When Band-Aids won't Cut it: The Climate Crisis is a Health Crisis

Sarah Hsu

On my first week of rotations as a medical student, I was assigned to Janine*, a young woman being admitted for a flare-up of Multiple Sclerosis. When triggered, her own immune system would attack her brain and spinal cord, leaving her unable to walk, think, or see. As I scoured through her medical charts, I noticed her flare-ups were triggered by heat.

"Knowing Janine would be discharged into a heat wave, I worried her electricity and AC would be -- or had been -- shut off."

One privilege of being a med student is the time to hear patients' stories. As we chatted, I wove in questions about her social history and her environment -- questions typically skipped by doctors in the interest of time. At first, I was relieved to hear that she had an AC unit, but I then learned she had recently lost her job due to the pandemic and was a few months behind on her electricity bill.

For the next three days, my weather app reported 98°, 94°, 99°F. Knowing Janine would be discharged into a heat wave, I worried her electricity and AC would be -- or had been -- shut off. To prevent flare-ups, we had prescribed medications to protect her from her own immune system. But she still needed protection from the heat.

"When heat waves happen -- outdoor laborers, elderly folks, and individuals on certain medications are more susceptible to heat strokes and organ damage."

Our tiny state of Rhode Island is the fastest warming state in the continental U.S. And due to climate change, the number of heat wave days in Rhode Island is projected to quadruple, from 10 to 40 days a year by 2050. When heat waves happen -- outdoor laborers, elderly folks, and individuals on certain medications are more susceptible to heat strokes and organ damage. When the heat and sunlight mix with car emissions on busy highways, the resulting ground-level ozone triggers more asthma attacks in kids living nearby. For Janine, more heat waves mean higher risk of flare-ups, and more debilitating, expensive hospital visits that may threaten her ability to find a job and support her asthmatic daughter.

"When the heat and sunlight mix with car emissions on busy highways, the resulting ground-level ozone triggers more asthma attacks..."

In medicine, there are "band-aids" or quick fixes to make the patient more comfortable and "bridge therapies" to buy patients time. For Janine's flare-ups, there was an effective band-aid: Obtaining a doctor's signature on a Medical Protective Status Form could prevent utility companies from shutting off her AC in retaliation for late payments. There was also an effective bridge therapy : Working with social workers to identify programs that would allow her continued access to electricity (like HEAP or local cooling centers), health insurance, and a living wage. But with climate change so daunting of a health crisis, these band-aid sand bridges won't be enough. So how do we practice preventative medicine?

"For Janine, more heat waves mean higher risk of flare-ups, and more debilitating, expensive hospital visits that may threaten her ability to find a job and support her asthmatic daughter."

I mulled this over a few weeks ago, after Hurricane Isaias tore its way through our state. It wasn't until I drove to the hospital, swerving around fallen trees and intersections without working stop lights that I realized a majority of the state was without electricity. I wondered how Janine was faring in the heat and prayed her daughter didn't need to plug in the nebulizer for her asthma. I thought about patients with refrigerated medications who could no longer safely take them if their power was cut. But when I thought about all the people experiencing homelessness, I remembered that buildings that normally harbored them from the storm refused to let people cluster due to COVID precautions. For these individuals, their "band-aids" were officially ripped off and their "bridges" were burned. There wasn't a doctor's signature that could protect these peoples' bodies from the torrential elements of that night.

"...health effects will fall on children and low-income communities of color, as they are more likely to face extreme effects of climate change while being the least likely to receive the proper protection from it."

Hurricanes and heat waves are a natural part of life on Earth. What is not natural -- is the sharp increase in number and intensity of natural disasters we are seeing. And what is unacceptable is that between 2030 and 2050, climate change is estimated to cause an additional 250,000 deaths each year due to injuries, illnesses, and the destabilization of food, water, shelter, and healthcare. Even more unacceptable is that the majority of these health effects will fall on children and low-income communities of color, as they are more likely to face extreme effects of climate change while being the least likely to receive the proper protection from it. For example, when the levees broke and failed to hold back the waters of Hurricane Katrina, Black communities were most severely affected by the flood. Yet, Black homeowners received $8,000 less in aid than white homeowners, leaving a larger percentage of Black families houseless and with limited options to relocate. If we don't take action, climate change will continue to expose and exacerbate the same inequities we are fighting to dismantle.

"If we don't take action, climate change will continue to expose and exacerbate the same inequities we are fighting to dismantle."

Without a doubt, healthcare professionals should be responsible for learning the basic therapies and services we can employ to help patients deal with the health effects of climate change. Similarly, patients have the right to be armed with knowledge about how climate change will affect their health and be empowered to ask for the care they deserve. But the only way to prevent climate change from harming the health of our communities is to take bold action against climate change.

"We need leaders who will write and vote for policies that will ensure affordable housing, secure electricity, economic security, and healthcare for all -- things that will protect the health of our communities and make us more resilient to climate change as a whole."

This year, we can do that by voting. With our vote cast on a ballot, we get to elect not only our President and all those he will appoint, but also our future city council members, state representatives, and senators. We need leaders who will write and vote for policies that will not only get us to net zero emissions by 2050 (or earlier!), but also policies that will ensure affordable housing, secure electricity, economic security, and healthcare for all -- things that will protect the health of our communities and make us more resilient to climate change as a whole. This is why doctors and medical students are asking Americans to vote.

For me, protecting my future patients from climate change means spending these next two months finding, uplifting, and electing these such candidates. Beyond "band-aids" and "bridges," the best prevention we can provide to our communities this fall is to vote for candidates who support a healthy and equitable future and encourage others to do the same.

*Patient's name and identifying details have been changed to protect the privacy of the individual.