Dr. Alexander Azan, an internal medicine physician and climate health research fellow in the Department of Population Health at NYU Langone, felt unprepared to appropriately care for patients when wildfire smoke covered New York City last summer. In a recent opinion piece published by the British Medical Journal (BMJ), Dr. Azan describes how last year’s wildfires were an urgent reminder that doctors and health systems need to adapt the ways they care for patients to meet the new challenges posed by climate change, including advocating for stronger federal protections from air pollution. 

Dr. Alexander Azan Dr. Alexander Azan

The Urgent Need to Adapt 

As a primary care doctor, I’m alarmed by how unprepared I was to care for my patients when wildfire smoke inundated New York City (NYC) last summer. In June 2023, air pollution from wildfires raging in Canada moved into many parts of the United States. As a result, communities across NYC experienced the worst air quality in the city’s recorded history. 

The first day wildfire smoke covered NYC, I was seeing patients. I work at a federally qualified health center (FQHC), which provides medical care to underserved communities in the U.S. Many of my patients have chronic health conditions that increase their risk of becoming very sick from exposure to poor air quality. That day, my patients didn’t know how to protect themselves from the smoke. Many arrived at their appointments without a mask. Some patients reported having difficulty breathing.

During the smoke event, the air quality index (AQI), which indicates how bad the air quality is on a scale from 1-500 (1 being great air quality and 500 being the worst air quality), came close to its maximum of 500. For reference, an AQI over 300 is considered to be “hazardous” – or dangerous for everyone to breathe, especially sensitive groups, such as children and people with asthma.  

That day in clinic, I called my most vulnerable patients to offer telemedicine appointments. My clinic staff and I handed out N95/KN95 masks. I quickly familiarized myself with health guidance issued by the American Lung Association that describes how people can protect themselves from air pollution exposure using the AQI. I counselled patients on this guidance, including, for example, when they should avoid outdoor activities based on their pre-existing health conditions and real time changes in air quality. 

This experience was an alarming example of the health impacts climate change is already causing. It was an urgent reminder that our healthcare system needs to adapt to peoples’ changing health needs driven by climate change. In the following text, I highlight excerpts from my BMJ Opinion piece that detail opportunities for healthcare systems and providers to improve our ability to care for patients during future climate disasters. 

Opportunities for Change in the Healthcare Sector

  • Training Health Professionals: the connection between climate change and health is increasingly being incorporated into undergraduate and graduate medical education, often through learner-driven curricula. However, research has shown that current climate medical education initiatives vary greatly depending on where they are taught. Currently, there is no required education on climate’s impacts on health for doctors in the U.S. This leaves doctors unprepared when a climate crisis occurs, as I and other healthcare workers felt during the New York City wildfire emergency. The incorporation of a standard educational framework on climate change and health across all levels of medical education would help ensure doctors know how best to care for their patients in future climate-driven disasters.
  • Telemedicine: Another tool that may help meet patient needs in response to our changing climate is telemedicine. Telemedicine allows patients to connect with their healthcare provider through video or phone appointments. It has been shown to be potentially helpful to patients during extreme climate events. For example, one study found that the more knowledge patients had about telemedicine services before a wildfire event, the less likely they were to visit a hospital or emergency department for preventable conditions in the year after a wildfire. Telemedicine offers a supplemental form of care that may be especially useful for vulnerable patients and providers, and, therefore, should be considered as a useful tool in healthcare providers’ climate preparedness plans.
  • Healthcare Centers as Clean Air Spaces: Additionally, all healthcare centers, especially FQHCs, should be equipped with U.S. Environmental Protection Agency (EPA)-recommended preventative measures to protect patients’ health. Studies have shown that most of a person’s exposure to outdoor air pollution from wildfires happens while sheltering indoors. This exposure can be worse when buildings are not retrofitted to filter harmful components in the air during wildfires. The EPA currently recommends that buildings provide N95 respirator masks and install MERV13+ filters for heating, ventilation and air conditioning units to reduce indoor exposure to wildfire smoke. Healthcare centers should adopt these policies in order to serve as clean air spaces during poor air quality events for the communities they serve. 

Opportunities for Public Policy Change 

  • Support for Screening Patients for Climate-Change Related Health Risks: There is growing availability of social resources available to patients most vulnerable to climate-driven weather. For example, in New York State, the Home Energy Assistance Program (HEAP) offers air conditioning to low-income patients vulnerable to extreme heat exposure. Such programs offer tremendous opportunity to connect patients to climate adaptive resources through existing clinic-community partnerships. A new rule by the Centers for Medicare and Medicaid Services now encourages certain U.S. hospital systems to screen for social determinants of health. Similar federal policies should be encouraged to incorporate climate-related determinants of health into screening practices. Funding for this type of screening would help ensure patients are given the resources they need to protect their health during climate driven extreme weather events. 
  • Physician Advocacy Opportunities to Further Reduce Air Pollution: Stronger federal actions to reduce air pollution, including the greenhouse gases that drive climate change and its health impacts, are crucial. Notably, the U.S. EPA recently strengthened the annual National Ambient Air Quality Standard (NAAQS) for particulate matter with the goal of improving public health protection from air pollution exposure. This stronger standard is, in part, a result of patient and physician advocacy efforts, encouraging the EPA to ensure that the new annual NAAQS be driven by scientific evidence of the health benefits of a lower particulate matter standard. This is great news for health and is an example of the power of partnered physician and patient voices in advocating for the health of those most vulnerable to air pollution. Healthcare systems and professionals should continue to engage in their communities as these standards are implemented to ensure that the promise of clean air is delivered for all. Health professionals can also advocate for climate action more broadly. This includes final standards to reduce greenhouse gases from cars, trucks and the power sector. All of these rules are under development by EPA. (Learn more and take action.

Rising to the Challenge

Healthcare networks, especially FQHCs like the one where I practice, are crucial to providing care to communities. With proper training, sustainable funding, and targeted advocacy, healthcare systems and providers can rise to meet the needs of our patients who are the most vulnerable to the health effects of climate change. Now is the time to act.

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