By Stacey Butterfield
A Thursday morning session at Internal Medicine Meeting 2023 offered tips on combating what Nitin Damle, MD, MS, MACP, sees as "the biggest health threat of the 21st century": climate change.
But first, he explained why this global issue is particularly relevant to internal medicine physicians. "What we need to focus on is what's happening with our patients," said Dr. Damle, a former ACP President and a clinical associate professor of medicine at Alpert Medical School of Brown University in Providence, R.I.
Climate change has the potential to exacerbate a host of clinical conditions, from allergies and asthma to infectious diseases, migration-related illnesses, and cardiovascular and respiratory diseases, he noted.
Certain populations are most at risk of negative health effects from increasing heat in particular. "The elderly, because they sweat less, they have less of a thirst drive, they tend to be nonambulatory," said Dr. Damle. "Laborers, because they're placed at greater risk because of their occupation. … The homeless, because they have really virtually no options." Small children and athletes are also particularly likely to suffer from heat effects, he added.
A host of commonly prescribed drugs also increase the risk of heat-related problems, including diuretics, angiotensin-converting enzyme inhibitors, laxatives, antipsychotics, anti‐Parkinson drugs, and antihistamines.
Dr. Damle listed some simple public health measures that could help protect at-risk patients. "First of all, identifying the population at risk, communicating as a clinical team to reach these vulnerable patients, preparing some guidance for them, educating them about heat-related illness, making sure they have access to cooling centers."
Physicians should also keep an eye on the climate risks to their patients' lungs. "There's about 7 million deaths attributable to air pollution every year" around the world, said Dr. Damle, noting that those with asthma and chronic obstructive pulmonary disease are particularly vulnerable.
"Advice to patients who have lung disease: Pay attention to local weather trends and excessive heat and wildfires. Avoid physical activity and stay indoors during those times. Wear an N95 mask if you can," he said. "Ask patients about how much they know about air pollution or their exposure and inform them about early symptoms that they really need to call you about." It may also be helpful to get high-risk patients an inhaler to have on hand for bad-air days, Dr. Damle noted.
To try to reduce the frequency of such occasions, he recommended steps anyone can take to help protect the planet. "There's personal things that you can do like commute less, drive electric cars, walk, bike, limit your air travel, don't use [single-use] water bottles, and just plant a tree," said Dr. Damle.
Physicians can use their position in society to push for larger-scale change by getting involved in environmental advocacy on the local, state, or national level. "You have to get people who are in power, policymakers, to understand what the issues are and what you'd like them to do," said Dr. Damle. "But it can't be a complicated message. It has to be very simple, and it has to be the same drumbeat over and over again."
The key points to cover in advocacy efforts are that climate change is real and human‐caused; is bad for patients, physicians, and the community in a number of ways; and requires an immediate response. "It's here, it's an emergency, and we need to take action," Dr. Damle concluded. ■