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I arrived in the US from Kingston, Jamaica
in the summer of '68.

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My family of six crammed
into a small, two-bedroom apartment

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in a three-story walk-up in Brooklyn.

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The block had several children --

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some spoke Spanish, some spoke English.

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Initially, I wasn't allowed
to play with them

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because, as my parents said,
"Them too rambunctious" --

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(Laughter)

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so I could only watch them from my window.

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Rollerskating was one
of their favorite activities.

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They loved hitching a ride
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
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
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
of the bus at the top of the block,

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and as they rolled down laughing
and screaming, "Mira, mira, mira, mira,"

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the bus abruptly stopped.

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The experienced riders
adjusted and quickly let go,

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but the new girl lurched back
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
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,
"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,
"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
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
more we could do.

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The something I could do
was become a doctor.

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I became an internist

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

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the vulnerable,

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like those neighbors I had
when I first immigrated to America.

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

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I saw a shocking increase
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
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
and advocates and educators

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and physicians like me
who treat the disease,

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we found a way forward.

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There was a massive education effort
to reduce HIV transmission

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and provide legal protection
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
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
there were new treatments

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that transformed this life-threatening
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
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
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
of high blood pressure, diabetes,

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heart disease and asthma

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with overlapping chronic
obstructive pulmonary disease --

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COPD.

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

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so I was surprised she needed refills
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 
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
to document serious medical conditions

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requiring equipment that would be impacted

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if the patient's electricity
was disconnected.

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"But Ms. Anna Mae," I said,

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

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I don't think you qualify."

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Further questioning revealed
she had been using her air conditioner

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

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Needing to buy more asthma inhalers
left her little money;

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she couldn't pay all the bills
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
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
on those hot streets

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due to dehydration --

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just not enough blood
getting to the kidneys.

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

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But with no other support,
what could he do?

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

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

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of Fort Lauderdale with COPD.

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She was arrested after fighting
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
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
diseases like Zika and dengue

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

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I also see signs of impending
climate gentrification.

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That's when richer people
move into poorer neighborhoods

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that are at higher elevation

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and less subject to flood damage
from climate change.

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

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

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to make room for a luxury
apartment complex

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whose developers understood
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
warming trend is on the way.

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

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and it was my low-income patients
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
in four major ways.

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Directly, through heat,
extreme weather and pollution;

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through the spread of the disease;

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through disruption
of our food and water supply;

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and through disruption
of our emotional well-being.

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In medicine we use mnemonics
to aid our memory,

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and this mnemonic, "heatwave,"

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shows the eight significant
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,
like Zika, dengue and Lyme.

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And E: Emotional stresses increasing.

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

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They are the proverbial
canary in a coal mine.

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Truly, their experiences
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
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
and other health professionals --

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we will find solutions.

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We have done this with the HIV crisis.

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There [it] was thanks to the activism
of patients with HIV

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that demanded medications
and better research,

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and the collaboration
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
to international health agencies,

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NGOs, politicians
and pharmaceutical companies

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that HIV medication became
available in low-income countries.

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

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to address the health effects
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
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
and their doctors, hand-in-hand,

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with some basic tools,

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can do so much to make
this climate transition less brutal

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for all of us.

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These patients inspired me
to found a clinicians' organization

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to fight climate change.

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We focus on understanding
the health effects of climate change,

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learning to advocate for patients
with climate-related illnesses

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and encouraging real-world solutions.

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A recent Gallup study showed
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
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
contacts allows us

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to see things before others.

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

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

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

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by making sure there are
billing codes to identify them.

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We can do climate-related health research.

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We can teach how to have
green practices in homes.

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We can advocate
for our patient energy needs.

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We can help them get safer homes.

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We can help them get necessary
equipment in those homes

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when conditions worsen.

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We can testify in front of lawmakers
as to the findings,

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and we can medically treat
our patients' climate-related illnesses.

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Most importantly, we can help prepare
our patients mentally and physically

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for the health challenges they will face,

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using a model of medicine

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that incorporates
economic and social justice.

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This would mean Ms. Sandra
Faye Twiggs with COPD,

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who died after being released from jail

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after a fight with
her daughter over a fan,

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would have known that the heat
in her apartment made her sick and angry

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and seek a safer place to go for cooling.

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Even better, her apartment
would never have been so hot.

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From the poor, I've learned
our lives are not only vulnerable

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but are stories of resilience,
innovation and survival.

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Like that wise old man
who loudly spoke truth to the cop

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that summer night:

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"Ain't no ambulance coming,"

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and compelled him to deliver
that little girl to the hospital instead.

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You know what?

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Listen up.

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If there's going to be a medical
response to climate change,

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it is not going to be
just waiting for an ambulance.

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It is going to happen because
we the clinicians take the first step.

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We make so much noise

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that the issue cannot
be ignored or misunderstood.

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It is going to start
with the stories our patients tell

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and the stories we tell on their behalf.

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We're going to do what is right
for our patients like we've always done,

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but also what is right
for our environment,

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for ourselves

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and for all the people on this planet --

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all of them.

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Thank you.

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(Applause and cheers)