoes transmit diseases like Lyme disease and West Nile. Extreme weather events – like hurricanes, floods and wildfires – are also intensified. And while headlines often only include the immediate injury and death tolls from these disasters, there are significant longer-term impacts from them as well-like harms to mental health-that we are only beginning to better understand. In addition, these events can displace people from their homes and make it harder to access health care services. Even if the hospital or clinic is still standing and open, they may not have electricity or the necessary supplies.
In the United States, 70% of health care respondents to a recent survey reported that climate change was already impacting their organization’s health care delivery. In my experience, everyone’s health is already impacted by climate change to some degree – even if that impact remains subtle, like a worsening of allergies from higher pollen or a transient cough from wildfire smoke. But climate change is also contributing to significant illness and death, especially among those who are most vulnerable.
The good news is that we already have the solutions we need for a just transition away from fossil fuels. Renewable energy sources are widely available and often cheaper than fossil fuels-especially if governments stop providing fossil-fuel subsidies. But we need the societal and political will to implement them. Advocating for renewable energy by contacting your elected representatives is powerful, especially when framed as a prescription for improving your health and those of your loved ones and neighbors.
My work continues to be guided by the plea of my patient’s mother, and it is a question everyone must ask themselves: What am I missing in the environment that is harming my health? An equitable transition away from the burning of fossil fuels, root causes of air pollution and climate change, requires all of us.
We can only do it by working together. My Band-Aids in the emergency department are not sufficient.
Editor’s note: Certain potentially identifiable patient characteristics were altered to maintain confidentiality. The views expressed here are the personal opinions of the author and do not reflect the views of her institutions.