The other public health crisis

According to prominent medical doctors, we are in the midst of “the biggest public health challenge of the 21st century.” But it’s not the one you think.

The toll of the COVID-19 pandemic is enormous and devastating. But the public health impacts of climate change could be vastly greater. 

Dr. Jonathan Patz from the University of Wisconsin commented that the effect of climatic extremes from excessive heat and related worker stress are “bread and butter health issues.” NYU’s Dr. William Rom pointed out that extreme heat, which we now know has severely disproportionate impacts on Black neighborhoods, causes nearly twice as many deaths as the next most deadly extreme weather event (flooding). And Stanford’s Dr. Kari Nadeau has emphasized the extraordinarily high rates of asthma suffered by children — particularly children of color — who are exposed to climate-related wildfires and the combustion products of the fossil fuels that cause climate change.

This is jarring news. Climate change has largely been framed as a threat to the environment, not to our health. Climate scientists, environmentalists and technocrats have had the climate stage largely to themselves, with white coated-doctors spotted only occasionally in the gallery. But the medical profession is demanding that we recognize climate change for the health crisis that it already is, rather than the environmental catastrophe that it threatens to become. 

It is easy to see, in retrospect, how the dominant framing of climate change arose. Of course climate scientists have focused on the environment, rather than health. They have been studying the anthropogenic roots and environmental expressions of climate change, including the relentless upward rise in global temperatures and its connection to extended summers, shortened winters and incremental sea-level rise. Climate scientists are chronicling a slow-moving environmental disaster, punctuated in recent years by a proliferation of climate change-influenced extreme weather events. 

Advocates have followed the scientists’ lead and emphasized global warming’s threats to the environment. Looking for ways to convey the seriousness of climate change, environmental groups have often pointed to the Arctic, where climate change’s environmental impacts are more pronounced, to find its poster child: a polar bear. Sympathetic, yes, and perhaps more likely to spark charitable contributions than an image of a diseased lung, but not hitting close to home. 

Lawyers also have leaned into environmental harms when establishing their standing to bring climate lawsuits. In the landmark Supreme Court case that allowed for regulation of climate-warming greenhouse gases under the Clean Air Act, the then-attorney general of Massachusetts pointed to the potential loss of some of its coastal lands as enough of an injury to establish standing. Again, the story revolved around an environmental impact and not on the rising hospitalizations and other state-borne medical costs due to climate change.  

The Trump administration has hidden behind the traditional emphasis on climate change’s longer-term, incremental impacts to downplay the implications of rolling back restrictions on the U.S.’s largest sources of the greenhouse gases that cause climate change. But the medical community is now telling us, in a full-throated way, that emissions from the automotive, electricity and oil and gas industries already are severely harming our health — in addition to the environment. More specifically, climate-strengthened floods and wildfires are killing people in their path and poisoning the air and fouling the water for millions more; warm water-strengthened hurricanes are injuring and killing thousands, while also knocking out health care facilities and lifelines for days, weeks, and even months at a time; and extreme heat events are filling emergency rooms with stressed-out victims of dehydration and heat stroke and, in all too many cases, death.  

To make matters worse, when greenhouse gases increase, so do more localized pollutants that are the products of fossil fuel combustion, such as particulate matter and smog-forming ozone. A large cohort of health studies, including long-term epidemiological tests, have confirmed that exposure to these pollutants cause respiratory disease, including asthma (which now afflicts one out of every five children in the U.S.), and thousands of premature deaths every year. Thus, by allowing power plants to burn more fossil fuels, cars to guzzle more gas and the oil and gas industry to vent more methane, the Trump administration is unleashing a multi-pronged assault on Americans’ health. And, tragically, the health impacts are hitting hardest on low-income and often minority Americans who live near the industrial plants and highways that are spewing those pollutants into the air. 

COVID-19 reminds us, daily, about the importance of doctors’ voices. Their recent arrival on the climate change stage is welcome, and overdue. We need the medical community’s help in expanding the climate change conversation from the environment to the real and present danger it poses to public health — particularly to the most vulnerable among us. Lives depend on it.  

David J. Hayes is executive director of the State Energy & Environmental Impact Center at the NYU School of Law; he served as deputy secretary and chief operating officer of the U.S. Department of the Interior in the Clinton and Obama administrations. Richard L. Revesz is Lawrence King professor of Law and dean Emeritus at NYU School of Law, where he directs the Institute for Policy Integrity.