Healthy Environment, Healthy People

How is climate change influencing our health?

Why does climate change have a greater impact on vulnerable populations and low-income people?

How does the U.S. health care system affect the climate?

How can health care systems improve their impact on the climate and the environment?

ChristianaCare’s inaugural Climate and Health Conference addressed these topics and raised possible solutions at the John H. Ammon Medical Education Center on the Newark campus on April 12.

At the conference, the common denominator was this: An unhealthy environment can lead to illnesses and deaths from air pollution, high heat, contaminated water and extreme weather events. Health systems, government entities, community organizations and individuals all have a role to play in decreasing these effects.

“Climate, the environment and health care systems are intertwined,” said Greg O’Neill, MSN, APRN, AGCNS-BC. “We need to pay close attention to this relationship so we can improve health for everyone.” O’Neill is director of Patient & Family Health Education and co-chair of the Environmental Sustainability Caregiver Committee at ChristianaCare.

Climate change and intensifying health conditions

Negative health effects are so closely tied to the environments where people live, work and play that The Lancet called climate change “the greatest global health threat facing the world in the 21^st century [and] the greatest opportunity to redefine the social and environmental determinants of health.” At the conference, speakers spoke to specific areas of concern.

Asthma. Air pollutants, while largely invisible, are associated with asthma. What’s more, people who live in urban areas with little green space are more likely to have uncontrolled asthma, said speaker Robert Ries, M.D., an emergency medicine resident at ChristianaCare. And there’s the rub, he said: When people with asthma spend time in green spaces, it may improve their health.

“In Canada,” he said, “some doctors prescribe nature – two hours a week for better overall health outcomes. Could we do that here?”

Heat-related illness. Temperatures worldwide have been rising, increasing the likelihood of heat-related health incidents. Heat waves may be harmful to children and older adults, particularly those who don’t have access to air conditioning, swimming pools or transportation to the beach, said speaker Alan Greenglass, M.D., a retired primary care physician. Children visit the emergency room 20% more frequently during heat waves.

“Climate, the environment and health care systems are intertwined.” – Greg O’Neill

Weather-related illness. Climate change is causing more floods, which may result in respiratory problems due to mold growth; and droughts, which may threaten water safety and contribute to global food insecurity, said speaker Anat Feingold, M.D., MPH, an infectious disease specialist at Cooper Health.

Stress and anxiety. Climate change can affect mental health, even leading to “solastalgia,” which is distress about environmental change and its effect on one’s home, said speaker Zachary Radcliff, Ph.D., an adolescent psychologist at Nemours. He encouraged clinicians in the audience to keep this mental health concern in mind when seeing patients as it may become more prevalent.

Cardiovascular disease risk. Frequent consumption of red meat increases the risk of cardiovascular disease, the top cause of death in the U.S. It’s also unhealthy for the environment, said speaker Shirley Kalwaney, M.D., an internal medicine specialist at Inova. Livestock uses 80% of available farmland to produce only 17% of calories consumed, creating a high level of greenhouse gas emissions. By comparison, plant-based whole foods decrease the risk of cardiovascular disease and diabetes. They use only 16% of available farmland, producing 82% of calories consumed. This makes reducing red meat in our diets one of the most powerful ways to lower the impact on our environment.

Health equity and the environment

People in low-income communities are more likely to live in urban areas that experience the greatest impacts of climate change, including exposure to air pollutants and little access to green space, said speaker Abby Nerlinger, M.D., a pediatrician for Nemours.

A Harvard study in 2020 demonstrated that air pollution was linked with higher death rates from COVID-19 — likely one of the many reasons the pandemic has disproportionally harmed Black and Latino communities.

Similarly, access to safe, affordable housing is essential to a healthy environment, said Sarah Stowens, Ed.D., manager of State Policy and Advocacy for ChristianaCare, who advocated for legislation including the Climate Solutions Act, another bill that increased oversight regarding testing and reporting of lead poisoning and a policy to reduce waste from topical medications.

Opportunities for change in health care

Reduce emissions from pharmaceuticals and chemicals. These emissions are responsible for 18% of a health system’s greenhouse gas emissions. One way to reduce this number is for clinicians to prescribe a dry-powder inhaler (DPI) instead of a metered-dose inhaler (MDI) when applicable and safe for the patient and to give patients any inhalers that were used in the hospital at discharge if they are going home on the same prescription.

ChristianaCare joined the White House Climate Pledge to use 100% renewable energy by 2025, reduce greenhouse gas emissions by 50% by 2030 and reach zero net emissions by 2050.

Hospitals have opportunities to reduce greenhouse gases while caring for patients, said Deanna Benner, MSN, APRN, WHNP, women’s health nurse practitioner and co-chair of ChristianaCare’s Environmental Sustainability Caregiver Committee.

The health care sector is responsible for 8.5% of U.S. greenhouse gas emissions, the highest per person in the world. U.S. greenhouse gas emissions account for 27% of the global health care footprint. One way to significantly reduce the carbon footprint is to use fewer anesthetic gases associated with greater greenhouse gas emissions, Benner said.

Limit single-use medical devices. Did you know that one surgical procedure may produce more waste than a family of four produces in a week?  Elizabeth Cerceo, M.D., director of climate health at Cooper Health, posed this question during her talk. Sterilizing and reusing medical devices, instead of using single-use medical devices, she said, may meaningfully reduce hospital waste.

ChristianaCare’s commitment to healthy environments and healthy people

As one of the nation’s leading health systems, ChristianaCare is taking a bold, comprehensive approach to environmental stewardship.

ChristianaCare reduced its carbon footprint by 37% in 2023 by purchasing emission-free electricity.

ChristianaCare joined the White House Climate Pledge to use 100% renewable energy by 2025, reduce greenhouse gas emissions by 50% by 2030 and achieve zero net emissions by 2050.

“I’m proud to be part of an organization taking proactive steps now to protect our environment and the health of our community going forward.” – Deanna Benner

ChristianaCare has created an Environmental, Social and Governance structure to help advance a five-year strategic plan that delivers health equity and environmental stewardship.

Nearly 150 staff members have become Eco-Champions, an opportunity to be environmental change-leaders in the workplace.

In 2023, ChristianaCare’s successful environmental stewardship included:

• Reducing our carbon footprint by 37% by purchasing emission-free electricity.
• Recycling 96,663 pounds of paper, which preserved 11,485 trees.
• Reducing air pollution by releasing an estimated 33,000 fewer pounds of nitrogen oxides and sulfur oxides through the use of a cogeneration energy plant on the Newark campus.
• Donating 34,095 pounds of unused food to the Sunday Breakfast Mission in Wilmington, Delaware.
• Donating 1,575 pounds of unused medical equipment to Project C.U.R.E., ChristianaCare’s Virtual Education and Simulation Training Center and Delaware Technical Community College.

“In quality improvement, they say you improve the things that you measure,” O’Neill said in expressing goals for continued success.

In looking ahead, said Benner, “I really hope that this conference is the catalyst for positive change with more people understanding how climate is connected to health, so that we can protect health from environmental harms and promote a healthy environment for all people to thrive.”