By Cathryn Domrose
When Katie Huffling, MS, RN, CNM, worked as nurse midwife in the Washington, D.C., area, she noticed on days with elevated pollution levels that mothers-to-be with previously controlled asthma came into her office wheezing and struggling for breath, putting themselves and the fetuses they were carrying at risk. Huffling adjusted medications and advised her patients to stay inside on bad air days, but many of them worked and didn’t have cars or even air conditioning. Staying out of the bad air wasn’t a reasonable option. She asked herself, “What can I do to help?”
Nurses and other heathcare providers around the world are seeing the effects of changing climate conditions — including increased surface ozone levels and other air pollution — on their patients and asking the same question. A report from the 2015 Lancet Commission on Health and Climate Change, released in June, lists direct global effects of climate change, including increased heat stress, floods, drought and frequency of intense storms. Indirect threats include increases in air pollution levels (which rise on hot days), vector-born illnesses such as Lyme disease and West Nile virus, food insecurity, displacement and mental health stressors.
The report has called for governments to ensure public health departments and healthcare providers are involved in any climate change response. “Responding to climate change could be the greatest global health opportunity of the 21st century,” stated the commission, an international group of scientists, engineers, public policy experts and health professionals.
Many reports from national and international organizations have shown an alarming rise in carbon dioxide emissions and other greenhouse gases in almost direct proportion to human-related activity, particularly burning fossil fuels. These gases, trapped in the earth’s atmosphere, warm the air and contribute to a range of conditions from increasingly severe storms in some areas to exacerbated drought in others, according to these reports.
A 2012 survey of U.S. public health nurses found most believe climate change is real, at least somewhat controllable and has a negative impact on human health. Since that survey, increased evidence linking climate change to health and recent weather-related disasters have probably convinced more nurses that climate change affects their patients’ health, and they need to be prepared to deal with those effects, said the study’s lead author, Barbara J. Polivka, PhD, RN, a professor and researcher at the University of Louisville School of Nursing.
Figuring out how to address a sweeping global — and often controversial — public health issue is a sticking point for many. A 2015 Swedish study found that although nurses felt they had a responsibility to address climate and environmental issues, it was overshadowed by more pressing, day-to-day job requirements. Polivka’s study found similar attitudes among American nurses. But some nurses believe the profession cannot afford to ignore the situation and its impact on their patients.
The new normal
“As more and more [scientific data] is coming out, this is the biggest public health threat that we face today,” said Huffling, now program director for the Alliance of Nurses for Healthy Environments. “Nursing is about prevention and advocacy. There are a lot of positive things we can do.”
The first step is preparing for a new normal, said Barbara Sattler, DrPH, RN, FAAN, a professor in the public health program at the University of San Francisco who has written extensively on environmental health. Many of the events connected to climate change — heat waves, Lyme disease, hurricanes, wildfires — are well known and have protocols in place for responding to them. “These are things we’ve always been involved in, but we need to pay much more attention to them,” Polivka said. “These climate-related things are happening more often and they have an impact on the public health system.”
An increase in wildfires, tornadoes and floods puts increased stress on communities where people are displaced, Sattler said. “What do nurses in those communities know about basic disaster planning?”
The healthcare community needs to draw on what it has learned from Hurricane Katrina, Hurricane Sandy and other natural disasters, Sattler said, and prepare for the next one.
“It’s important for nurses wherever they practice to be familiar with the climate changes they are seeing and know how to help people adopt to these changes,” said Laura Anderko, PhD, RN, professor at the School of Nursing and Health Studies and director of the mid-Atlantic Center for Children’s Health and the Environment at Georgetown University in Washington, D.C.
Research shows certain populations — children, the elderly, people who work outside, people with mental health problems — have a greater risk for climate-related health problems. For instance, nurses in Florida should consider how large numbers of elderly patients will be affected by flooding and more intense tropical storms, she said. Those in Washington, where people are younger, need to think about the effects of heat and poor air quality on people who work outdoors.
Children are particularly vulnerable to climate-change-related illnesses, she said. Their developing lungs and immune systems make them susceptible to allergies and asthma; they play outside, climb trees, crawl through bushes, where ticks and mosquitoes congregate.Children have higher rates of asthma than do adults, and children between the ages of 5 and 9 have the highest rates of reported Lyme disease, according to the CDC.
Sometimes addressing climate-related health problems means rethinking health policies already in place. For example, schools focused on obesity prevention encourage children to run and play outside. But children with asthma should not be outside on poor quality air days, Anderko said. School nurses must be able to work with school administrators to provide indoor alternatives on bad air days for children with asthma.
Getting past climate change skeptics
Nurses also need to be sensitive to the beliefs of patients and others in their communities about climate-related health effects. Part of Polivka’s study involved focus groups in Ohio, where many lawmakers question the science and economics of climate change policies, and where public health departments vie for local funding. Public health nursing administrators in these groups seemed uncomfortable using the term climate change, she said, because they saw it as politically charged. Instead they talked about “building resiliency” or “sustainability.” “The language was very important,” Polivka said. “They have to be careful.”
For example, Polivka said her community has had a lot of rain in early summer. “Suddenly we have a lot of mold and what do we do about that?” Polivka said. “We don’t have to talk about it in terms of climate change, but we do have to talk about what the health effects are.”
Huffling advises avoiding arguments with those who don’t consider climate change a solvable problem, and working with people who believe it is real and harmful, to show what they can do to help slow it down, and to raise awareness about climate-related health problems in the community.
To help nurses feel more comfortable addressing climate and health, nursing schools must help students make the correlation between the global picture and what nurses see in practice, said Eileen Sullivan-Marx, PhD, RN, FAAN, dean at New York University College of Nursing. “It’s not just the fact that the glaciers are melting,” she said. “It’s about that when glaciers melt, we need to connect that to health.”
More water run-off means more flooding, more risk of water contamination, previously rare water pathogens could become more common, all things nurses should be aware of, she said.
Sullivan-Marx attended a White House roundtable on climate change in July with other leaders from schools of nursing, medicine and public health. The White House asked them to commit to recognizing that global climate change impacts health and that students should be learning in classrooms about those health effects, she said.In many cases, schools can take what is already in the curriculum and incorporate evidence showing how increased carbon emissions seem to exacerbate or increase the incidence of certain health conditions, Sullivan-Marx said. Or include best practices, such as asking if an elderly patient being discharged from a hospital on a hot day has air conditioning. “We can’t just teach facts,” she said. “We can make linkages in case studies that we haven’t been doing in the past.”
Sattler opens her classes by describing to students her experiences as a Red Cross volunteer on the Gulf Coast just after Hurricane Katrina. She talks about how unprepared the government agencies were, how people ran out of medication, and how every town converted churches and community centers into dormitories and food kitchens. She shows them her photos of nurse volunteers living in barns and tents, telling them, “We’re going to have to do this again.”
She has taken students on field trips to see the oil and natural gas fields in Central California, near drought-stricken communities where wells have run dry and there’s a six-month wait for a well company to dig a new one, and people rely on bottled water.
As students read the literature linking increased burning of fossil fuels to rapidly rising carbon dioxide levels which contribute to global warming, she wants them to understand the real-world effects of what they read, and their own responsibility in slowing the rise of those emissions through decreased energy use and other conservation measures.
“I show them what happens to the whole community” when there is over-reliance on gas and oil, she said. “And what happens is the community gets very stressed. The whole way in which we live right now needs to be examined and adjusted. We have a role in this, a personal role and a professional role.”
The personal role for nurses might be examining their own impact on the environment and taking simple steps such as turning off lights, conserving water in a drought area and cutting down on driving, nurses involved in environmental health said. At work, nurses can urge the creation of green teams if their hospitals don’t have them, examine facility practices and look for ways to save energy, which usually results in saving money. Turning off lights and televisions in empty hospital rooms, opening shades when it’s cold and closing them when it’s warm, using natural sunlight whenever possible are all good common sense practices, Huffling said. NYU encourages students and employees to walk, ride bikes or take public transit, Sullivan Marx said. The school building has been designed to serve as a shelter during severe storms.
After Huffling asked herself how she could help her patients with asthma, she began researching the link between climate and health, and becoming more involved in the Alliance of Nurses for Healthy Environments and the Union of Concerned Scientists. The turning point for her involvement, she said, came about four years ago when she testified at an Environmental Protection Agency hearing on changing regulations for ozone levels. She talked about the science showing the relationship between air pollution and asthma, and asthma and preterm pregnancy. Then she described the wheezing patients she and her colleagues had seen on days when ozone levels were high.
After her three-minute testimony, Huffling said, she had never felt more powerful. She now escorts groups of nurses to Washington, D.C., to meet with legislators and other policy makers. She sees them come away with similar feelings of empowerment — and surprise at the way even lawmakers who disagree listen to their messages. “We don’t get into the technical stuff,” she said. “We’re talking about the health impact of what we’re seeing with our patients. It’s about real people.”
Cathryn Domrose is a staff writer.
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How climate change affects health
Reports from U.S. and international agencies cite increasing health problems related to climate change, including:
Allergies, asthma and respiratory illness, as air pollens and ground-level ozone pollution increase
Vector-borne illnesses such as West Nile and Lyme disease, as warmer temperatures allow ticks and mosquitoes to thrive
Heatstroke and frostbite from extreme heat and cold
Water-borne illnesses such as an increase in exposure to toxic algae or chemicals
Health risks from climate-related disasters, including wildfires, floods and droughts
Extreme temperatures also can exacerbate chronic conditions including cardiovascular disease and diabetes. Prolonged heat exposure is associated with increased hospital admissions for cardiovascular, kidney and respiratory disorders, according to the U.S. Global Change Research Program Climate and Health Assessment.
Many of those who oppose policies to address climate change agree the earth is getting progressively warmer. But they argue that the changes are not human-caused, that negative health effects of air pollution and a slightly warmer climate are exaggerated and that increased CO2 levels are beneficial to plants.