Roger Hicks, MD
I live in the foothills of the Sierra Nevada in Northern California, where, like numerous other parts of the world, extreme weather events are becoming increasingly routine occurrences. The “hot days” are hotter and more abundant, and the droughts are more severe. In turn, this has precipitated more wildfires, which lead to problematic smoke and hazardous air quality.
When I opened my urgent care (UC) clinic 24 years ago, I never thought that I would be caring for climate change refugees, yet that is exactly what happened in the fall of 2018. The Camp Fire, fueled by the extreme climate forces mentioned above, displaced more than 50,000 residents of the town of Paradise and the surrounding communities. Many of those who were forced to evacuate their homes had to flee so quickly they didn’t have an opportunity to gather their important belongings, including medications. The fire burned down the refugees’ homes, workplaces, doctors’ offices, and pharmacies and caused the emergency evacuation of their fire-damaged hospital.
I suspect some of you have also served climate change refugees at your clinics—perhaps without even realizing it. Consider the families displaced during any of the increasingly powerful hurricanes that have ravaged the Gulf Coast in recent years or those who’ve become ill from exposure when extreme heat waves or ice storms cripple the power grid. Millions are affected by events such as these each year in U.S. and worldwide, and it’s during these times of stress and displacement that unexpected medical needs very often arise. I believe that our duty extends beyond serving these patients when they present to our UC centers in this context. It is time for the urgent care community to get involved upstream and take action to mitigate the cause of all these tragedies: climate change itself.
Despite any political rhetoric, there is no longer credible doubt that human activity contributes to climate change, and climate change affects human health.[1] The effects are myriad, and climate change is a threat multiplier for health problems. Climate change produces increasingly frequent extreme heat events, extreme weather, drought, food-borne diseases, the spread of vector-borne diseases, and mental health issues. Air pollution—whether caused by emissions from power plants, internal combustion engines, or forest fires—is synergistic with extreme heat and disproportionately affects children, pregnant women, and people with lung or cardiac problems.[2],[3],[4]
Climate change is not only leading to deleterious effects on human health, but is also affecting our ability to deliver healthcare as well, including in urgent care.[5] We have seen this unfold in the form of forced healthcare facility closures and emergency evacuations due to extreme weather, flooding, and fire, which have caused disruptions for patients and healthcare personnel alike.[6]
As healthcare professionals, we have the good fortune and responsibility of a “bully pulpit” because we are implicitly trusted by our patients and the public at large in ways few others experience. By virtue of the work we do, we are also more aware than those in the general population of the specific health effects of climate change as we see their consequences with our own eyes.
Urgent care has experience coming through when facing uncertain times. Most recently, we stepped up during the pandemic. While many doctors’ offices and clinics were telling people with COVID-related concerns to stay away, we kept our doors open. It was the right thing to do, and in so doing, we earned the public’s trust. This position raised awareness of the vital role urgent care plays in our healthcare system and society as a whole. We have the opportunity to position ourselves similarly with respect to responding to climate change. And our patients and the planet are counting on us to take this responsibility seriously.
Make a Change
While we are experiencing the harsh effects of climate change, in recent years, we’ve also seen that with technological advances, a clean energy future is achievable. This is not a fringe movement any longer; there are already many communities around the world engaged in this transition. However, like the tobacco industry before it, the fossil fuel industry is undermining progress by deceiving the public about the side effects of its products. But we are clearly at stage in human history where there is little doubt that the negative impacts of burning more fossil fuels far outweigh the benefits, especially as many cleaner, viable alternatives now exist.
Increasingly within medicine, healthcare professionals, who note the undeniably negative impacts of climate change on the health of our population, have become engaged. For example, organizations, such as the Medical Society Consortium on Climate and Health, which represents more than 50 medical societies and more than 700,000 healthcare professionals, have led a counteroffensive in lobbying for policies that might abate climate change.[7] The American College of Emergency Physicians has pledged to combat the climate crisis through education, research, advocacy for public policy, and has taken steps to reduce the carbon footprint of their own facilities.[8] The American Board of Pediatrics has developed a Maintenance of Certification module on climate, health, and equity and is the first board to offer such content.[9] Citing the devastating effects on health, over 200 peer reviewed journals in the life sciences, including the New England Journal of Medicine, have recently called on world leaders to take emergency action to halt climate change.[10],[11]
These organizations, which represent clinicians, are taking these positions because the impact of climate change on public health is now so apparent. However, creating legislation and policy that slows the progress of climate change is not only good for the health of our citizens but also fiscally sound. Interventions that reduce fossil fuel emissions can also save money by reducing overall healthcare spending, especially among the most vulnerable populations.[12]
It’s time for the UC community to join the charge against climate with our healthcare professional colleagues. This is such a multi-faceted and far-reaching issue that the ways in which we can be involved are truly endless. However, I want to suggest 3 specific ways in which the UC community can show our support for this cause immediately.
1. Incorporate curricula discussing the health effects of climate change into our specialty conferences. By educating ourselves and colleagues, we can begin to organize and inspire one another and then share these learnings with our patients and others in our community.
2. Lead by example by advocating for reducing the carbon footprint of our own clinics first.
3. Directly lobby our local, state, and federal government leaders for policies affecting the environment through the lens of the effects of sustainability on the health of our patients.
As urgent care did during the COVID pandemic, we must again step up to fight an even larger existential threat: the decreasing livability of the only planet we have. From our trusted position, acting against the ongoing climate change crisis is nothing short of our duty. We owe it to our patients. We owe it to ourselves.
Roger Hicks, MD, FCUCM, is the Medical Director of Dignity Health’s Sierra Nevada Urgent Care Clinic, a member of the College of Urgent Care Medicine’s Board of Directors and its Clinical Response Committee, and represents the college on the Steering Committee of the Medical Consortium on Climate and Health.
- [1]. TillerT, Schott C. The Critical Relationship between Climate Change Awareness and Action: An Origin-Based Perspective. ResearchGate. Accessed April 23, 2024. https://www.researchgate.net/publication/263142193/The_Critical_Relationship_between_Climate_Change_Awareness_and_Action_An_Origin-Based_Perspective.
- [2]. Perera F, Nadeau K: Climate Change, Fossil-Fuel Pollution, and Children’s Health. New England Journal of Medicine. 2022; 386:2303-2314
- [3]. Perera F. Pollution from Fossil-Fuel Combustion is the Leading Environmental Threat to Global Pediatric Health and Equity: Solutions Exist. Int J Environ Res Public Health. 2017 Dec 23;15(1):16. doi: 10.3390/ijerph15010016. PMID: 29295510; PMCID: PMC5800116.
- [4]. Bekkar B, Pacheco S, Basu R. Association of Air Pollution and Heat Exposure With Preterm Birth, Low Birth Weight and Stillbirth in the US. JAMA Network Open. 2020;3(6):e208243.
- [5]. Tarabochia-Gast, A. T., Michanowicz, D. R., Bernstein, A. S. (2022). Flood risk to hospitals on the United States Atlantic and Gulf Coasts from hurricanes and sea level rise. GeoHealth, 6, e2022GH000651. https://doi.org/10.1029/2022GH000651
- [6]. Salas, R. The Climate Crisis and Clinical Practice. N Engl J Med. 2020; 382:589-591
- [7]. Medsocieties for Climate & Health website. Accessed March 20, 2024. https://medsocietiesforclimatehealth.org/about/
- [8]. American College of Emergency Physicians website. Impact of Climate Change on Public Health and Implications for Emergency Medicine. Accessed March 20, 2024. https://www.acep.org/patient-care/policy-statements/impact-of-climate-change-on-public-health-and-implications-for-emergency-medicine
- [ix]. Patel L, Byron L, Maher, K. Integrating Climate Change Education Into Board Certification For Pediatricians: A Model For Other Specialties. Journal of Climate Change and Health. 2022, Volume 5,100093, ISSN 2667-2782
- [10]. Atwoli L, Baqui A, Benfield T, Bosurgi R, Godlee F, Hancocks S, et al. Call For Emergency Action to Limit Global Temperature Increase, Restore Biodiversity, and Protect Health. N Engl J Med. 2021; 385:1134-1137
- [11]. Wise J. Climate Crisis: Over 200 Health Journals Urge World Leaders To Tackle “Catastrophic Harm”. BMJ 2021; 374:n2177
- [12]. Markandya A, Sampedro J, Smith SJ, et al. Health Co-Benefits From Air Pollution And Mitigation Costs Of The Paris Agreement: A Modelling Study. Lancet Planet Health. 2018;2(3):e126-e133.
