A ‘thousand points of light’ strategy is needed for climate-change medicine

The World Health Organization now characterizes climate change as the single biggest health threat facing humanity. So just how worried should we be?

Climate effects on health are already apparent. They are varied, potentially severe and incompletely understood. On a global scale, about 30 percent of the human population already lives in areas where temperatures and humidity lead to increasing mortality. Deaths from heat exposure begin to rise after an average daily temperature of around 72 degrees, and the share of those exposed to this is expected to rise to more than half the world’s population within this century.

The public health response remains murky. The pandemic taught us that we are unlikely to soon have a dedicated “czar” who can effectively mobilize resources and organize a well-choreographed approach to climate medicine. Our shared pandemic experience underscored a need for collaboration with actors outside of government to manage an effective response to a mounting climate-related health crisis.

Instead, we should expect more of a George H. W. Bush approach — “a thousand points of light,” where heroes of all sorts must address the inexorably evolving spectrum of climate health concerns.

One practical area of focus is on educating providers to anticipate, recognize and manage climate health impacts. For example, warmer weather has been associated with the spread of tick-borne diseases, such as Lyme disease, anaplasmosis, ehrlichiosis and spotted fever rickettsiosis. This entails a need for more training, so that providers without experience with these conditions know how to recognize and treat them. 

Another climate medicine topic is the direct effect of higher temperatures on vulnerable people and their potential to worsen various medical conditions, such as diabetes mellitus, cardiovascular disease, chronic obstructive lung disease, asthma, chronic kidney disease, mental health disorders, dementia and pregnancy. Still others include the health effects of wildfires, hurricanes and floods; implications of power outages, pollution; and the emergence of new pathogens and their spread to populations that they have not previously affected. Also, worry about climate change itself (eco-anxiety) has had an impact, including among children.

As concerning as they are, these topics are probably not top-of-mind unless you live in a region where you have already seen the consequences. They also compete for mindshare with other existential concerns (geopolitical tensions that could erupt into conflict, economic upheaval, bioterrorism, another pandemic) — there is, tragically, ample opportunity to pick your worry.

Even those who are convinced of the evolving risks may harbor doubts as to the timing and severity of climate events. And there is lingering mistrust as to whether the risks are sufficiently strong and pervasive to require immediate action. 

Yet the evidence is mounting that health effects of climate change will ultimately affect all of us in one way or another. And the issues seem increasingly topical. Where I live in Greater Boston, we recently experienced the health consequences of wildfires for the first time in memory.

Our understanding of the direct connection between climate change and health impacts is accumulating and helping guide our ability to predict, prevent, and respond to these challenges. However, it will take increasing engagement, mobilization, and enablement of stakeholders.

Public health organizations must find new ways to harness the emerging, decentralized capabilities in local, regional, and academic centers and in the private sector. The good news is that, unlike the pandemic, the pace of negative effects from climate change is comparatively slower, potentially allowing for deliberate and effective approaches to mitigate human health consequences.

The devil lies in how well a thousand points of light will gain timely traction and sufficient coordination to have the impact that we are all depending on.

Dr. Peter Bonis is the chief medical officer of Wolters Kluwer Health and adjunct professor of medicine at Tufts University School of Medicine.