0:00:01.292,0:00:05.583
I arrived in the US from Kingston, Jamaica[br]in the summer of '68.

0:00:06.083,0:00:09.643
My family of six crammed[br]into a small, two-bedroom apartment

0:00:09.667,0:00:12.226
in a three-story walk-up in Brooklyn.

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The block had several children --

0:00:14.083,0:00:16.726
some spoke Spanish, some spoke English.

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Initially, I wasn't allowed[br]to play with them

0:00:19.208,0:00:22.143
because, as my parents said,[br]"Them too rambunctious" --

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(Laughter)

0:00:23.208,0:00:25.601
so I could only watch them from my window.

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Rollerskating was one[br]of their favorite activities.

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They loved hitching a ride[br]at the back of the city bus,

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letting go of the rear bumper

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as the bus arrived[br]at the bottom of the block

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in front of my building.

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One day there was a new girl with them.

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I heard the usual squeals of laughter[br]interspersed with, "Mira, mira!

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Mira, mira!"

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Spanish for, "Look, look!"

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The group grabbed onto the back[br]of the bus at the top of the block,

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and as they rolled down laughing[br]and screaming, "Mira, mira, mira, mira,"

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the bus abruptly stopped.

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The experienced riders[br]adjusted and quickly let go,

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but the new girl lurched back[br]and fell onto the pavement.

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She didn't move.

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The adults outside ran to help her.

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The bus driver came out[br]to see what had happened

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and call for an ambulance.

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There was blood coming from her head.

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She didn't open her eyes.

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We waited for the ambulance,

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and waited,

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and everyone said,[br]"Where is the ambulance?

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Where is the ambulance?"

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The police finally arrived.

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An older black American man said,[br]"Ain't no ambulance coming."

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He said it again loudly to the cop.

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"You know ain't no ambulance coming.

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They never send no ambulance here."

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The cop looked at my neighbors[br]who were getting frustrated,

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lifted the girl into the patrol car

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and left.

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I was 10 years old at the time.

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I knew this wasn't right.

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I knew there was something[br]more we could do.

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The something I could do[br]was become a doctor.

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I became an internist

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and committed my career to caring[br]for those we often call the underserved,

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the vulnerable,

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like those neighbors I had[br]when I first immigrated to America.

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During my early training years[br]in Harlem in the '80s,

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I saw a shocking increase[br]in young men with HIV.

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Then when I moved [to] Miami,

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I noticed HIV included women and children,

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primarily, poor black and brown people.

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Within a few years, an infection[br]seen in a select population

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became a worldwide epidemic.

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Again I got the urge to do something.

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Fortunately, with the help of activists[br]and advocates and educators

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and physicians like me[br]who treat the disease,

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we found a way forward.

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There was a massive education effort[br]to reduce HIV transmission

0:02:47.750,0:02:51.309
and provide legal protection[br]for those with the disease.

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There was a political will to make sure

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that as many patients[br]as possible worldwide,

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regardless of ability to pay,

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could get access to medication.

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Within a couple of decades[br]there were new treatments

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that transformed this life-threatening[br]infection to a chronic disease,

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like diabetes.

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Now there's a vaccine on the horizon.

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Over the last five to seven years,

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I've noticed a different epidemic[br]among the patients in Florida,

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and it looks something like this.

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Ms. Anna Mae, a retired clerical worker[br]living on a fixed income in Opa-locka,

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walked in for medication refills.

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She had common chronic conditions[br]of high blood pressure, diabetes,

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heart disease and asthma

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with overlapping chronic[br]obstructive pulmonary disease --

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COPD.

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Ms. Anna Mae was one[br]of my more adherent patients,

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so I was surprised she needed refills[br]of her breathing medicines

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earlier than usual.

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Towards the end of the visit,

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she handed me a Florida Power and Light [br]form and asked me to sign it.

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She was behind on her light bill.

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This form allowed physicians[br]to document serious medical conditions

0:04:01.417,0:04:03.768
requiring equipment that would be impacted

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if the patient's electricity[br]was disconnected.

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"But Ms. Anna Mae," I said,

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"you don't use any medical[br]devices for breathing.

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I don't think you qualify."

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Further questioning revealed[br]she had been using her air conditioner

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day and night because of the heat[br]so she could breathe.

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Needing to buy more asthma inhalers[br]left her little money;

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she couldn't pay all the bills[br]so it piled up.

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I filled out the form,

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but knowing she might be denied,

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I also sent her to the social worker.

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Then there was Jorge,

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such a sweet, kind man

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who often gifted our clinic

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with some of the fruits he sold[br]on the streets of Miami.

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He had signs of worsening kidney function

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whenever he worked days on end[br]on those hot streets

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due to dehydration --

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just not enough blood[br]getting to the kidneys.

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His kidneys worked much better[br]whenever he took some days off.

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But with no other support,[br]what could he do?

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As he says, "Rain or shine,[br]cold or heat, I have to work."

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But the most damning case of all[br]may be Ms. Sandra Faye Twiggs

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of Fort Lauderdale with COPD.

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She was arrested after fighting[br]with her daughter over a fan.

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On her release from jail,

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she returned to her apartment,

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coughed nonstop

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and died three days later.

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Here's what else I noticed:

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the data show allergy seasons[br]are starting weeks earlier,

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nighttime temperatures are rising,

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trees are growing faster

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and mosquitos carrying dangerous[br]diseases like Zika and dengue

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are showing up in areas[br]they didn't exist before.

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I also see signs of impending[br]climate gentrification.

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That's when richer people[br]move into poorer neighborhoods

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that are at higher elevation

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and less subject to flood damage[br]from climate change.

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Like in my patient Madame Marie[br]who came in stressed and anxious,

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because she was evicted from her apartment[br]in Miami's Little Haiti

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to make room for a luxury[br]apartment complex

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whose developers understood[br]that Little Haiti would not flood

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because it's ten feet above sea level.

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An undeniable, clear and consistent[br]warming trend is on the way.

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A health emergency even bigger[br]than HIV/AIDS seems to be in the works,

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and it was my low-income patients[br]that were dropping clues

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of what this would look like.

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This new epidemic is climate change,

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and it has a variety of health effects.

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Climate change impacts us[br]in four major ways.

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Directly, through heat,[br]extreme weather and pollution;

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through the spread of the disease;

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through disruption[br]of our food and water supply;

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and through disruption[br]of our emotional well-being.

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In medicine we use mnemonics[br]to aid our memory,

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and this mnemonic, "heatwave,"

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shows the eight significant[br]health effects of climate change.

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H: Heat illnesses.

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E: Exacerbation of heart and lung disease.

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A: Asthma worsening.

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T: Traumatic injuries,

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especially during extreme weather events.

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W: Water and foodborne illnesses.

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A: Allergies worsening.

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V: Vector-borne diseases spreading,[br]like Zika, dengue and Lyme.

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And E: Emotional stresses increasing.

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Poor, vulnerable people are already[br]feeling the effects of climate change.

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They are the proverbial[br]canary in a coal mine.

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Truly, their experiences[br]are like oracles or prophecies.

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The guiding light for us to pay attention

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that we are doing something to our world[br]first that's hurting them first.

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But in a matter of time, we are next.

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If we act together --

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doctors, patients[br]and other health professionals --

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we will find solutions.

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We have done this with the HIV crisis.

0:08:03.375,0:08:06.851
There [it] was thanks to the activism[br]of patients with HIV

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that demanded medications[br]and better research,

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and the collaboration[br]of doctors and scientists

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that we were able to control the epidemic.

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And then it was thanks[br]to international health agencies,

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NGOs, politicians[br]and pharmaceutical companies

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that HIV medication became[br]available in low-income countries.

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There is no reason we can't also apply[br]this model of collaboration

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to address the health effects[br]of climate change before it's too late.

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Climate change is here.

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It's already damaging the health[br]and homes of poor people.

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Like my patient Jorge,

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most of us will have to work,

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whether rain or shine,

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cold or heat.

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But together these patients[br]and their doctors, hand-in-hand,

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with some basic tools,

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can do so much to make[br]this climate transition less brutal

0:08:58.333,0:09:00.143
for all of us.

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These patients inspired me[br]to found a clinicians' organization

0:09:03.333,0:09:05.559
to fight climate change.

0:09:05.583,0:09:08.976
We focus on understanding[br]the health effects of climate change,

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learning to advocate for patients[br]with climate-related illnesses

0:09:12.458,0:09:15.000
and encouraging real-world solutions.

0:09:15.833,0:09:20.393
A recent Gallup study showed[br]three of the most respected professions

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are nurses, doctors and pharmacists.

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So as respected members of society,

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we have amplified voices[br]to influence climate change policy

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and politics.

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There is so much we can do.

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As clinicians, our many patient[br]contacts allows us

0:09:35.542,0:09:37.601
to see things before others.

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And this puts us in an ideal position[br]to be on the frontlines of change.

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We can teach climate-related illnesses[br]in our health-professional schools.

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We can collect data on our patients'[br]climate-related conditions

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by making sure there are[br]billing codes to identify them.

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We can do climate-related health research.

0:09:55.417,0:09:58.309
We can teach how to have[br]green practices in homes.

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We can advocate[br]for our patient energy needs.

0:10:01.125,0:10:03.226
We can help them get safer homes.

0:10:03.250,0:10:06.059
We can help them get necessary[br]equipment in those homes

0:10:06.083,0:10:07.768
when conditions worsen.

0:10:07.792,0:10:11.184
We can testify in front of lawmakers[br]as to the findings,

0:10:11.208,0:10:15.458
and we can medically treat[br]our patients' climate-related illnesses.

0:10:16.750,0:10:21.851
Most importantly, we can help prepare[br]our patients mentally and physically

0:10:21.875,0:10:24.268
for the health challenges they will face,

0:10:24.292,0:10:25.851
using a model of medicine

0:10:25.875,0:10:29.667
that incorporates[br]economic and social justice.

0:10:30.667,0:10:34.226
This would mean Ms. Sandra[br]Faye Twiggs with COPD,

0:10:34.250,0:10:37.851
who died after being released from jail

0:10:37.875,0:10:40.434
after a fight with[br]her daughter over a fan,

0:10:40.458,0:10:44.726
would have known that the heat[br]in her apartment made her sick and angry

0:10:44.750,0:10:47.643
and seek a safer place to go for cooling.

0:10:47.667,0:10:51.625
Even better, her apartment[br]would never have been so hot.

0:10:52.417,0:10:55.934
From the poor, I've learned[br]our lives are not only vulnerable

0:10:55.958,0:11:00.268
but are stories of resilience,[br]innovation and survival.

0:11:00.292,0:11:03.434
Like that wise old man[br]who loudly spoke truth to the cop

0:11:03.458,0:11:04.726
that summer night:

0:11:04.750,0:11:07.143
"Ain't no ambulance coming,"

0:11:07.167,0:11:11.208
and compelled him to deliver[br]that little girl to the hospital instead.

0:11:12.083,0:11:13.476
You know what?

0:11:13.500,0:11:14.750
Listen up.

0:11:15.500,0:11:19.559
If there's going to be a medical[br]response to climate change,

0:11:19.583,0:11:23.125
it is not going to be[br]just waiting for an ambulance.

0:11:23.708,0:11:28.018
It is going to happen because[br]we the clinicians take the first step.

0:11:28.042,0:11:29.726
We make so much noise

0:11:29.750,0:11:33.458
that the issue cannot[br]be ignored or misunderstood.

0:11:34.083,0:11:37.184
It is going to start[br]with the stories our patients tell

0:11:37.208,0:11:39.875
and the stories we tell on their behalf.

0:11:40.625,0:11:45.226
We're going to do what is right[br]for our patients like we've always done,

0:11:45.250,0:11:48.226
but also what is right[br]for our environment,

0:11:48.250,0:11:50.226
for ourselves

0:11:50.250,0:11:52.851
and for all the people on this planet --

0:11:52.875,0:11:54.309
all of them.

0:11:54.333,0:11:55.643
Thank you.

0:11:55.667,0:11:57.708
(Applause and cheers)