ACP: Physicians must be a force for environmental health and justice

Physicians who take the care of their patients seriously must work harder to take care of the planet.

Reducing pollution and climate change are at the heart of a new position paper from the American College of Physicians (ACP). The document expands on the organization’s directions for 2016 with new recommendations for physicians, the healthcare sector and policy makers.

“Human health is affected by the quality of the air we breathe and the water we drink, the substances we are exposed to, and changes in the Earth’s climate,” said the article published on October 25. 2022 in the Annals of Internal Medicine.

An accompanying editorial noted that climate and weather have contributed to an increase in natural disasters over the past 50 years. This year alone, wildfires burned on the West Coast, 39 people died in historic flooding in Kentucky and 157 people died when temperatures exceeded 110 degrees in Washington – the deadliest weather event of this State.

“Creating sustainable social and physical infrastructure requires systematic accounting and management of potential threats, resources, inputs, outcomes, and attendant risks, benefits and harms,” ​​said the editorial by Emily Senay, MD , MPH, and Andrew Hantel, MD. “The US healthcare system lags far behind other economic sectors in engaging in this essential practice that improves performance, reduces costs and mitigates harm. We look forward to CPA translating these recommendations into concrete partnerships and advocacy for research funding that push our healthcare system towards sustainability, mitigation and resilience.

An additional guest post described three scopes of greenhouse gas emissions, which come directly from healthcare organizations, indirectly from energy and utility providers, and indirectly from supply chains and other sources. . Health care accounts for 8.5% of annual greenhouse gas emissions in the United States – 2.5 billion tons per year – and large hospitals represent less than 1% of commercial buildings, but consume 5.5 % commercial energy.

Reducing emissions and energy use among them could deliver “early wins” for environmental health, the authors said.

Policy recommendations

The CPA included six policy recommendations:

• Immediate action to limit global temperature rise to 1.5 degrees Celsius above pre-industrial levels.

The guidance document suggested efforts ranging from greater use of zero-emission energy sources to sustainable food production and consumption practices, to integrating climate change and health content into medical school curricula and continuing medical education.

• Action to achieve environmental justice, especially for communities with people of color, low-income people, and marginalized populations.

“Federal, state and local authorities should act aggressively to prohibit discriminatory practices related to environmental health,” ACP said. To go further, government leaders and planners should conduct meaningful outreach regarding decisions that affect community health, including infrastructure proposals, location of toxic waste dumps and facilities, construction projects and land use.

• Reduce indoor and outdoor air pollution, support federal clean air law, and support strict air quality standards for pollutants.

In addition to reviewing evidence of health effects, the ACP called for strict enforcement by the US Environmental Protection Agency (EPA).

• Strengthen the safe drinking water law, the clean water law, the lead and copper rule and other laws and regulations to ensure clean and safe water.

Lead water pipes must be replaced, wells must be improved, and health agencies must have sufficient resources to monitor water safety and respond to disease or contamination.

• Reduce exposures to toxic substances and chemicals, especially for children, pregnant women and other at-risk populations.

The EPA needs enforcement resources, and chemical manufacturers should be required to provide health and safety information for their products. Agencies responsible for lead reduction, exposure screening and treatment must be adequately resourced.

• Provide sustainable and sufficient funds to federal agencies with an environmental health mission.

In addition to the EPA, the Department of Health and Human Services has agencies and offices dedicated to health and environmental studies. They must study emerging issues such as the health effects of exposure to nanomaterials, microplastics and new chemicals.

Medical environment

The ACP recommendations are the latest among several statements on the interaction of medicine and the environment this year.

Last month, the Federal Agency for Healthcare Research and Quality published “Reducing Healthcare Carbon Emissions: A Primer on Measures and Actions to Mitigate Climate Change”, with strategies to reduce greenhouse gas emissions. greenhouse thanks to the energy of buildings, transport, etc.

In a separate development, leaders of the First, Do No Harm campaign praised the National Academy of Medicine for calling on the healthcare sector to cut carbon emissions. First, Do No Harm pushed healthcare organizations to divest their investments in fossil fuel companies.

The American Thoracic Society and the American Medical Association (AMA) ripped up the US Supreme Court’s ruling that the EPA lacked congressional authority to limit carbon dioxide emissions from power plants coal. The AMA also declared climate change a public health crisis threatening the well-being of all.