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 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 that 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-May], 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-May] 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 & 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. Annna-May]," 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 were 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 Ft. 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 showed 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 attenion
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 profressionals -
we will find solutions.
We have done this with the HIV crisis.
[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 pharmeceutical 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.
The patients inspired me to found the 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 their 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)