Climate Change and Social Determinants of Health

Updated on November 10, 2022

Every day we witness the health consequences of the climate crisis.

A 12-year-old girl whose family was displaced from their home in Guatemala because of severe weather and crop failure is in the Emergency Department with pervasive thoughts of death, sleeplessness, and mood changes that are consistent with the aftereffects of trauma.

A retired postal worker missed her follow up appointment after treatment for breast cancer because the heat index topped 100 degrees and she’s afraid if she leaves her home, she will suffer from heat exhaustion. 

A schoolteacher scrambled to find care for her elderly father who was forced to move in with her in Massachusetts after prolonged power outages after Hurricane Maria threatened his ability to receive life-sustaining dialysis treatment at home. 

These are our patients. As a child psychiatrist and a primary care physician, we are surrounded by chronic illness and health emergencies that are rooted in climate change. The non-profit health care system where we practice, Mass General Brigham, is preparing for the new reality of caring for patients in a warming world. We are adapting our curricula to ensure trainees have the knowledge and skills necessary to recognize, treat, and prevent the health effects of climate change. We are developing strategies to identify patients at risk for adverse health effects of extreme heat so that we can intervene before they occur. And, we are preparing our physical buildings against extreme weather events that can disrupt operations and access to critical supplies.

While these interventions are essential to our future, they are also just a band-aid, applied to the downstream consequences of a crisis that, today, is an unmitigated, existential threat. 

Unfortunately, this reactive approach is familiar to those of us in medicine. We have known for decades that social determinants of health are the foundation for healthy lives. This includes financial stability, access to education and healthcare, living in safe neighborhoods, and being supported by connected communities. And we have known for decades that experiencing the opposite of these, including poverty, racism, and lack of access to essential services are risk factors for life-threatening illnesses. Despite clear evidence that these risk factors drive human disease and suffering, we have made shockingly little progress in addressing them.

Instead, we spend our days tossing life preservers to drowning patients. We prescribe anti-inflammatory medicines and inhalers to patients who breathe polluted air, both in their neighborhoods and inside their homes, but we don’t offer them clean air to breathe. We adjust insulin for patients with obesity, but we don’t help them access fresh produce or greenspace to exercise. We hospitalize children with self-injury or explosive rage who live with families coping with traumas, many of them inflicted by poverty, but we don’t invest in effective solutions that are proven to ensure sustainable livelihoods.

This week, people from all over the world will come together at COP27, the 2022 United Nations Climate Change Conference, to take global action toward solving the climate crisis. At last year’s COP26, climate change was, for the first time, successfully framed as a health issue. We must build on this momentum and move towards a bold vision of a healthier future, embracing that the solutions to climate change are the same solutions that will reduce the prevalence of debilitating chronic diseases, right at their source.

For example, electrifying our transportation and buildings through decarbonization and eliminating fossil fuel infrastructure would mean less pollution and cleaner air for people to breathe. We would reduce the rising rate of asthma and premature births, and, in time, we would see less cardiovascular disease and fewer cases of cancer. Enacting policies that reduce agricultural emissions by decreasing our consumption of animal protein – from reforming our federal farm subsidy programs to building co-op supermarkets in food deserts – would reduce cardiovascular disease. Expanding tree cover and other greenspace would lower temperatures in urban heat islands that were originally created by racist lending and planning policies, preventing heat stroke, bringing better birth outcomes, less violence, and fewer mental health crises, including suicides.

We often imagine a world where we can get to our patients before they reach emergency, before they are riddled with chronic disease, and before they sink deeper into a cycle of diagnoses caused and worsened by the environments in which they live. A crisis of this magnitude desperately demands the urgency and breadth of broad systemic change. As physicians on the front lines, we are not asking for change – we are demanding it. The health sector has changed the narrative around climate change and now, a gathering like COP27 must serve as the catalyst for revolution, complete with an audacious suite of polities that will limit the long-term effects. When our lives, the lives of our patients, and our children’s lives are at stake, there should be no choice but to act.

Elizabeth Pinsky, MD, is a child and adolescent psychiatrist and pediatrician at Mass General Brigham and serves as the Associate Director of the MGH Center for Environment and Health. Gregg L. Furie, MD, is a primary care physician at Mass General Brigham and serves as Medical Director for Climate and Sustainability at Brigham and Women’s Hospital.