Aaron Bernstein, M.D., M.P.H., a pediatric hospitalist at Boston Children’s Hospital, is interim director of the Center for Climate, Health, and the Global Environment and co-leads Climate MD at Harvard’s T.H. Chan School of Public Health. As a pediatrician, Bernstein has seen the health effects of a worsening climate, having treated kids with breathing difficulties, vector-borne diseases, and trauma from natural disasters. Through education and advocacy, Bernstein and his colleagues are helping clinicians understand the health effects of climate change and how to take steps to protect vulnerable patients. We asked Bernstein about this work.
Safeguarding Patients from the Health Effects of Climate Change: An Interview with Aaron Bernstein
Transforming Care: You and colleagues recently published a commentary in the Journal of the American Medical Association calling on health care leaders to take “patient-centered climate action.” What do you mean by that?
Bernstein: That means we don't just worry about putting solar panels on hospitals and other health care buildings and figuring out how to reduce waste and use green chemicals. All of this is important, but it isn't going to protect patients immediately, particularly those who are most affected by more severe heat waves, stronger storms, or worse air or water quality. This includes older people, people of color, and people with chronic health conditions.
Transforming Care: How is Climate MD working to help protect patients most at risk from climate change?
Bernstein: We’re trying to equip health care providers in rural and low-income neighborhoods with the tools they need to protect vulnerable patients. One way we’re doing this is through collaborations with the National Association of Community Health Centers and Americares, which works with federally qualified health centers and free and charitable clinics. What we hear time and again is these clinics are the glue that holds the community together after a climate shock. Right now, many don’t have funding, training, or tools to do that. In collaboration with Americares, we’ve created resources about heat waves, wildfires, and other climate shocks that educate providers about risks to particular patients, offer tip sheets for patients, and help health care administrators prepare.
Transforming Care: How might a health clinic help protect someone during a heat wave?
Bernstein: By working to identify who might be vulnerable ahead of time — taking into account a patient’s age and medical conditions. When we ask about social determinants of health, we should ask about heat and whether a patient has air conditioning. We can use this knowledge to create disease-specific heat management plans. We can help make sure there’s a plan for where to go to get cool.
Transforming Care: Hospitals take part in emergency planning for things like heat waves as a condition of participating in Medicare or Medicaid. But what about clinics and other health care providers?
Bernstein: Health care providers aren’t always at the table when it comes to planning. A major U.S. city recently spent a year and a half building a new heat plan, and it did not include health care providers. There's a huge disconnect. The literature shows that a big risk factor for dying in a heat wave is if a patient is immobile or socially isolated. They can’t make it into a cooling center. So, instead of just creating cooling centers and asking people to come to them, we need health systems working with city planners and community organizers to think more proactively about who’s vulnerable and how to keep that person safe.
Transforming Care: Having worked through a pandemic and now facing workforce shortages, many health care providers are exhausted. How much appetite do you think they have to take on climate change?
Bernstein: Given all that has happened in the last three years, addressing climate change in clinical practice can seem like a big lift. It’s why we try to meet clinics where they are with the tools they say they need. Ultimately, the biggest difference we can all make is to prevent disease in the first place. Not only will that make people more resilient to climate shocks, it will reduce the health care sector’s carbon footprint and waste.
Martha Hostetter, Consulting Writer and Editor, Pear Tree Communications[email protected]
Martha Hostetter and Sarah Klein, “Safeguarding Patients from the Health Effects of Climate Change: An Interview with Aaron Bernstein,” Transforming Care, Commonwealth Fund, Oct. 20, 2022. https://doi.org/10.26099/5t07-bt11