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doi: 10.1002/wmh3.421
© 2021 The Authors. World Medical & Health Policy
published by Wiley Periodicals LLC on behalf of Policy Studies Organization
Health Professionals and the Climate Crisis: Trusted
Voices, Essential Roles
Edward Maibach , Howard Frumkin , and Samantha Ahdoot
Climate change has triggered a global public health emergency that, unless adequately addressed, is likely to
become a multigenerational public health catastrophe. The policy actions needed to limit global warming
deliver a wide range of public health benefits above and beyond those that will result from limiting climate
change. Moreover, these health benefits are immediate and local, addressing one of the most vexing challenges
of climate solutions: that the benefits of greenhouse gas reduction are seen as long‐term and global, which are
remote from the concerns of many jurisdictions. In this commentary, we identify roles that health pro-
fessionals and health organizations can play, individually and collectively, to advance equitable climate and
health policies in their communities, health systems, states, and nations. Ultimately, health voices can work
across national boundaries to influence the world's commitments to the Paris Agreement, arguably the
world's most important public health goal.
KEY WORDS: climate change, global health, public health, advocacy, public policy
Introduction
A stable climate is arguably the most fundamental determinant of human
health (McMichael, 2017). Earth's climate, however, is currently changing at an
unprecedented rate (World Meteorologic Organization, 2019). This rapid climate
change has triggered a global public health emergency that, unless adequately
addressed, is likely to become a sustained public health catastrophe that will last
many generations (IPCC, 2018; Harmer, 2020).
Serious direct health harms of climate change result from increasingly extreme
weather—including more frequent and severe heatwaves, storms, floods, and
droughts. Indirect health harms resulting from secondary consequences of climate
change are even more insidious—air pollution, vector‐borne illness, contaminated
water and food, crop and livestock loss and reduced nutrient value, damaged and
destroyed housing and farmlands, mental health impacts, and increases in conflict
and forced migration. All of these impacts are magnified by socioeconomic and
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biological factors—including age, gender, poverty and income inequality, under-
lying health problems, racism, and discrimination—such that the health of more
vulnerable, marginalized, and disempowered people tends to be harmed first and
worst (Ebi et al., 2018; Watts et al., 2015).
Currently, the world's stated goal—as ratified in the Paris Climate Agreement
in 2015—is to limit global warming to no more than 2°C. Subsequently, however,
the Intergovernmental Panel on Climate Change has warned that warming of 2°C
should not be considered safe; they suggested 1.5° as a more prudent global goal
(IPCC, 2018). Regrettably, global efforts to date are falling far short of what is
necessary to limit the warming to 2°, much less 1.5°, with models currently pro-
jecting 3° of warming as a more likely outcome (Watts et al., 2020). Planetary health
rescue will require far‐reaching transformations across the global economy; while
many of the needed technologies are now available, neither effective political
leadership nor widespread public buy‐in has yet emerged.
A Focus on Health May Help Untie the Gordian Knot
There is a bright silver lining to this dire situation. The policy actions that are
most needed to limit global warming to levels that could be considered safe for
public health and wellbeing also deliver a wide range of additional public health
benefits above and beyond those that will result from limiting climate change. In a
very real sense, climate solutions are health solutions.
Many of the public health benefits of climate policies begin accruing almost
immediately upon implementing the policy actions. Furthermore, the primary
beneficiaries of these policy actions are the people in the jurisdictions that imple-
ment them. In other words, the health benefits of climate solutions are proximal in
both time and space. This helps to solve one of the most vexing challenges asso-
ciated with climate solutions—that their climate change benefits accrue primarily in
the distant future, and are globally distributed, undermining many jurisdictions’
willingness to undertake them.
The decarbonization of electrical and transportation systems provides a useful
example. Although these are actions that must soon be taken worldwide in order to
achieve the goal of the Paris Agreement, any city, or state, or nation that shifts to
renewable electricity will immediately realize benefits from cleaner air and water,
healthier people, and reduced health costs. Moreover, these transitions are
employment‐intensive (Georgeson & Maslin, 2019). The jobs and other forms of
economic prosperity that are created will also further enhance public health and
wellbeing in that jurisdiction because secure employment and economic prosperity
are important social determinants of health.
The U.S. state of Wisconsin provides an excellent example. A University of
Wisconsin research team modeled the health and economic impacts that would
accrue if the state meets 100 percent of its energy needs with clean energy (e.g.,
wind, solar)produced in‐state (Abel & Spear, 2019). Achieving that goal would
create 161,100 net jobs (more than doubling the current number of energy jobs in
the state), increase state GDP by nearly 5 percent, increase state tax revenue by
2 World Medical & Health Policy
more than $500 M per year, and avoid human health damages that cost more than
$21B annually.
In addition to the rapid decarbonization of energy and transportation systems,
a wide variety of other policies that are necessary to achieve the goal of limiting
global warming to 2°C or less will also deliver short‐and long‐term health benefits.
These include improving food systems, the built environment, land‐use practices,
access to family planning services, and education of women and girls. These ben-
efits have been described in detail, and in most cases quantified (Gao
et al., 2018; Milner et al., 2020; Shindell, Faluvegi, Seltzer, & Shindell, 2018).
Health Professionals Can Play Many Important Roles
Another silver lining to the climate crisis is that physicians and other health pro-
fessionals increasingly understand the human health relevance of climate change
(Hathaway & Maibach, 2018). In large numbers, they believe the organizations that
represent them should engage in both public and policymaker education about the
climate crisis, as well as in advocacy to ensure that appropriate policy measures are
adopted to protect health (Kotcheretal.,2021;Sarfaty, Mitchell, Bloodhart, & Mai-
bach, 2014; Sarfaty et al., 2015; Sarfaty, Kreslake, Casale, & Maibach, 2016).
Research shows that physicians and other health professionals are highly
trusted sources of information around the world (Chen, Vasudev, Szeto, &
Cheung, 2018; Clemence, 2020; Reinhart, 2020; Ipsos, 2019), and that presenting
information about the health harms of climate change is an effective communica-
tion strategy that leads to enhanced issue engagement (Maibach, Sarfaty, Mitchell,
& Gould, 2019). Moreover, many health professionals are personally inclined to get
involved in relevant education and advocacy activities (Hubbert, Ahmed, Kotcher,
Maibach, & Sarfaty, 2020; Kotcher et al., 2021; Sarfaty et al., 2014, 2015).
Every physician and nurse fulfills multiple roles—as a family member, a
community member, a professional, and a citizen. Grounded in these roles, they
can, and we argue should help achieve the goal of limiting global warming to no
more than 2°C.
At the most basic level, change begins at home. Health professionals can take steps
to decarbonize their own personal lives, for example by powering their homes with
clean energy (e.g., solar), reducing their home energy use (e.g., heat pumps), embracing
low‐carbon forms of transportation (e.g., active and mass transportation, electric ve-
hicles), avoiding unnecessary air travel (e.g., vacationing closer to home), and embracing
a healthy, sustainable diet (e.g., eating less red meat and more grains, fruits, and veg-
etables). They can multiply the impact of these actions by explaining to others—their
family members, friends, neighbors, co‐workers, members of their faith community—
why they are taking these actions. Such modeling is effective; for example, people who
know somebody who gave up flying because of climate change are more likely to
change their own attitudes toward flying less (Westlake, 2017). Leading by example can
enhance health professionals’motivations to take further actions (Gifford, Kormos, &
McIntyre, 2011; Stankuniene, Streimikiene, & Kyriakopoulos, 2020)and makes their
leadership more credible in the eyes of others (Attari, Krantz, & Weber, 2016).
Maibach/Frumkin/Ahdoot: Health Professionals and the Climate Crisis 3
Change can also begin at work. Many of the actions noted above are equally
applicable to health professionals’work lives as they are to their personal lives. The
trusted voices of health professionals, as noted above, can be compelling for
patients. Seeing a bicycle in a physician's office sends an important message to
patients. Clinicians can and should advise patients to reduce dietary meat and walk
more, simply for the sake of the patients’health; if appropriate, they can explain
that such behavioral choices also benefit the larger community and the planet.
Health professionals can achieve an even greater impact by influencing the policies
of the health systems in which they work. Providing health care is energy‐intensive.
Power is currently produced predominantly with fossil fuels. Health professionals, in-
dividually and collectively, can implement policy changes in their clinic, hospital, hos-
pital system, or national health service aimed at increasing energy efficiency, de-
carbonizing energy sources through purchasing and/or on‐site production of clean
energy, eliminating the use of super heat‐trapping pollutants that are needlessly used in
inhalants and anesthetics, and sourcing low‐carbon‐footprint supplies and equipment.
As the health sector has considerable market power, such practices can help propel
market transformation across many industries. And because hospitals and clinics are
anchor institutions and leading employers in their communities, such practices can set
an example for other businesses, amplifying their impact.
Health professionals who are teachers also have opportunities to teach their stu-
dents about the relevance of climate change to human health, and the opportunities to
advance health through climate solutions, thereby helping to ensure readiness and
leadership among the next generation of health professionals. Health professionals who
conduct research can contribute in two additionalways:byaskingandansweringim-
portant questions at the nexus of climate and health, and by modifying their research
methods to reduce needless waste of energy and materials.
Arguably, health professionals—individually and collectively—can achieve
their greatest impact by advocating with the public and policymakers for policies
that will help stabilize the climate and improve health. Equitable climate and health
policies can and should be implemented at all levels of government (cities and
counties, states and provinces, as well as nations). Health professionals have a
unique and necessary role to play in explaining the need for such policies and in
advocating for their adoption. Beyond public policies, health professionals can also
use their influence, their trusted place in society, to encourage, if not demand, that
their nation's and the world's largest corporations also adopt policies that will help
stabilize the climate and promote human health and wellbeing.
Health professionals can also promote decarbonization in the private sector, using
their voices as university faculty members, pension fund stakeholders, and shareholders
in public companies, to call for disinvestment from fossil fuel companies
(Bergman, 2018; Law, Duff, Saunders, Middleton, & McCoy, 2018).Althoughcon-
troversial, divestment is widely recognized as an important tool in propelling the
transition to a post‐carbon economy (Hunt and Weber, 2018; McKibben, 2018).
Nor do health professionals have to limit themselves to informing and per-
suading decision‐makers regarding the climate emergency; they can themselves
aspire to political office. Perhaps the best‐known example of a health professional
4 World Medical & Health Policy
leading on climate change is a physician and former Norwegian Prime Minister
Gro Harlem Brundtland, but other physician and nurse elected officials from the
global (e.g., Bhutan's Prime Minister Lotay Tshering)to the national (e.g., U.S.
Representatives Jim McDermott, Lois Capps, Lauren Underwood, Raul Ruiz, Ami
Bera, and Kim Schrier), to the state and local (e.g., California Assembly member
Joaquin Arambula), have taken strong positions on climate change. Bringing the
trusted voices of health professionals into executive and legislative branches of
government is a powerful way to advance climate action.
Health professionals daily encounter the ravages of racism and poverty; they
know that these injustices are leading causes of preventable suffering and
premature death. They are well‐positioned to bring that awareness to climate
solutions—protecting vulnerable communities in adapting to climate‐related
hazards, and assuring that the benefits of decarbonization strategies are
distributed equitably (Ebi & Hess, 2020; Rouf & Wainwright, 2020; Shue, 2014).
More Powerful Together
As individuals, health professionals can achieve only so much. By working
together, health professionals can maximize their impact.
Joining an organization that focuses specifically on climate and health is per-
haps the easiest way for health professionals to align themselves with others
seeking to advance climate and health solutions. Examples of such organizations
include Alliance of Nurses for a Healthy Environment; Global Climate and Health
Alliance; Medical Society Consortium for Climate and Health; and Physicians for
Social Responsibility.
Another natural opportunity for physicians and other health professionals to
work together is to influence the professional societies to which they already be-
long. Health professional societies should develop strong climate and health res-
olutions and policies and should advocate actively for equitable, health‐promoting
climate policies in state and federal governments. They are more likely to do so
when their members initiate these actions.
Lastly, where there is a need, health professionals—and health organizations—
can work together to create new organizations. For example, in 2016, several
medical societies recognized the value of working together to unify and amplify the
voice of medicine as a strategy to influence U.S. federal policy on the issue of
climate and health. Together they launched the Medical Society Consortium on
Climate and Health, which currently has 32 national medical societies as members,
and more than 50 additional health organizations as affiliates and partners. With a
coalition of aligned health organizations, the Consortium helped develop a Policy
Action Agenda on Climate, Health, and Equity which guides the Consortium's
advocacy activities, and has subsequently been endorsed by nearly 200 health or-
ganizations. After the 2020 U.S. election, with a coalition of health organizations
that developed the Policy Action Agenda, the Consortium developed a compre-
hensive, “all‐of‐government,”set of climate, health, and equity recommendations
Maibach/Frumkin/Ahdoot: Health Professionals and the Climate Crisis 5
for the incoming Biden Administration and the new Congress to use in “protect
[ing] our nation's health in the face of the climate health emergency.”
As an outgrowth of the Medical Society Consortium on Climate and Health, in
2017 several physicians in Virginia organized the Virginia Clinicians for Climate
Action to advocate for equitable climate and health policies in their state. Their
collective actions have already had a significant demonstrable impact on enacting
important climate and health legislation (see Box 1). Their success has inspired
BOX 1 Health Professionals Advancing Climate and Health Policy in Virginia
The voice of the health community was historically absent from the climate policy discussion
in Virginia. Virginia Clinicians for Climate Action (VCCA)was formed in 2017 to fill this void.
Since its inception, VCCA has helped build a network of health partners and over 450 clinician
advocates for climate solutions. VCCA doctors, nurses, and allied health professionals write
opinion pieces, attend hearings, issue statements, and positions, collaborate with medical so-
cieties on climate and health programs, meet with legislators, hold monthly educational we-
binars, and partner with hospital systems to hold climate and health conferences and lectures.
VCCA's experience in Virginia demonstrates the power of unified a health voice to overcome
barriers blocking the necessary transition to a clean energy economy. Health professionals and
health organizations are becoming a powerful voice in climate and energy policymaking in the
state. Having heard from VCCA members across Virginia, State Health Commissioner
Dr. Norman Oliver established a Climate Change Committee at the Virginia Department of
Health in 2019. In 2020, a circuit court overturned and vacated the permit for a proposed
Atlantic Coast Pipeline compressor station, citing the health‐based impacts on the local, ma-
jority African‐American community. The pipeline was ultimately canceled, successfully con-
cluding years of campaigning by impacted communities and environmental justice advocates.
Subsequently, VCCA was joined by Healthcare Without Harm, Kaiser Permanente, Bon Se-
cours Mercy Health, and the Virginia Chapter of the American Academy of Pediatrics, in
support of landmark climate legislation, the Virginia Clean Economy Act (VCEA). This bill
passed in 2020, making Virginia the first southern state to commit to 100 percent clean elec-
tricity by 2050. Furthermore, Virginia joined the Regional Greenhouse Gas Initiative (RGGI)in
2021. These policies will be enacted with a focus on equity—50 percent of the revenue gen-
erated by participating in RGGI will be allocated toward energy efficiency programs for low‐
income communities. RGGI was the first climate legislation ever supported by a Virginia
medical society, the Virginia Chapter of the American Academy of Pediatrics, in 2015.
In 2021, VCCA joined partners to address transportation, the leading source of carbon pollu-
tion in the state. VCCA developed a report, webpage, and videos on the health effects of
vehicle pollution in Virginia, and the health benefits of stronger vehicle emission standards.
This report was recently cited in a press release from nine Virginia cities and counties sup-
porting clean transportation. A unified health voice is proving its value in advancing climate
policy in Virginia.
6 World Medical & Health Policy
health professionals in over a dozen additional U.S. states to create state‐focused
climate and health.
The goal of the Paris Climate Agreement is arguably the world's most im-
portant public health goal. Successfully addressing the climate crisis requires high‐
level policy action—ambitious Nationally Determined Contributions through the
U.N. Framework Convention on Climate Change, reversal of perverse economic
subsidies at the international and national level, transformative changes in agri-
culture, transportation, urban planning, energy, and manufacturing policies. It also
requires far‐reaching behavioral changes—in the choices people make regarding
how they eat, how they travel, how they consume goods, and how they use energy.
And it requires bold private‐sector action across the economy, from manufacturing
firms to health‐care organizations. For each of these, the voices of health pro-
fessionals can play a highly influential role.
Notes
All authors contributed to the conceptualization and writing of this com-
mentary.
Conflicts of interest: None declared.
Corresponding author: Edward Maibach, emaibach@gmu.edu
Edward Maibach, MPH, PhD, is a distinguished university professor of George
Mason University, Fairfax, VA.
Howard Frumkin, MD, DrPH, is a professor emeritus at the University of
Washington School of Public Health, Seattle, WA.
Samantha Ahdoot, MD, is an assistant professor of Pediatrics at the Virginia
Commonwealth University School of Medicine, Arlington, VA.
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