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Climate change: ‘Physicians need to be involved’

Sorensen in Guatemala

The University of Colorado School of Medicine’s Department of Emergency Medicine is a leader in studying the effects of climate change on human health, and Cecilia Sorensen, MD, has put the mileage on her shoes to prove it.

In the past year, she’s surveyed neighborhoods in Puerto Rico to study the aftermath of Hurricane Maria; made daily treks to the Syria-Lebanon border to examine the role of environmental change on women’s health; walked through sugar cane fields in Central America where heat stress may be a culprit behind workers’ increasing rates of kidney disease; and attended numerous conferences and board meetings across the nation.

Sorensen in Puerto Rico
Cecilia Sorensen, left, surveyed neighborhoods in Puerto Rico in the aftermath of Hurricane Maria.

“The work is so incredible,” she said. “There is so much opportunity for physicians to be involved in this topic.”

Sorensen is the inaugural fellow in the Living Closer Foundation Fellowship in Climate and Health Science Policy, a collaborative post-graduate training program offered through CU Anschutz, National Institutes of Environmental Health Sciences (NIEHS), Centers for Disease Control (CDC) and the Medical Society Consortium of Climate and Health.

The first of its kind in the nation, the fellowship was spearheaded by Jay Lemery, MD, associate professor of emergency medicine and co-author of “Enviromedics: The Impact of Climate Change on Human Health.” The program, which welcomes its second fellow this summer, received funding from the Denver-based Living Closer Foundation.

Potential CU-led consortium

“We’re getting indications that other major universities are super-excited about what we’ve done here,” Lemery said. “Going forward, we’re looking at doing the fellowship as a consortium. We could potentially send our fellow to Harvard to work on public health and human rights projects and vice versa. That would be the goal – to start to pool and share resources.”

Lemery said the threat to human health from climate change — natural disasters such as heat waves, wildfire, hurricanes and rising oceans as well as increases in vector-borne disease and air-quality degradation — is clearly borne out by science. However, physicians have been largely absent from the dialogue, and consequently, from the policy decisions that drive meaningful change.

Lemery
Jay Lemery, MD, spearheaded CU’s new fellowship on climate and health science policy.

Healthcare providers, as the professionals dealing with illness and injury on the front lines, are uniquely positioned to say, “this is a significant problem; something must be done,” Lemery said.

Force multiplier

“Climate change is a force multiplier – it will worsen health in many different ways and we have a chance to mitigate it. It’s not too late; we’re not doomed,” he said. “Just like we tell our patients: ‘Stop smoking now, while you’re in their 20s, because I can tell you what this looks like in your 60s.’ Climate change is the same thing.”

Lemery said the aftermath of Hurricane Maria, a category 5 hurricane that slammed Puerto Rico in September 2017, illustrates the need to study correlations between climate change and health. The death toll was initially reported as 64 by local authorities, but subsequent studies, including the one Sorensen took part in, revealed the statistical mean mortality from the storm to be approximately 4,600.

“If you can’t explain the damage of extreme weather on a vulnerable population, how are you going to understand the true impact of these threats?” Lemery said. “Like any science, you need data. Data fuels decisions and policy makers.”

Globetrotting fellow

In the past year, Sorensen has been on the forefront of offering – from a physicians’ viewpoint — hard science to the policy makers. Sorensen and Lemery were among the authors of the latest National Climate Assessment, which summarizes the impacts of climate change on the United States, both currently and into the future.

The CU fellowship has given Sorensen, who chairs the Education Committee for the Medical Climate Society for Climate Health, a seat at the table at some of the most important discussions taking place on the topic.

HEALTHCARE COSTS

The proposal to create the climate and health science fellowship at CU Anschutz included these data points:

  • Between 2000-2009, heat waves contributed an estimated $5 billion in direct healthcare costs in the United States.
  • The Zika epidemic in the Americas, which may have been facilitated by permissive climatic conditions that increased mosquito vector abundance, led to $1.1 billion in costs.

“As physicians, we bring a unique perspective because we take care of patients on the front line. We understand human physiology,” she said. “Public health experts understand the epidemiology and the statistics around disease, while we’re the experts on human health.

“So, when all these people team up, you gain an incredible perspective,” Sorensen added. “I think physicians are so vital to solving these problems.”

Environmental health = human health

Sorensen received her bachelor’s degree in environmental ecology from CU Boulder. She went on earn a doctor of medicine degree, leading to meeting Lemery during her residency in emergency medicine at Denver Health. They shared a strong interest in the intersection of environment and health, and a “light bulb went off.” To Sorensen it was obvious: the health of the environment is essential to all organisms on the planet which rely upon it.

In another project, Sorensen and researcher James Crooks at National Jewish Hospital are examining how wildfire and smoke exposure correlate with patients requiring ICU care. Because ICU beds are limited, predictive analytics would help hospitals adjust resources accordingly to meet higher demands. “We have the potential to predict a couple days out in places near wildfires that will see surges of people needing ICU care,” she said.

Potential sub-specialty: climate medicine

She hopes to continue working as a practicing physician, while also actively studying the interplay of climate and human health. In the near future, Sorensen predicts, climate medicine will become a popular sub-specialty in schools of medicine.

Sorensen in class
Cecilia Sorensen, MD, delivers introductory remarks about the new Climate and Health class, offered by the CU School of Medicine.

“You’d be amazed how many emails Jay and I get from interested students all around the country every week,” she said. “I’m currently working with a student at Johns Hopkins University who has come to us at the University of Colorado because we’re the people doing this. We need to keep creating opportunities to involve students in whatever we’re doing.”

Just this month, the Department of Emergency Medicine in the CU School of Medicine launched a new elective for fourth-year medical students – Climate Change & Human Health. The two-week course has about 20 students, several of whom are coming from out of state. The class is being collaboratively taught by over 15 faculty members from CU Anschutz and CU Boulder.

“There is so much interest in this topic from this next generation of physicians,” Sorensen said. “People are wanting to come here to figure out what we’re doing, because it’s very unique. For fourth-year medical students, there just aren’t opportunities to study climate change and medicine.”

Added Lemery, “In terms of education on climate and health, we’re it. There’s so much work to be done.”

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Physicians’ book ‘Enviromedics’ explores link between climate change and human health

The adverse impacts to human health from global warming are undeniable and on track to worsen, without significant interventions, in the coming decades.

Jay Lemery, MD, of CU Anschutz
Jay Lemery, MD

This is the view of Jay Lemery, MD, associate professor of medicine in the CU School of Medicine, and the wider scientific community. Lemery co-authored a recently published book, “Enviromedics: The Impact of Climate Change on Human Health” with Paul Auerbach, MD, professor of emergency medicine at Stanford University School of Medicine.

Lemery, who is also section chief of the Wilderness and Environmental Medicine Section in the SOM’s Department of Emergency Medicine, has a strong interest in the interplay of the environment and human health.

Asked why he and Auerbach wrote the book, Lemery said, “It’s clear there’s been a conspicuous absence of physicians and health care providers engaging in the dialogue on climate change and its impact on human health. We also felt the science was being politicized and risk assessments for most Americans were skewed. So we wanted to take a step back and weigh in from the physicians’ point of view, essentially saying, ‘We know sickness – this is what we do every day,’ and point to what we see coming down the pike.”

The book takes the reader to the bedside, providing vignettes of the sicknesses physicians are seeing across the globe. The book’s message is clear: Climate change is and will be a driver to make these health problems worse.

‘Changes in vector-borne diseases’

Lemery chatted with Today about “Enviromedics” and the dire prognosis for the planet and its inhabitants if climate change continues unchecked.

Today: What are the effects of climate when it comes to human biology? What are physicians seeing in that regard?

Lemery:

  • Extreme heat events are real and becoming more prevalent and intense. We’re seeing heat illness, heat stress – acute conditions – but we also see things like chronic kidney disease spiking in vulnerable places, like among field workers in central America and south Asia. We’re seeing pre-existing health conditions – diabetes, heart disease, congestive heart failure – all exacerbated by extreme heat. In general, we’re seeing exacerbations of chronic disease with vulnerable populations – the very old, the very sick, the very young.
  • We’re also seeing changes in vector-borne diseases – infectious diseases like malaria, dengue, even Zika – and the range of these diseases is increasing in altitude and latitude. Also, the life cycles of the vectors – the mosquitoes and ticks that carry the diseases – are being altered by climate change.
  • After extreme weather events, we see not only the trauma from flooding and extreme damage to infrastructure – causing hundreds of deaths like this summer with the hurricanes – but also the breakouts of water-borne disease. This happens after the fact, when water supplies, sewage systems and food-growth areas are all mixed and spread out after these weather events.
  • We’re seeing degraded air quality over huge swaths; even in the U.S., huge swaths of the American West have been affected all summer from wildfires, which are now more intense and long-lasting than anytime in the historical record.
  • For people who suffer from allergies, the aero-allergen seasons are longer and the pollen counts are higher than we’ve ever seen.
  • From the sea-level rise caused by global warming, we’re seeing higher storm surges, and there’s been a slow erosion, particularly of low-lying areas in the low-lying nations in the Pacific and Indian oceans. These are communities, and in some cases nations, that are looking at the best science and saying, ‘We probably won’t have a home in 100 years.’ So we are now actually seeing migrations of people who are resettling in places like Australia and New Zealand.
  • There are also force multipliers. Food security is affected by extreme weather; extreme precipitation events, extreme drought events and extreme heat events all disrupt food supply. In poverty-stricken areas, when the food supply is disrupted, food insecurity and the consequential malnutrition or even starvation becomes more at risk than it was previously.

‘We know this is coming’

Today: Someone may say, “Even though you’re a scientist, you’re not a climatologist, you’re not a meteorologist. Why should we listen to you on the subject of climate change?” If someone were to say that to you, what would be your response?

Book "Enviromedics"
Jay Lemery, MD, associate professor of medicine in the CU School of Medicine, co-authored “Eviromedics: The Impact of Climate Change on Human Health.”

Lemery: That’s exactly right. It’s time that we as physicians, as health care providers, as the people who deal with injury and sickness and even death, step forward and say, ‘This is the same thing. What we’re seeing and what we can anticipate as drivers of morbidity and mortality, we know this is coming.’ So it’s important to hear it from your doctor, from those of us who wear the metaphorical white coat, and say, ‘This is a big deal.’ We’ve spent a lot of time delivering altruistic-oriented messages – ‘Save the whales’ or ‘Love mother Earth’ – or abstract messages – like ‘There’s 400 parts per million of carbon dioxide in the atmosphere’ – but I don’t think those messages have worked.

We need to bring it back to a simple message: This is about the health of your parents, your kids’ risk of asthma and other health issues that affect the people you love. This comes down to the very basic health issues of humanity – and if that’s not a fulcrum for change, I’m not sure what is. That’s why we wrote the book.

Today: Where does the science stand on the direct link to these kinds of health issues right now?

Lemery: The science is pretty clear, and frankly no one is really debating this anymore: Human-caused climate change is driving a lot of these health issues. Now, some of them are direct, but many more are indirect. So, where public health was tenuous as first, force multipliers are making the situation worse. I think it’s important to understand that the data is clear, and the people who spend their careers studying this across all spectrums of environmental earth science have been saying the same thing: This is real; the change is real; and the historical record has never shown anything near this. It’s beyond historical fluctuations.

‘Trajectories going up across all metrics’

 Today: Will climate change affect people in the next five or 10 years, or the next 50 years? How fast will these effects get worse?

Also written by Dr. Lemery

In 2015, Jay Lemery, MD, co-authored “Global Climate Change and Human Health” with George Luber, PhD.

Lemery: We’re seeing the effects now. This summer has seen some of the strongest storms on record in the Atlantic basin. In the last few years, we’ve seen absolutely the most extreme storms on record. We know that the heat waves we’re seeing now are all beyond historical precedent. The majority of the warmest years on record have been in the last 10 to 20 years. Meanwhile, the Arctic sea ice is at its lowest point on average than has ever been recorded.

The fact that these effects are cumulative is very worrisome. We know that the data tell us that if we stop producing carbon now, it will be a long, long time before the Earth equalizes. And of course we’re not stopping carbon production, so I think the trends we’re seeing are going to worsen and last centuries into the future. To what degree will be the trajectory? I think that’s being postulated as varied, but, unfortunately, the trajectories are going up across all metrics.

Editor’s note: Matthew Kaskavitch, digital engagement strategist, contributed to this report. 

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Researchers say climate change may accelerate infectious disease outbreaks

Aside from inflicting devastating natural disasters on often vulnerable communities, climate change can also spur outbreaks of infectious diseases like Zika , malaria and dengue fever, according to a new study by researchers at the University of  Colorado Anschutz Medical Campus.

“Climate change presents complex and wide-reaching threats to human health,” said Cecilia Sorensen, MD, lead author of the study and the Living Closer Foundation Fellow in Climate and Health Policy at CU Anschutz. “It can amplify and unmask ecological and socio-political weaknesses and increase the risk of adverse health outcomes in socially vulnerable regions.”

When natural disasters strike such places, she said, the climatic conditions may make the public health crisis significantly worse.

Dr. Cecilia Sorensen, lead author of the study and the Living Closer Foundation Fellow in Climate and Health Policy at CU Anschutz.
Dr. Cecilia Sorensen, lead author of the study and the Living Closer Foundation Fellow in Climate and Health Policy at CU Anschutz.

The researchers said these vulnerabilities can happen anywhere. After Hurricane Katrina hit New Orleans, cases of West Nile disease doubled the next year. Climate change in Africa appears to be increasing cases of malaria. And the recent destruction in Houston, Florida and Puerto Rico due to hurricanes may usher in more infectious diseases in the years ahead.

The study focused specifically on a magnitude 7.7 earthquake that struck coastal Ecuador in April 2016, coinciding with an exceptionally strong El Niño event. El Niños are associated with heavy rainfall and warmer air temperatures. They are also linked to outbreaks of dengue fever.

Sorensen, a clinical instructor in emergency medicine at CU Anschutz, was in Ecuador with her co-authors working with the Walking Palms Global Initiative. They were operating a mobile health clinic after the disaster.

“We were seeing all of these viral symptoms in the wake of the quake,” she said. “We noticed a huge spike in Zika cases where the earthquake occurred. Prior to this, there were only a handful of Zika cases in the whole country.”

In fact, the researchers found the number of Zika cases had increased 12-fold in the quake zone.

Zika virus is transmitted by mosquitos. Symptoms are usually mild but the infection can cause major abnormalities and even death in a developing fetus.

Warmer temperatures and increased rainfall from the El Niño, along with a devastated infrastructure and an influx of people into larger cities, likely caused the spike in Zika cases, Sorensen said.

Natural disasters like Hurricane Katrina can spur outbreaks of infectious disease.
Natural disasters like Hurricane Katrina can spur outbreaks of infectious disease.

“We saw so many people affected by the earthquake that were sleeping outside without any shelter from mosquitoes, so we were worrying that the region’s changing climate could facilitate the spread of diseases,” she said. “Natural disasters can create a niche for emerging diseases to come out and affect more people.”

Sorensen’s team reviewed the existing research on the link between short-term climate changes and disease transmission. They applied those findings to explain the role of the earthquake and El Niño in the Zika outbreak.

They suggest El Niño created ideal conditions for Zika-carrying mosquitos to breed and make more copies of the Zika virus. The warmer temperatures and increased rainfall from El Niño have previously been associated with a higher likelihood of dengue outbreaks. Warmer temperatures can also accelerate viral replication in mosquitoes and influence mosquitos’ development and breeding habits.

At the same time, the El Niño event brought warmer sea-surface temperatures, which have been shown to correlate with outbreaks of mosquito-transmitted diseases. Estimates from remote sensing data in coastal Ecuador show that sea-surface temperatures were higher than average from 2014-2016.

The team also believes an increase in water scarcity after the earthquake indirectly benefited mosquito development. The quake damaged municipal water systems, forcing people to store water in open containers outside their homes. These served as additional habitats for mosquito larvae.

The new findings could be used by governments to identify and protect vulnerable communities before natural disasters happen, Sorensen said.

“One idea is to develop disease models that can use existing climate models to predict where these vectors will show up due to climate variability,” she said. “Applying these new models to areas that have pre-existing social vulnerabilities could identify susceptible regions, allowing us to direct healthcare resources there ahead of time.”

The study was published October 12 in GeoHealth, a publication of the American Geophysical Union.

The co-authors of the study from CU Anschutz include Emilie Calvello-Hynes, MD, assistant professor of emergency medicine and Jay Lemery, MD, associate professor of emergency medicine and chief of wilderness and environmental medicine.

The other co-authors include: Mercy J. Borbor-Cordova, Faculty of Naval Engineering, Oceanic Sciences and Natural Resources, Escuela Superior Politecnica del Litoral, Guayaquil, Ecuador; Avriel Diaz, Dept. of Evolution, Ecology and Environmental Biology, Columbia University; Anna M. Stewart-Ibarra, Department of Public Health and Preventative Medicine, SUNY Upstate Medical University, Syracuse, NY.

This paper is a collaboration of the University of Colorado Consortium for Climate Change and Health.

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Consortium takes lead on studying climate change effects on health

A group of University of Colorado scientists are taking a leadership role to investigate the effects of climate change on health, which has emerged as a dominant issue of this century and beyond.

They are launching education, research and community partnerships with a clear aim: safeguard human health.

Dr. Rick Johnson of CU Anschutz

Richard Johnson, MD, Medicine-Renal Medicine Diseases, SOM, is a founding member of UC4Health.

UC4Health (University of Colorado Consortium on Climate Change and Health) has already brought together more than 20 faculty members at CU Anschutz, CU Denver and CU-Boulder to study the broad effects of climate change, including waterborne, foodborne and vector-borne diseases.

Only a handful of academic institutions have responded to the issue, said Richard Johnson, MD, professor, Medicine-Renal Medicine Diseases, School of Medicine (SOM) and a founding member of UC4Health. He said CU’s deep and diverse spectrum of health experts and scientists – physicians, climatologists, anthropologists, immunologists, epidemiologists, pediatricians, geneticists, physiologists and more – sets the institution up to be a strong leader in the field.

‘Banding together’

“Climate change and health is a neglected field despite the fact that the climate is actively changing on us,” says Johnson, pointing to recent data that shows January and February were the planet’s warmest months on record. “Here at CU, we have a grassroots movement in that physicians and scientists are banding together to address the problem.”

The group applied for a School of Medicine Transformational Research Funding grant last fall, proposing a Clinical Center for Climate and Health. While the grant was not selected for final inclusion, it created the environment for faculty from disparate research areas to come together to tackle problems around climate change and health. By operating as a consortium, members say, the group can take a broader approach to its trifold mission of research, education and partnerships.

Rosemary Rochford of CU Anschutz

Rosemary Rochford, PhD, professor of Immunology-Microbiology, SOM, and Environmental/Occupational Health, Colorado School of Public Health, is the leader of UC4Health.

UC4Health leader Rosemary Rochford, PhD, professor of Immunology-Microbiology, SOM, and Environmental/Occupational Health, Colorado School of Public Health (ColoradoSPH), emphasizes that the group is not looking into the causes of climate change, but rather the health effects from it.

A key question, is ‘How do research and academic institutions develop the next generation of scientists to deal with this problem?’ “The educational piece is huge, and it has to be interdisciplinary by its nature,” Rochford says. “Instead of reacting to what’s already been studied, I think we should be leading the field.”

‘A fantastic step’

David Goff, MD, PhD, dean of the ColoradoSPH, says planetary health was a major topic of discussion at a recent Association of Schools and Programs of Public Health conference. “The concept is similar to what our folks are working on in the consortium,” he says. “It’s the idea of safeguarding both human health and the natural systems that underpin it.”

Membership in the consortium is open, and the group anticipates that as the UC4Health gains recognition, it will bring more faculty into this important research arena. For more information, contact Rosemary Rochford at Rosemary.Rochford@ucdenver.edu

While the past century has seen tremendous improvements in human health, Goff says, other activities have put stress on the planet by degrading the soil, oceans and atmosphere. The question for this century and beyond, he says, is ‘How do we sustain our current status and improve human health while at the same time not degrading the planet?’

Goff is among the CU Anschutz leadership team that supports the consortium, saying UC4Health demonstrates yet another way CU innovates and collaborates with partner universities for the greater good – in this case, a more comprehensive approach to planetary health. “This is a fantastic step to focus on the importance of climate in human health and ecosystem health, in terms of the plants and animals we share the environment with,” he says.

A few examples of UC4Health progress so far:

  • Education: Rochford; Elizabeth Carlton, PhD, MPH, assistant professor, Environmental and Occupational Health, ColoradoSPH; and Jay Lemery, MD, associate professor, Emergency Medicine, SOM; received approval for a “Climate and Health” course to be offered this fall in the ColoradoSPH at CU Anschutz. Lemery and Christopher Davis, MD, assistant professor of emergency medicine, SOM, will teach “Introduction to Polar Medicine” in Greenland – “Nobody’s done anything else like this,” Lemery says – over a week in August.
  • Research: Three main research themes are envisioned: metabolic diseases, disaster medicine, and infectious diseases. The consortium plans to host at least two international/national leaders in climate and health next academic year.
  • Community partnerships: In the Transformational Research application, the group received letters of support from a diverse array of leadership from government agencies as well as local community partners. The Aspen Global Change Institute invited UC4Health to conduct a conference this September.

Consortium research will focus on understanding the effects of climate change on human health and then develop tools, policies and the necessary workforce to monitor, adapt and mitigate those effects.

Sarah Horton of CU Denver

Sarah Horton, PhD, associate professor of Anthropology, is a CU Denver member of the consortium.

Consortium member Sarah Horton, PhD, associate professor of Anthropology at CU Denver, says environmental topics “will only increase in importance” this century, such as how climate change is transforming the landscape of diseases. She investigates the growing occupational risks faced by outdoor workers amid unpredictable and rising summer temperatures. For example, there have been 13 confirmed deaths among farmworkers between 2005 and 2014 in California alone due to working in the heat.

‘A matter of environmental justice’ 

Heat illness also interacts synergistically with chronic disease such as hypertension, diabetes and cardiovascular disease, Horton says. New investigations – including research conducted by Johnson and others in the consortium – suggests that chronic heat exposure may play a role in kidney failure, helping to explain the epidemic of chronic kidney disease of unknown origin affecting agricultural workers in Central America.

Such research can lead to workplace interventions and public policy, according to Horton. “The consortium can play an important role in helping mitigate the effects of heat stress faced by vulnerable populations,” she says. “This is a matter of not only pressing research but also environmental justice.”

Opportunities for collaboration

Rochford says there are ample opportunities in Colorado for investigator collaborations – not just among the campuses, but also with the National Center for Atmospheric Research (NCAR) and the National Oceanic and Atmospheric Administration (NOAA). Representatives at the Centers for Disease Control have also expressed support for the consortium.

“At the end of the day, we have to not only identify the diseases that are being affected by climate change, but also how to help people,” Rochford says. “This consortium illustrates a link between those diseases and the way people can be helped, and the ways their health can be improved.”

UC4Health will also investigate local environmental implications of climate change, such as how high-performing Colorado athletes are affected by climbing temperatures.

“Addressing this health problem requires a multidisciplinary team,” Johnson said. “What’s exciting is that the University of Colorado has expertise in these fields and is developing leaders and innovative programs to move the field forward.”

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