Assessing climate change as a public health crisis

Triage is my first impression of healthcare and the public health system. Categorizing individual bodies by who can really help themselves in order to save the many, the political body, is the air healthcare providers breathe when it comes to mass casualties and disaster. The process of providing care through triage begins like this: check for airway and breathing, patients that can’t breathe on their own after two attempts to breathe for them are considered dead. Black tag. Check circulation and major bleeding. Red tag. Check their level of consciousness, can they follow directions? Can they walk to safety and bring others? Green tag. Triage in emergency assessment operates on detachment and relies on the forced health equality of the casualty at hand, but the public health crisis of climate change leverages emergency care against high risk populations that are threatened by the air we breathe. 


The term enviromedics represents a new layer of emergency care from the negative impacts climate change has on human health. Climate action and human health are intertwined as enviromedics highlights vulnerable populations such as the elderly, laborers, low-income, and mundane archetypes of life are inflicted by subtle changes that degrade the landscape of everyday health in a reality of run-away climate change. Dr. Jay Lemery, Professor of Emergency and Climate Medicine at the University of Colorado, and Dr. Paul Auerbach, Professor of emergency and disaster medicine at Stanford University established the term enviromedics and methods of recognition through patient case stories  that frame climate change as a current illness rather than narrative based within polar bears and the melting ice. 


Enviromedics centers the patient assessment within the emergency department as the pulse of daily health. A 41-year-old New Hampshire man without underlying medical conditions comes into the hospital with a fever and muscle aches 3 days after coming back from the beach. He develops severe symptoms and is diagnosed with Eastern Equine Encephalitis (EEE) transmitted from the bite of an infected mosquito. The CDC reports 289 similar stories of West Nile, another mosquito vector borne disease, in 2024. Of those patients, 195 developed severe neurological complications such as inflammation of the brain and paralysis, and at least 18 died. Cases of mosquito vector borne disease such as EEE and West Nile begin to pop up during the summer in Massachusetts, New Jersey, Vermont, and Wisconsin as state health officials urge residents to spray before going outdoors. As record high summers become a common occurrence, public health struggles to account for the north migration of disease previously associated with tropical regions.


Heat and health are inextricably linked. Rising temperatures welcome disease unknown to the average northeastern family doctor, and the spectrum of young people and the elderly are the first to be threatened by the heat itself. The book “The Heat Will Kill You First” by climate change journalist Jeff Goodell equates the public response to health effects of rising temperatures to the boiling frog. Goodell exemplifies the vulnerable populations of the young, the old, the chronically ill, migrants and refugees, the homeless, and agricultural laborers as the bearers of heat waves and urban heat buildup. Both children and the elderly are reliant on a stable environment to regulate their own body temperature or cool themselves off. A history of asthma and cardiopulmonary diseases such as chronic obstructive pulmonary disease is compounded by air pollution from wildfire as an increase in post-fire particulates is associated with an 11% increase in asthma-related ED visits and a flare in COPD hospitalizations 3 days after exposure, according to the NIH. 


Heat finds unexpected interactions with mental health conditions and the efficacy of associated psychiatric drugs. The American Psychiatric Association lists antipsychotic meds, anticholinergic meds, like the “benzos” used to treat anxiety and insomnia, and can increase person’s ability to regulate heat as well as their awareness of their own rising  body temperature. The interaction between those with severe mental illness and social services, infrastructure, and the medical supply chain represent another weak point that is disrupted by extreme weather and natural disaster exacerbated by climate change. Enviromedics then displays a ripple effect from cluster cases of respiratory distress, dehydration, and mosquito vector disease in the ED to create a public health need to care for “climate refugees”. 




















References

Edwards, E., & Carroll, L. (2024, August 29). Mosquito viruses are spreading: What to know about West Nile and EEE. NBC News. https://www.nbcnews.com/health/health-news/mosquito-viruses-are-spreading-know-west-nile-eee-rcna168653

Goodell, J. (2023). The Heat Will Kill You First. Little, Brown.

Lemery, J., & Auerbach, P. S. (2017). Enviromedics : the impact of climate change on human health. Rowman & Littlefield.

Who Is Affected by Climate Change? (2024). Psychiatry.org. https://www.psychiatry.org/patients-families/climate-change-and-mental-health-connections/who-is-affected-by-climate-change

Wilgus, M.-L., & Merchant, M. (2024). Clearing the Air: Understanding the Impact of Wildfire Smoke on Asthma and COPD. Healthcare, 12(3), 307–307. https://doi.org/10.3390/healthcare12030307

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