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← The link between climate change, health and poverty

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Showing Revision 10 created 06/03/2020 by Erin Gregory.

  1. I arrived in the US from Kingston, Jamaica
    in the summer of '68.
  2. My family of six crammed
    into a small, two-bedroom apartment
  3. in a three-story walk-up in Brooklyn.
  4. The block had several children --
  5. some spoke Spanish, some spoke English.
  6. Initially, I wasn't allowed
    to play with them
  7. because, as my parents said,
    "Them too rambunctious" --
  8. (Laughter)

  9. so I could only watch them from my window.

  10. Rollerskating was one
    of their favorite activities.
  11. They loved hitching a ride
    at the back of the city bus,
  12. letting go of the rear bumper
  13. as the bus arrived
    at the bottom of the block
  14. in front of my building.
  15. One day there was a new girl with them.
  16. I heard the usual squeals of laughter
    interspersed with, "Mira, mira!
  17. Mira, mira!"
  18. Spanish for, "Look, look!"
  19. The group grabbed onto the back
    of the bus at the top of the block,
  20. and as they rolled down laughing
    and screaming, "Mira, mira, mira, mira,"
  21. the bus abruptly stopped.
  22. The experienced riders
    adjusted and quickly let go,
  23. but the new girl lurched back
    and fell onto the pavement.
  24. She didn't move.
  25. The adults outside ran to help her.

  26. The bus driver came out
    to see what had happened
  27. and call for an ambulance.
  28. There was blood coming from her head.
  29. She didn't open her eyes.
  30. We waited for the ambulance,
  31. and waited,
  32. and everyone said,
    "Where is the ambulance?
  33. Where is the ambulance?"
  34. The police finally arrived.
  35. An older black American man said,
    "Ain't no ambulance coming."
  36. He said it again loudly to the cop.
  37. "You know ain't no ambulance coming.
  38. They never send no ambulance here."
  39. The cop looked at my neighbors
    who were getting frustrated,
  40. lifted the girl into the patrol car
  41. and left.
  42. I was 10 years old at the time.

  43. I knew this wasn't right.
  44. I knew there was something
    more we could do.
  45. The something I could do
    was become a doctor.
  46. I became an internist
  47. and committed my career to caring
    for those we often call the underserved,
  48. the vulnerable,
  49. like those neighbors I had
    when I first immigrated to America.
  50. During my early training years
    in Harlem in the '80s,

  51. I saw a shocking increase
    in young men with HIV.
  52. Then when I moved [to] Miami,
  53. I noticed HIV included women and children,
  54. primarily, poor black and brown people.
  55. Within a few years, an infection
    seen in a select population
  56. became a worldwide epidemic.
  57. Again I got the urge to do something.
  58. Fortunately, with the help of activists
    and advocates and educators
  59. and physicians like me
    who treat the disease,
  60. we found a way forward.
  61. There was a massive education effort
    to reduce HIV transmission
  62. and provide legal protection
    for those with the disease.
  63. There was a political will to make sure
  64. that as many patients
    as possible worldwide,
  65. regardless of ability to pay,
  66. could get access to medication.
  67. Within a couple of decades
    there were new treatments
  68. that transformed this life-threatening
    infection to a chronic disease,
  69. like diabetes.
  70. Now there's a vaccine on the horizon.
  71. Over the last five to seven years,

  72. I've noticed a different epidemic
    among the patients in Florida,
  73. and it looks something like this.
  74. Ms. Anna Mae, a retired clerical worker
    living on a fixed income in Opa-locka,
  75. walked in for medication refills.
  76. She had common chronic conditions
    of high blood pressure, diabetes,
  77. heart disease and asthma
  78. with overlapping chronic
    obstructive pulmonary disease --
  79. COPD.
  80. Ms. Anna Mae was one
    of my more adherent patients,
  81. so I was surprised she needed refills
    of her breathing medicines
  82. earlier than usual.
  83. Towards the end of the visit,
  84. she handed me a Florida Power and Light
    form and asked me to sign it.
  85. She was behind on her light bill.
  86. This form allowed physicians
    to document serious medical conditions
  87. requiring equipment that would be impacted
  88. if the patient's electricity
    was disconnected.
  89. "But Ms. Anna Mae," I said,
  90. "you don't use any medical
    devices for breathing.
  91. I don't think you qualify."
  92. Further questioning revealed
    she had been using her air conditioner
  93. day and night because of the heat
    so she could breathe.
  94. Needing to buy more asthma inhalers
    left her little money;
  95. she couldn't pay all the bills
    so it piled up.
  96. I filled out the form,
  97. but knowing she might be denied,
  98. I also sent her to the social worker.
  99. Then there was Jorge,

  100. such a sweet, kind man
  101. who often gifted our clinic
  102. with some of the fruits he sold
    on the streets of Miami.
  103. He had signs of worsening kidney function
  104. whenever he worked days on end
    on those hot streets
  105. due to dehydration --
  106. just not enough blood
    getting to the kidneys.
  107. His kidneys worked much better
    whenever he took some days off.
  108. But with no other support,
    what could he do?
  109. As he says, "Rain or shine,
    cold or heat, I have to work."
  110. But the most damning case of all
    may be Ms. Sandra Faye Twiggs

  111. of Fort Lauderdale with COPD.
  112. She was arrested after fighting
    with her daughter over a fan.
  113. On her release from jail,
  114. she returned to her apartment,
  115. coughed nonstop
  116. and died three days later.
  117. Here's what else I noticed:

  118. the data show allergy seasons
    are starting weeks earlier,
  119. nighttime temperatures are rising,
  120. trees are growing faster
  121. and mosquitos carrying dangerous
    diseases like Zika and dengue
  122. are showing up in areas
    they didn't exist before.
  123. I also see signs of impending
    climate gentrification.

  124. That's when richer people
    move into poorer neighborhoods
  125. that are at higher elevation
  126. and less subject to flood damage
    from climate change.
  127. Like in my patient Madame Marie
    who came in stressed and anxious,
  128. because she was evicted from her apartment
    in Miami's Little Haiti
  129. to make room for a luxury
    apartment complex
  130. whose developers understood
    that Little Haiti would not flood
  131. because it's ten feet above sea level.
  132. An undeniable, clear and consistent
    warming trend is on the way.

  133. A health emergency even bigger
    than HIV/AIDS seems to be in the works,
  134. and it was my low-income patients
    that were dropping clues
  135. of what this would look like.
  136. This new epidemic is climate change,
  137. and it has a variety of health effects.
  138. Climate change impacts us
    in four major ways.
  139. Directly, through heat,
    extreme weather and pollution;
  140. through the spread of the disease;
  141. through disruption
    of our food and water supply;
  142. and through disruption
    of our emotional well-being.
  143. In medicine we use mnemonics
    to aid our memory,
  144. and this mnemonic, "heatwave,"
  145. shows the eight significant
    health effects of climate change.
  146. H: Heat illnesses.

  147. E: Exacerbation of heart and lung disease.

  148. A: Asthma worsening.

  149. T: Traumatic injuries,

  150. especially during extreme weather events.
  151. W: Water and foodborne illnesses.

  152. A: Allergies worsening.

  153. V: Vector-borne diseases spreading,
    like Zika, dengue and Lyme.

  154. And E: Emotional stresses increasing.

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

  156. They are the proverbial
    canary in a coal mine.
  157. Truly, their experiences
    are like oracles or prophecies.
  158. The guiding light for us to pay attention
  159. that we are doing something to our world
    first that's hurting them first.
  160. But in a matter of time, we are next.
  161. If we act together --

  162. doctors, patients
    and other health professionals --
  163. we will find solutions.
  164. We have done this with the HIV crisis.
  165. There [it] was thanks to the activism
    of patients with HIV
  166. that demanded medications
    and better research,
  167. and the collaboration
    of doctors and scientists
  168. that we were able to control the epidemic.
  169. And then it was thanks
    to international health agencies,
  170. NGOs, politicians
    and pharmaceutical companies
  171. that HIV medication became
    available in low-income countries.
  172. There is no reason we can't also apply
    this model of collaboration
  173. to address the health effects
    of climate change before it's too late.
  174. Climate change is here.

  175. It's already damaging the health
    and homes of poor people.
  176. Like my patient Jorge,
  177. most of us will have to work,
  178. whether rain or shine,
  179. cold or heat.
  180. But together these patients
    and their doctors, hand-in-hand,
  181. with some basic tools,
  182. can do so much to make
    this climate transition less brutal
  183. for all of us.
  184. These patients inspired me
    to found a clinicians' organization

  185. to fight climate change.
  186. We focus on understanding
    the health effects of climate change,
  187. learning to advocate for patients
    with climate-related illnesses
  188. and encouraging real-world solutions.
  189. A recent Gallup study showed
    three of the most respected professions

  190. are nurses, doctors and pharmacists.
  191. So as respected members of society,
  192. we have amplified voices
    to influence climate change policy
  193. and politics.
  194. There is so much we can do.
  195. As clinicians, our many patient
    contacts allows us
  196. to see things before others.
  197. And this puts us in an ideal position
    to be on the frontlines of change.
  198. We can teach climate-related illnesses
    in our health-professional schools.

  199. We can collect data on our patients'
    climate-related conditions
  200. by making sure there are
    billing codes to identify them.
  201. We can do climate-related health research.
  202. We can teach how to have
    green practices in homes.
  203. We can advocate
    for our patient energy needs.
  204. We can help them get safer homes.
  205. We can help them get necessary
    equipment in those homes
  206. when conditions worsen.
  207. We can testify in front of lawmakers
    as to the findings,
  208. and we can medically treat
    our patients' climate-related illnesses.
  209. Most importantly, we can help prepare
    our patients mentally and physically
  210. for the health challenges they will face,
  211. using a model of medicine
  212. that incorporates
    economic and social justice.
  213. This would mean Ms. Sandra
    Faye Twiggs with COPD,

  214. who died after being released from jail
  215. after a fight with
    her daughter over a fan,
  216. would have known that the heat
    in her apartment made her sick and angry
  217. and seek a safer place to go for cooling.
  218. Even better, her apartment
    would never have been so hot.
  219. From the poor, I've learned
    our lives are not only vulnerable

  220. but are stories of resilience,
    innovation and survival.
  221. Like that wise old man
    who loudly spoke truth to the cop
  222. that summer night:
  223. "Ain't no ambulance coming,"
  224. and compelled him to deliver
    that little girl to the hospital instead.
  225. You know what?

  226. Listen up.
  227. If there's going to be a medical
    response to climate change,
  228. it is not going to be
    just waiting for an ambulance.
  229. It is going to happen because
    we the clinicians take the first step.
  230. We make so much noise
  231. that the issue cannot
    be ignored or misunderstood.
  232. It is going to start
    with the stories our patients tell
  233. and the stories we tell on their behalf.
  234. We're going to do what is right
    for our patients like we've always done,
  235. but also what is right
    for our environment,
  236. for ourselves
  237. and for all the people on this planet --
  238. all of them.
  239. Thank you.

  240. (Applause and cheers)