New book: Climate change is a health issue; MDs can make a difference

Can physicians play a role in mitigating the effects of global warming?
Nov. 11, 2015

When pollsters reached out to 1,058 U.S. adults about climate change in mid-October, they asked them whether they viewed global warming as an environmental issue, a moral issue, a religious issue, a social justice issue, a scientific issue, or a poverty issue.

Jay Lemery, MD, and George Luber, PhD, would have said “yes” to all of the above. And they would have suggested another category – one that’s the focus of a new 672-page book they co-edited. Global warming, Luber, Lemery and a host of co-authors argue, boils down to a health issue.

The book, “Global Climate Change and Human Health,” was published on Nov. 2. It’s a textbook intended for MD/DO and Master in Public Health students, says Lemery, a University of Colorado School of Medicine associate professor of Emergency Medicine and the department’s chief for wilderness and environmental medicine. Luber, a medical anthropologist, is chief of the Climate and Health Program at the Centers for Disease Control and Prevention’s National Center for Environmental Health. The book is a collaboration with roots harking back to the 1980s, when its co-editors were teenagers (see sidebar).

Lemery says his driving motivation for the project was to give the next generation of physicians and health leaders the tools they need to prepare for the health impacts of global warming and to become powerful advocates for climate mitigation and adaptation.

“This is a body of knowledge that can really add a tremendous amount to what many people have framed as the greatest public health problem facing us in the coming century – and centuries,” said Lemery.

Lessons from the doctor

Lemery has been thinking about health and global warming for years. In 2012, his essay Lessons from Dr. Strangelove called on the members of the Wilderness Medical Society to embrace educating patients and the public on the connections between climate change impacts and human health. The reference to the famous film alludes to the role doctors played in pressing for nuclear disarmament. During the height of the Cold War, the U.S. and Soviet doctors who founded International Physicians for the Prevention of Nuclear War (IPPNW) sounded a stark warning to humanity – that “nuclear war would be the final epidemic; that there would be no cure and no meaningful medical response.” The IPPNW won the 1985 Nobel Peace Prize.

In the book’s foreword, Luber and Lemery say climate change has similarly grave health implications.  “From the direct effects of weather extremes on morbidity and mortality to the potential for profound changes in disease ecology and geography brought about by state shifts in the Earth’s system,” they write, “climate change will be the defining issue for public health in this century.”

Climate change is, as Lemery puts it, a “risk multiplier” for vulnerability, particularly among those who are already the most at risk – the very young and very old, the poor, the sick; those living in floodplains and urban heat islands and in huts on low-lying coasts; those where the public infrastructure and government are already hard pressed to deliver clean food or water or adequate health care. It’s a topic of deep interest to Lemery, who co-edited a June 2014 Health and Human Rights Journal special issue on climate justice.

“While you and I, in a resource-rich setting, will be relatively shielded, it’s the vulnerable populations of the world that are going to bear the brunt of this. Frankly, they’re going to get pummeled,” Lemery said. “And from a justice point of view, they’re the ones who are least responsible.”

Climate-health connections are vivid

The book spends ample time describing the agents of future pummeling: waterborne and vector-borne (think malaria and dengue) disease, respiratory impacts from poor air quality, spiking allergens, toxic algae blooms, nutritional deficiencies and even mental health effects. Add to these the blows of heatstroke and dehydration from raw heat in places that scientist predict will become too hot to inhabit, and we run the risk of health crises associated with mass migration from rising seas and desert cauldrons on scales dwarfing the current exodus from Syria, Iraq and Afghanistan into Europe, Lemery argues.

There’s a concreteness and urgency to all this that restatements of carbon-dioxide concentrations in parts per million lack, said Lemery.

“We need to stop talking about ‘save the whales,’ and altruism and abstraction,” he said. “What does that mean to the average person on the street?”

Luber tapped Lemery for the project because he realized that speaking to the public health community wasn’t enough.

“Jay comes in not only with skill in pedagogy and teaching, but also in connecting with clinicians,” Luber said. That was his contribution: to have this text really align with how med schools ought to be teaching, and getting clinicians familiar with this topic and showing its relevance to their work.”

Moving the needle

Those clinicians can then help educate the masses about a problem that, fully 40 percent of respondents to that climate poll were either “not too worried” or “not worried at all” about.

Lemery wants to change that by tapping into “the power of the white coat,” as he put it. Physicians and other health care professionals enjoy exceptional public trust (a recent Gallup poll placed nurses, doctors and pharmacists atop the rankings in terms of honesty and ethical standards, miles above advertising salespeople, car salespeople and the cellar-dwellers, members of Congress).

This all may seem far afield from Emergency Medicine, but Richard Zane, MD, chair of the CU Department of Emergency Medicine and executive director of emergency services at UCHealth, begs to differ.

“Global Climate Change and Human Health” is “an incredible achievement,” Zane said.

“It’s right in the middle of exactly what we’re supposed to do as academicians and physicians,” he said. “Our role is to care for our patients and understand the circumstances under which we care for [them] – not just today, but tomorrow and a decade from now. And that’s exactly what this book does.”

Climate book co-authors go way back

It was 1996, and George Luber was a medical anthropology graduate student at the University of Northern Arizona. He was under the weather, running a fever, and in a Kinko’s copy center. This triumvirate of woe deepened with the realization that his Kinko’s card wasn’t working. Luber went up to the counter good and angry.

“My card’s not working, man,” he said to a tall, scruffy employee.

The guy in the blue shirt looked at him for a long moment. “George Luber,” he said.

“George Luber, yeah,” Luber said. He didn’t recognize this Kinko’s associate who somehow knew his name. “Whose card’s not working.”

The associate reached his nametag toward Luber’s face. It read “JAY.”

“Thanks, Jay.” Luber said. “My card’s not working.”

As these words came out, the churning facial recognition process deep in Luber’s brain spit out a match.

“Jay Lemery! Holy s***!”

Lemery was taking time off before medical school, working as a golf caddy, a ski instructor, a Red Lobster waiter, and Kinko’s copy boy.

He and Luber had been high school buddies in Glens Falls in upstate New York, where Lemery had grown up and Luber had spent a couple of years during a childhood of constant transition on the wings of his father’s job as a pharmaceutical executive. They had spent summers in Vermont, Luber teaching tennis at Stratton Mountain Resort, Lemery working a tennis tournament. They had been close friends. Then Luber’s family moved again, to Florida, and in the pre-Internet age, they had lost touch.

It wouldn’t happen again.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.