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Axios Climate Truths: New health crisis

National

Vitals

Axios Vitals

The world is facing a climate change-fueled health crisis — from increased emergency department visits due to heatstroke, exacerbated asthma and even heart attacks to injuries and illness linked to severe storms. 

Why it matters: The growing threats to human health only promise to get more complex and expensive, and health systems have to make major changes to how they prepare for those threats, experts say. 

They're already estimated to exceed $800 billion a year in increased health costs.

"It's challenging because this is happening fast," Beth Schenk, executive director of environmental stewardship for Washington state-based Providence health system, tells Axios.

Last summer, the health system found itself in the center of a "shocking" heat wave in the Pacific Northwest at the same time that its workforce was already stretched thin due to COVID surges. 

The extreme heat stressed its buildings' cooling systems and forced the health system to reduce services in some cases even as its emergency rooms were filling due to heat-related illnesses, she said. 

"The requirements for your hospitals are to be appropriate for your climatic conditions. Well, our climatic conditions when we built those hospitals were not for 116 degrees," she said.

"That has certainly colored how we're planning now in our hazard vulnerability assessments, in our resiliency building, to be prepared for that again. It seems inevitable," she said.

Zoom in: During California's record-breaking heat event earlier this month, Kaiser Permanente switched to generators for power at its individual facilities to help reduce the stress on the state's electric grid, said Ramé Hemstreet, Kaiser Permanente's chief sustainable resources officer.

The goal was to ensure that more individuals in the community kept their power, including their cooling units.

"It highlights the fact we need to think about resiliency more broadly," said Hemstreet. The health system already generates about 28% of its energy onsite but is investing in more microgrid and solar fuel cells moving forward, Hemstreet said.

The big picture: The World Health Organization (WHO) calls climate change "the single biggest health threat facing humanity."

Climate change has also been linked to increased risks for kidney disease, obesity and diabetes, injuries, the transmission of infectious diseases, some cancers and poorer mental health.

What they're saying: "We are learning more and more that the combustion of fossil fuels is contributing to a massive epidemic of chronic disease around the world that dwarfs AIDS, malaria and tuberculosis combined," said Gary Cohen, president and founder of Health Care Without Harm, a group that focuses on reducing health care's carbon footprint.

There's a growing recognition among U.S. health systems that the threats from climate change will have a major impact on their operations.

"A lot of health care systems have started to grapple with the direct physical risks to their own facilities," said Brodie Boland, a leader in McKinsey's work on climate risk in the real estate and infrastructure sectors. 

Between the lines: Equity is central to the discussion about the health impacts of climate change.

"Climate change is impacting everybody. But it's not impacting everybody in the same way," said Seema Wadhwa, who is Kaiser Permanente's executive director of environmental stewardship.

For instance, older individuals and those who are immunocompromised are more vulnerable to the impacts of high temperatures and poor air quality.

Those individuals who depend on insulin or dialysis could be at greater risk in the event of a power outage or blockages to transportation. Some communities face greater threats than others.

What to watch: Community resiliency needs to become a far bigger focus as the climate changes, experts said.

"A hospital can do what it can from a backup generator and asset hardening perspective, but if the city around it has been severely damaged, there's only so much you can do," Boland said.

In one example, Providence said its population health team realized during last year's heat emergency that it was sitting on a massive amount of valuable information in its electronic health record that could help its response.

That EHR data helped them reach out directly to individuals at greater risk of health complications due to the heat and get them to places with cooling or air filtration and ensure they had access to medications, Schenk said.

1. The climate-driven health crisis

The threats to human health only promise to get more complex and expensive.

Illustrated collage of a body xray with pain points highlighted. 

Climate truths

The world is facing a <a class="gtmContentClick" data-vars-link-text="climate change" data-vars-click-url="https://www.axios.com/energy-environment/climate-change" data-vars-content-id="52b1b655-0ff8-4cea-a7f5-40c82340a964" data-vars-headline="The climate-driven health crisis" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/energy-environment/climate-change" target="_self">climate change</a>-fueled health crisis — from increased emergency department visits due to heatstroke, exacerbated asthma and even heart attacks to injuries and illness linked to severe storms. Why it matters: The growing threats to <a class="gtmContentClick" data-vars-link-text="human health" data-vars-click-url="https://www.axios.com/health" data-vars-content-id="52b1b655-0ff8-4cea-a7f5-40c82340a964" data-vars-headline="The climate-driven health crisis" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/health" target="_self">human health</a> only promise to get more complex and expensive, and health systems have to make major changes to how they prepare for those threats, experts say.

The U.S. health system faces critical questions about cost, access and equity. Technological advances and new discoveries about diseases like cancer and Alzheimer’s are transforming patient care and reshaping public health.

Health

Breaking climate science and policy coverage as extreme weather events reshape communities. Keep tabs on the race to a low carbon economy, which may be bumpy as governments, climate tech startups and major oil and gas companies race to find their niche amid the changing energy landscape.

Energy & Climate

The combination of extreme heat and air pollution is extremely lethal, and this noxious mix is likely to become more common as global warming worsens.

The big picture: It has long been known that particulate pollution emitted from car tailpipes, factories and power plants can aggravate chronic health problems and prove deadly. Add extreme heat, and the threat is especially dangerous.

Particulate matter refers to tiny airborne particles, including PM2.5, so named since it is 2.5 microns in length. This is about the width of a human hair.

In addition to cars and factories, wildfire smoke also emits such pollution.

According to a study published in June in the American Journal of Respiratory and Critical Care Medicine, co-exposure to heat extremes and particulate pollution is likely to become more frequent due to human-caused climate change. 

Other studies have also found harmful effects from wildfire smoke, which has become a growing problem in the West during the past decade. 

This week, smoke from multiple nearby wildfires prompted the National Weather Service to warn residents of large parts of Oregon, Washington, Montana and Wyoming to "[s]tay inside if possible. Keep windows and doors closed."

"If it's too hot, run air conditioning on recirculate or consider moving to a cooler location," the Sept. 12 warning stated.

Zoom in: The June study found that co-exposure to both extreme heat and air pollution at the same time "had a greater mortality effect" than if you just added their effects together, according to Mostafijur Rahman, the paper's lead author and a postdoctoral fellow at the Keck School of Medicine at the University of Southern California. 

"During the top 1% of hottest and most polluted days, [mortality] risk increased by 21%," the study found, Rahman told Axios via email. 

Hot days do not automatically have higher amounts of harmful particulate pollution, he said, but wildfires producing hazardous air quality tend to take place on the hottest days.

For example, several large, fast-moving blazes, such as the Mosquito Fire, grew in size across the West during the recent record-breaking heat wave. Air quality across California and in the Pacific Northwest deteriorated soon thereafter, in the middle of the worst September heat wave the region had ever experienced. 

How it works: "Older adults may be more susceptible to effects of extreme heat and air pollution exposure, in part because this stress comes on top of age-related chronic health conditions like heart disease, high blood pressure, diabetes or chronic lung disease," Rahman said. 

In addition, older adults may have a harder time getting to cooling centers if the shelters are located in the hottest parts of a community.

According to the study, the excess risk of mortality for extreme heat and pollution exposure among those over 75 years of age was 36.2%, compared to just 8.5% for those age 75 or below. 

Other research shows that children are particularly at risk from smoke-related health effects as well, with higher asthma rates and other ailments resulting from prolonged exposure.

Some cities are taking action to try to reduce the impact of air pollutants.

Phoenix, which currently has a visibility rating of good or excellent on only 70-80% of days, has set a goal to improve the air quality to good or excellent at least 90% of the time by 2050, Jessica Boehm of Axios Phoenix writes.

In June, the city adopted a transportation electrification plan that aims to get to 280,000 electric vehicles on Phoenix roads by 2030. This includes the electrification of the city's fleet and the installation of at least 500 public charging stations in the next decade.

Minneapolis has adopted "green zones" aimed at improving air quality and other environmental pollution issues in low-income neighborhoods, Torey Van Oot of Axios Twin Cities reports.

But activists and some people involved in the project say the initiative has yet to have its intended impact and that more changes are needed.

What's next: Rahman suggested that a special alert be developed for use during co-occurring heat and PM2.5 extremes. 

Governments are already experimenting with new ways to warn residents of heat risks, including a new system being developed in California.

2. The deadly mix of extreme heat and air pollution

The noxious mix is likely to become more common as global warming worsens.

Illustration of patients' hands, smokestacks, and abstract shapes. 

The combination of <a class="gtmContentClick" data-vars-link-text="extreme heat" data-vars-click-url="https://www.axios.com/science/extreme-weather" data-vars-content-id="359e6ed9-1b44-479f-b756-33b06f22f3c4" data-vars-headline="The deadly mix of extreme heat and air pollution" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/science/extreme-weather" target="_self">extreme heat</a> and air pollution is extremely lethal, and this noxious mix is likely to become more common as <a class="gtmContentClick" data-vars-link-text="global warming" data-vars-click-url="https://www.axios.com/energy-environment/climate-change" data-vars-content-id="359e6ed9-1b44-479f-b756-33b06f22f3c4" data-vars-headline="The deadly mix of extreme heat and air pollution" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/energy-environment/climate-change" target="_self">global warming</a> worsens.The big picture: It has long been known that particulate pollution emitted from car tailpipes, factories and power plants can aggravate chronic health problems and prove deadly. Add extreme heat, and the threat is especially dangerous.

Heat-related deaths in Washington, 2010–2022

Data: Washington State Department of Health; Chart: Kavya Beheraj/Axios

A 2021 heat wave that killed at least 157 people in Washington state drove home why even regions accustomed to fresh air and moderate temperatures need to calibrate their public health efforts to confront extreme climate events.

Why it matters: The dual threats of extreme heat and smoke from wildfires can be fatal in places where many households lack air conditioning, or they could worsen chronic heart and lung diseases. 

But mitigation strategies have to account for a complex stew of factors, from social determinants of health like income and health literacy to communications systems capable of reaching those most at risk.

How it works: King County, one of three counties in the Seattle area, undertook a heat mapping project to identify areas with hard landscapes and less shade that hold heat longer to help guide decisions like where to open cooling centers.

The public health department established temperature thresholds at which point communities would open cooling centers.

Emergency management officials plan to send push alerts to landlines and cellphones ahead of extreme weather events, urging recipients to seek out a cooling center and to check in on vulnerable neighbors or family members.

"Maybe that will get people to start to understand that heat here in the Pacific Northwest is something they need to take seriously and is a killer," Brendan McCluskey, emergency management director at King County, tells Axios.

The officials also plan to apply for FEMA grants to help them buy heat pumps or air conditioners for residents.

Community organizations are stepping up in other parts of the state where local governments aren't coordinating planning.

In Spokane, Gonzaga University is using a National Oceanic and Atmospheric Administration grant to produce maps pinpointing heat islands and the most vulnerable neighborhoods, Brian Henning, director and founder of the Gonzaga Center for Climate, Society, and the Environment, tells Axios.

The Gonzaga team is also polling residents to find out precisely how many homes have air conditioning — data that can help the team create a heat action plan that the city can adopt.

In a state where the average high temperature peaks at 78°, just 53% of households used air conditioning in 2020, per a report by the U.S. Energy Information Administration. 

The big picture: State government efforts are increasingly focused on the threats climate change poses, with lawmakers approving more than $600 million through 2023 to reduce the emission of greenhouse gases.

The Department of Health can direct funding to local health departments to work on climate change and heat plans, as well as help local partners coordinate efforts.

Plans also call for longer-term changes like planting more trees and protecting areas from wildfires.

The Department of Natural Resources is running a pilot program in central and eastern Washington communities that are vulnerable to wildfires to make sure residents are signed up for emergency messaging and know what to do in the event of a fire or unhealthy air.

The efforts track, in some ways, with those in states like California that are facing increasingly catastrophic wildfire seasons. Mitigation plans there include encouraging people to wear N95 masks, install high-efficiency air filters and use air cleaners to reduce indoor particle levels.

The other side: Relying on solutions like air conditioning and purifiers puts the electrical grid in jeopardy, and some experts think they can't be the sole solution.

"If you have built your infrastructure dependent on electricity, and there's a power outage during more extreme events, you kind of set yourself up for a catastrophic event," said Claire Richards, an assistant professor at Washington State University College of Nursing and a member of the Washington Physicians for Social Responsibility Climate Action Task Force.

3. How the Pacific Northwest is combatting heat and smoke

The dual threats can be fatal in places where many households lack air conditioning.

A 2021 heat wave that killed <a class="gtmContentClick" data-vars-link-text="at least" data-vars-click-url="https://www.nytimes.com/interactive/2021/08/11/climate/deaths-pacific-northwest-heat-wave.html" data-vars-content-id="b73859e5-6e1e-463d-9fff-a38b19e704cf" data-vars-headline="How the Pacific Northwest is combatting heat and smoke" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.nytimes.com/interactive/2021/08/11/climate/deaths-pacific-northwest-heat-wave.html" target="_blank">at least</a> 157 people in Washington state drove home why even regions accustomed to fresh air and moderate temperatures need to calibrate their public health efforts to confront extreme climate events.Why it matters: The dual threats of extreme heat and smoke from wildfires can be fatal in places where many households lack air conditioning, or they could worsen chronic heart and lung diseases.

Climate anxiety is an increasingly accepted phenomenon that many psychologists and therapists are tailoring their practices to treat.

The big picture: The symptoms are especially prevalent among young people, and while it's not treated as an official clinical diagnosis, it can be debilitating at times, mental health professionals tell Axios. 

The experience of climate anxiety, referred to more broadly as "ecoanxiety," can be life-altering and distinct from other anxiety-provoking periods in someone's life, said psychotherapist Caroline Hickman, who is based in Bath in the U.K. 

Zoom in: Hickman was the lead author of a broad study on climate anxiety and its effects on young people around the world that was published in The Lancet late last year. 

That study of 10,000 people between ages 16 and 25 in 10 countries found greater levels of concern and more acute distress associated with climate change than she and her colleagues expected, Hickman said. 

For Hickman, the cognitive impacts of climate anxiety, particularly on young people, is distinctive since it affects how people imagine themselves in the future.  

"This is a level of horror and dread and distress I have not encountered before," Hickman said, noting that a lot of the negative emotions stem from the lack of action on the part of those in positions of power.

The intrigue: Distress also is the result of the lack of a light at the end of the tunnel, since climate change will be a lifelong challenge. 

Despite this, climate anxiety should not be classified as a mental illness and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), Hickman said. 

"It's a sign of mental health, not mental illness," she said, noting that worrying about climate change is a rational response. "But the suffering needs to be legitimized and understood."

Other mental health professionals agreed that climate anxiety should not be an official diagnosis in the DSM, since that could be a slippery slope to adding every anxiety trigger to the book.

Those suffering from climate anxiety may be diagnosed with broader anxiety-related disorders such as generalized anxiety disorder or depression.

Yes, but: Mental health professionals do think climate anxiety is a real and increasingly prevalent challenge, particularly as the impacts of global warming become more severe and pervasive. 

Thomas Doherty, a Portland, Oregon-based psychologist who specializes in ecoanxiety and wrote one of the earliest papers on the topic, said there are aspects that make this problem unique, but a DSM listing isn't appropriate. 

"There aren't specialized diagnoses for every life problem," he said. "There isn't unemployment depression or relationship breakup depression. ... There's anxiety, and there's a context."

Between the lines: The Lancet study found that about 60% of respondents were very or extremely worried about climate change.

More than 45% of respondents said their climate change-related feelings hurt their daily life and functioning. Levels of concern were high in vulnerable nations like the Philippines and developed nations alike.

According to Hickman, younger people are angry at older generations and those in power for not acting sooner and more boldly based on the scientific evidence of human-caused climate change. 

What's next: Mental health professionals have much they need to learn from climate anxiety sufferers. "There are still lots of questions about the different aspects of the emotional response to climate change," Susan Clayton, a psychology professor at the College of Wooster in Ohio, told Axios via email.  

The bottom line: A focus of therapy for climate anxiety sufferers is to help people navigate their feelings and eventually lead fuller lives, both Hickman and Doherty said. 

"The goal, ultimately, is to help us cope with climate change as a lifelong thing. It's going to be a part of all of our lives and into our children and grandchildren's lives," Doherty said.

If you need help for climate anxiety, the Climate Psychology Network and the Climate Psychiatry Alliance can connect you with a mental health professional who specializes in this area.

4. Feeling anxious about climate change? You're not alone

Young people in particular are feeling despair over climate change and the lack of government action.

Climate anxiety is an increasingly accepted phenomenon that many psychologists and therapists are tailoring their practices to treat.The big picture: The symptoms are especially prevalent among young people, and while it&#x27;s not treated as an official clinical diagnosis, it can be debilitating at times, <a class="gtmContentClick" data-vars-link-text="mental health professionals" data-vars-click-url="https://www.axios.com/2021/09/28/americans-concern-about-climate-hits-all-time-highs" data-vars-content-id="03efb40a-20a0-49b2-9039-af341fadec04" data-vars-headline="Feeling anxious about climate change? You&#x27;re not alone" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2021/09/28/americans-concern-about-climate-hits-all-time-highs" target="_self">mental health professionals</a> tell Axios.

5. Climate change alters battle against infectious diseases