The link between climate change, health and poverty

For the poor and vulnerable, the health impacts of climate change are already here, says physician Cheryl Holder. Unseasonably hot temperatures, disease-carrying mosquitoes and climate gentrification threaten those with existing health conditions, while wealthier people move to higher ground. In an impassioned talk, Holder proposes impactful ways clinicians can protect their patients from climate-related health challenges -- and calls on doctors, politicians and others to build a care system that incorporates economic and social justice.

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

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

in a three-story walk-up in Brooklyn.

The block had several children --

some spoke Spanish, some spoke English.

Initially, I wasn't allowed
to play with them

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

(Laughter)

so I could only watch them from my window.

Rollerskating was one
of their favorite activities.

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

letting go of the rear bumper

as the bus arrived
at the bottom of the block

in front of my building.

One day there was a new girl with them.

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

Mira, mira!"

Spanish for, "Look, look!"

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

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

the bus abruptly stopped.

The experienced riders
adjusted and quickly let go,

but the new girl lurched back
and fell onto the pavement.

She didn't move.

The adults outside ran to help her.

The bus driver came out
to see what had happened

and call for an ambulance.

There was blood coming from her head.

She didn't open her eyes.

We waited for the ambulance,

and waited,

and everyone said,
"Where is the ambulance?

Where is the ambulance?"

The police finally arrived.

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

He said it again loudly to the cop.

"You know ain't no ambulance coming.

They never send no ambulance here."

The cop looked at my neighbors
who were getting frustrated,

lifted the girl into the patrol car

and left.

I was 10 years old at the time.

I knew this wasn't right.

I knew there was something
more we could do.

The something I could do
was become a doctor.

I became an internist

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

the vulnerable,

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

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

I saw a shocking increase
in young men with HIV.

Then when I moved [to] Miami,

I noticed HIV included women and children,

primarily, poor black and brown people.

Within a few years, an infection
seen in a select population

became a worldwide epidemic.

Again I got the urge to do something.

Fortunately, with the help of activists
and advocates and educators

and physicians like me
who treat the disease,

we found a way forward.

There was a massive education effort
to reduce HIV transmission

and provide legal protection
for those with the disease.

There was a political will to make sure

that as many patients
as possible worldwide,

regardless of ability to pay,

could get access to medication.

Within a couple of decades
there were new treatments

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

like diabetes.

Now there's a vaccine on the horizon.

Over the last five to seven years,

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

and it looks something like this.

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

walked in for medication refills.

She had common chronic conditions
of high blood pressure, diabetes,

heart disease and asthma

with overlapping chronic
obstructive pulmonary disease --

COPD.

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

so I was surprised she needed refills
of her breathing medicines

earlier than usual.

Towards the end of the visit,

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

She was behind on her light bill.

This form allowed physicians
to document serious medical conditions

requiring equipment that would be impacted

if the patient's electricity
was disconnected.

"But Ms. Anna Mae," I said,

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

I don't think you qualify."

Further questioning revealed
she had been using her air conditioner

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

Needing to buy more asthma inhalers
left her little money;

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

I filled out the form,

but knowing she might be denied,

I also sent her to the social worker.

Then there was Jorge,

such a sweet, kind man

who often gifted our clinic

with some of the fruits he sold
on the streets of Miami.

He had signs of worsening kidney function

whenever he worked days on end
on those hot streets

due to dehydration --

just not enough blood
getting to the kidneys.

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

But with no other support,
what could he do?

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

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

of Fort Lauderdale with COPD.

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

On her release from jail,

she returned to her apartment,

coughed nonstop

and died three days later.

Here's what else I noticed:

the data show allergy seasons
are starting weeks earlier,

nighttime temperatures are rising,

trees are growing faster

and mosquitos carrying dangerous
diseases like Zika and dengue

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

I also see signs of impending
climate gentrification.

That's when richer people
move into poorer neighborhoods

that are at higher elevation

and less subject to flood damage
from climate change.

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

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

to make room for a luxury
apartment complex

whose developers understood
that Little Haiti would not flood

because it's ten feet above sea level.

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

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

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

of what this would look like.

This new epidemic is climate change,

and it has a variety of health effects.

Climate change impacts us
in four major ways.

Directly, through heat,
extreme weather and pollution;

through the spread of the disease;

through disruption
of our food and water supply;

and through disruption
of our emotional well-being.

In medicine we use mnemonics
to aid our memory,

and this mnemonic, "heatwave,"

shows the eight significant
health effects of climate change.

H: Heat illnesses.

E: Exacerbation of heart and lung disease.

A: Asthma worsening.

T: Traumatic injuries,

especially during extreme weather events.

W: Water and foodborne illnesses.

A: Allergies worsening.

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

And E: Emotional stresses increasing.

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

They are the proverbial
canary in a coal mine.

Truly, their experiences
are like oracles or prophecies.

The guiding light for us to pay attention

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

But in a matter of time, we are next.

If we act together --

doctors, patients
and other health professionals --

we will find solutions.

We have done this with the HIV crisis.

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

that demanded medications
and better research,

and the collaboration
of doctors and scientists

that we were able to control the epidemic.

And then it was thanks
to international health agencies,

NGOs, politicians
and pharmaceutical companies

that HIV medication became
available in low-income countries.

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

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

Climate change is here.

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

Like my patient Jorge,

most of us will have to work,

whether rain or shine,

cold or heat.

But together these patients
and their doctors, hand-in-hand,

with some basic tools,

can do so much to make
this climate transition less brutal

for all of us.

These patients inspired me
to found a clinicians' organization

to fight climate change.

We focus on understanding
the health effects of climate change,

learning to advocate for patients
with climate-related illnesses

and encouraging real-world solutions.

A recent Gallup study showed
three of the most respected professions

are nurses, doctors and pharmacists.

So as respected members of society,

we have amplified voices
to influence climate change policy

and politics.

There is so much we can do.

As clinicians, our many patient
contacts allows us

to see things before others.

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

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

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

by making sure there are
billing codes to identify them.

We can do climate-related health research.

We can teach how to have
green practices in homes.

We can advocate
for our patient energy needs.

We can help them get safer homes.

We can help them get necessary
equipment in those homes

when conditions worsen.

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

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

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

for the health challenges they will face,

using a model of medicine

that incorporates
economic and social justice.

This would mean Ms. Sandra
Faye Twiggs with COPD,

who died after being released from jail

after a fight with
her daughter over a fan,

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

and seek a safer place to go for cooling.

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

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

but are stories of resilience,
innovation and survival.

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

that summer night:

"Ain't no ambulance coming,"

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

You know what?

Listen up.

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

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

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

We make so much noise

that the issue cannot
be ignored or misunderstood.

It is going to start
with the stories our patients tell

and the stories we tell on their behalf.

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

but also what is right
for our environment,

for ourselves

and for all the people on this planet --

all of them.

Thank you.

(Applause and cheers)