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

Physicians serious about caring for their patients must double down on their efforts to care for the planet.

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

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

An accompanying editorial noted climate and weather conditions have contributed to a surge in natural disasters in the last 50 years. Just this year, wildfires burned on the West Coast, 39 people died in historic flooding in Kentucky, and 157 people died when temperatures topped 110 degrees in Washington – that state’s deadliest weather event.

“Creating sustainable social and physical infrastructure requires systematic accounting and management of potential threats, resources, inputs, outcomes, and concomitant risks, benefits, and harms,” said the editorial by Emily Senay, MD, MPH, and Andrew Hantel, MD. “The U.S. health care system is far behind other economic sectors in engaging in this critical practice that improves performance, reduces costs, and mitigates harms. We eagerly await ACP's translation of these recommendations into action-able partnerships and research funding advocacy that push our health care system toward sustainability, mitigation, and resiliency.”

An additional guest article outlined three scopes of greenhouse gas emissions, which come directly from health care organizations, indirectly from energy and utility suppliers, and indirectly from supply chains and other sources. Health care accounts for 8.5% of annual U.S. greenhouse gas emissions – 2.5 billion tons a year – and large hospitals account for fewer than 1% of commercial buildings, but consume 5.5% of commercial energy.

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

Policy recommendations

ACP included six policy recommendations:Immediate action to limit global temperature rise to 1.5 degrees Celsius above preindustrial levels.

The policy paper suggested efforts ranging from greater use of zero-emissions energy sources, to sustainable food production and consumption practices, to integrating climate change and health content in medical school curricula and physicians’ continuing education.Action to achieve environmental justice, particularly for communities with people of color, people with low incomes, and marginalized populations.

“Federal, state, and local officials should aggressively act to prohibit discriminatory practices related to environmental health,” ACP said. Going further, government leaders and planners should conduct meaningful outreach regarding decisions that affect community health, including infrastructure proposals, siting landfills and toxic waste facilities, construction projects and land use.Reduce indoor and outdoor air pollution, support the federal Clean Air Act, and support robust air quality standards for pollutants.

Along with examining evidence of health effects, ACP called for strict enforcement by the U.S. Environmental Protection Agency (EPA).Bolster the Safe Drinking Water Act, the Clean Water Act, the Lead and Copper Rule, and other laws and regulations to ensure clean, safe water.

Lead waterlines must be replaced, wells should be improved, and health agencies should have sufficient resources to monitor water safety and respond to illnesses or contamination.Reduce exposures to toxic substances and chemicals, especially for children, pregnant people, and other at-risk populations.

EPA needs resources for enforcement, and chemical manufacturers should be required to provide health and safety information on their products. Agencies handling lead abatement, exposure screening, and treatment must have enough resources.Give sustainable and sufficient money to federal agencies with an environmental health mission.

Apart from EPA, the Department of Health and Human Services has agencies and offices dedicated to environmental health and study. They need to research emerging issues such as health effects of exposure to nanomaterials, microplastics, and new chemicals.
Medical environment

The ACP recommendations are the latest among several declarations about 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 through building energy, transportation, and more.

In a separate development, leaders of the First, Do No Harm campaign praised the National Academy of Medicine for calling for the health care sector to reduce its carbon emissions. First, Do No Harm pushed for health care organizations to divest their investments in fossil fuel businesses.

The Amercian Thoracic Society and the American Medical Association (AMA) ripped the U.S. Supreme Court ruling that the EPA did not have congressional authority to cap carbon dioxide emissions from coal-fired electric power plants. AMA also declared climate change a public health crisis threatening the well-being of all people.