In A Warming World, Climate-Resilient Health Care Delivery Is Key | ASHP Midyear

We are already feeling the effects of climate change: Global temperatures are on the rise, with 2024 on track to be the warmest year on record, the volume of Antarctic sea ice has decreased as glacier loss accelerates, and the mean surface air temperature was 1.54° degrees above the pre-industrial average.¹

Pharmacists can influence institutional-level climate change-related policies to ensure continued health care delivery. | Image credit: Es sarawuth - stock.adobe.com

“If you are a person who feels that there has been no increase in the global temperature, I have nothing else to say to you,” said Ronald Blanton, MD, MS, chair of the Department of Tropical Medicine and Infectious Disease at the Tulane University Celia Scott Weatherhead School of Public Health and Tropical Medicine in New Orleans, Louisiana. “If you are a person who feels that it has or has not been due to human intervention, I would only say that there is no reason to make it worse—and that we may possibly make it better.”

Blanton spoke during a session at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition focused on the preparations that the US health care industry must make in the face of a changing climate.²

What Drives Climate Change?

Before proposing solutions to the problem, it’s important to understand how climate change effects health. Increased temperatures, extreme weather events, and sea level rise give way to multiple exposure pathways, such as extreme heat, poor air quality and reduced quality of food and water, changes in infectious agents, and population displacement—all of which, Blanton emphasized, is happening in the now. Heat-related illnesses, food-, water-, and vector-borne diseases, and mental health consequences as a result of the changing climate have already been documented.

“We’re not talking about the future,” he said. “We’re talking about the present.”

For some, it can be easy to ignore these changes because they appear to be impacting people living in other parts of the world. And, Blanton acknowledged, climate effects are—and will not be—equal everywhere.

READ MORE: Weathering the Storm: Medication Preparedness in Hurricane Season

“There are limited parameters in which human life can exist, in which humans can actually function,” Blanton said. In some areas of the globe, there will simply not be enough resources to support human life. “These are becoming areas that are uninhabitable, including areas of the United States.”

Even within the US, these effects will not be distributed equally. Temperatures are expected to increase in the Midwest and desert West, while precipitation will increase in the Northeast and Rocky Mountains. Desertification is already occurring in California and Arizona, rendering parts of those states unlivable.

Human beings will also be impacted by climate change in unequal ways. Very young children, adults aged 65 years and older, people with chronic conditions, and pregnant women stand to experience disproportionate effects. Perhaps most impacted, though, will be members of low income and minority groups—in part, Blandon explained, due to the association of low income and minority individuals as outdoor workers.

Individuals with low income or no high school diploma are 25% more likely to live in areas with the highest projected labor losses with 2°C of global warming, said Blandon, a benchmark “we are nearing at present.” Neighborhoods with higher poverty have greater sources of environmental risk, such as air pollution and heat islands, with residents experiencing elevated temperature-related mortality. Residents of low-lying affordable housing are particularly vulnerable to coastal flooding, and more likely to have fewer financial resources to protect against and recover from flooding.

“We see that today in our indigenous communities within New Orleans,” Blanton said. “Many of them are beginning to lose a lot of patrimony just due to sea level rise.”

And although Blanton believe that vector-borne diseases will not be “the major issue” as temperatures rise, increased temperatures will affect change. “There is a physiologic relationship between vectors and their ability to transmit disease,” Blanton explained. “Most vectors have an intrinsic incubation period in which the vector itself becomes capable of transmitting disease. That period is shortened when the temperature rises; the lifespan of mosquitos and other vectors also increases.”

Although at some point it may get too hot for mosquitoes—“There is a limit to how much vectors can stand in terms of heat,” Blanton said—until that point, the potential exists for an increase in the rates of vector-transmitted diseases.

“In infectious diseases, we often focus on the pathogen,” said Blanton. “But the thing that infectious diseases do is, they reveal a lot about us.” Blanton looks to the COVID-19 pandemic for an illustrative example: “There’s a large question of why the US had more COVID-19 than anyone else. There’s a large question why most of Africa did not, but South Africa did.”

The answers to those questions “have more to do with how we behave than with the DNA or RNA of any vector we can look at.”

Addressing Climate Change Through Policy

Climate change “is here,” said Vincent T. Idemyor, PharmD, “And we need to find a way to start dealing with it. There’s no way to run away.” Idemyor, a professor in the department of clinical pharmacy and management and a distinguished visiting scholar from the University of Port Harcourt in Port Harcourt, Nigeria, believes that pharmacists must have a seat at the table when it comes to things like developing climate-sensitive care guidelines and medication management strategies.

Medication management especially falls under the purview of pharmacists. “We need to develop strategies for managing drug shortages due to climate events,” said Idemyor, citing the recent shortages of IV fluid as a result of Hurricane Helene. “These are things we should anticipate and incorporate into our management strategies.” A resilient supply chain, strategic inventory management, and localized sourcing and procurement policies should be addressed now—not when a climate event happens.

Drug-related policy issues should also be addressed now, said Idemyor, adding that these issues are not just related to storage; many classes of medications, including diuretics, beta blockers, antidepressants, and stimulants, can lead to drug-induced heat-related illness and hyperthermia. Drugs that impair temperature regulation can increase a person’s core body temperature, reduce the ability to sweat, and—coupled with increased high temperatures—the risk of heat stroke. Similarly, some antibiotics, opioids, and central nervous system stimulants, are heat sensitizing medication and can lead to hyperthermia.

These issues in particular highlight the importance of pharmacist involvement in the development of climate policy. Should a climate-related medication problem arise in an institution, Idemyor said, it will be the pharmacist’s problem to deal with.

Medical education must also change to meet changing climate concerns. “Many medical schools looked at the literature and agreed that climate science is going to be part of the curriculum, which is a good thing,” said Idemyor. “Pharmacy will also need to follow suit.”

Ultimately, though, collaboration is key: Engagement with public-private partnerships and participation in global health and climate initiatives on the professional level will position pharmacists to be a part of the shared decision-making that must go into addressing climate change in health care.

“The pharmacist is the [medication] champion,” Idemyor said, “and they should be at the table.”

Follow along with our coverage of the 2024 ASHP Midyear Clinical Meeting and Exhibition here.

References

1. 2024 is on track to be hottest year on record as warming temporarily hits 1.5°C. News release. World Meteorological Organization. November 11, 2024. Accessed December 10, 2024. https://wmo.int/news/media-centre/2024-track-be-hottest-year-record-warming-temporarily-hits-15degc

2. Idemyor VT, Blanton R. Preparing healthcare service delivery for climate change impacts. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA.