This article is part of an ongoing series where experts talk about the link between climate change and mental health.
If your doctor starts talking to you about the link between climate change and your health, you might have Mona Sarfaty, MD, MPH FAAFP, to thank for it.
Sarfaty was a family medicine professor and physician for over 30 years when she noticed that climate change was seeping into her practice, affecting the well-being of her patients. She’s now using her background in medicine and policy (in the late 80s to early 90s, Sarfaty served as the Associate Director for Health Policy and Senior Health Policy Advisor for the U.S. Senate Committee on Labor and Human Resources) to get more doctors involved in the fight against climate change.
She’s also the Director of the Medical Society Consortium on Climate and Health based within the George Mason University Center for Climate Change Communication (where she’s also the director of the Program on Climate and Health). The Consortium was created in collaboration with medical societies to explore how physicians are seeing the health effects of climate change manifest in their practices, and to help them send a message to the public and policymakers about how to take action.
Here, she explains what losing a home can do to someone’s mental health and why doctors are an important resource for educating others on the links between climate and health.
The following interview has been edited for length and clarity.
Thrive Global: You’re a family medicine doctor. How did you get into climate change and health?
Mona Sarfaty: It wasn’t until I noticed that climate change was making our family practice patients sicker that it got my attention. When I realized that health harms from climate change are happening to people right now, I was convinced that I should get involved.
My first step was to assess the experience of physicians around the country through surveys. It was striking that they were seeing health harms related to climate change among their own patients. We asked for anecdotes and received many—mostly about people with allergies and lung conditions who were having a harder time each year from heat, air pollution and pollen.
They described allergy sufferers whose symptoms were starting earlier in the year, lasting longer, and requiring more medicine. They told of people with asthma, bronchitis, and chronic lung disease who had breathing trouble during heat waves and wildfires—even when the fires were hundreds of miles away. They described people with mental health conditions that started because they faced life-disrupting events such as extreme weather, evacuations, and loss of their homes and belongings.
These findings were so striking that I was able to bring large medical associations to the table to talk about joint work on solutions to the brewing crisis. Once we had five or six large societies, it wasn’t long before others were willing to join. Last spring, we published a report called “Medical Alert! Climate Change is Harming Our Health.” It received lots of attention from the press and our efforts went mainstream. The report sends the message that climate change is causing health harms today, and will cause much more harm soon if we fail to act.
Who doesn’t want the cleaner air and water that comes with using clean renewable energy?
The most vulnerable people are children, pregnant women, older people, and those who live with conditions like low income or assets, minority status, or risk due to geography. It is important to let everyone know that there are also real health benefits associated with climate change solutions, especially the use of clean energy. Clean renewable energy does not pollute the air or the water, and clean air and clean water are sources of good health. Who doesn’t want the cleaner air and water that comes with using clean renewable energy?
TG: A lot of the research I’ve seen about climate change and health is about how it will affect patients, but your research has also focused on how it will impact the way doctors are able to treat their patients. Can you talk to me more about that research?
MS: The greatest surprise for me was that most physicians indicated they wanted to make their own workplaces environmentally sustainable. There was little indication before the surveys that environmental sustainability was a priority for doctors. It showed that many physicians understand that not only must we respond to health problems, we must also change the way we manage our business. About 8 percent of greenhouse gases in the U.S. come from the medical care sector. Doctors and hospitals can reduce their energy use, increase efficiency of energy use, reduce waste, and get their energy from clean renewable sources just like every other sector.
Our surveys showed that doctors connect the carbon emissions that cause global warming to the air pollutants that cause breathing problems. When the carbon emissions transform to ozone at the ground level on a warm sunny day, they irritate lungs and cause a rise in doctor visits for lung problems. The smoke from wildfires has a similar effect—and jeopardizes heart health as well. Allergy care is affected as well because increased temperatures have brought longer pollen seasons that produce more pollen. Some pollens are more intense and evoke more allergy symptoms. Doctors must advise patients to take more medicine and start taking it earlier—or remain indoors.
We surveyed African American physicians as a group and discovered that they viewed their own patients as especially vulnerable to climate impacts. We knew climate change would affect vulnerable citizens but we didn’t expect this to be so corroborated by their doctors. It took 6 months for all children who were separated from their families during Hurricane Katrina to be reunited with them. A story appeared in the press this past week about a woman whose life has still not returned to normal since Hurricane Katrina 12 years ago. For people who have lost homes and family members, depression, anxiety and PTSD can cause ongoing distress interfering with a normal life.
For people who have lost homes and family members, depression, anxiety and PTSD can cause ongoing distress interfering with a normal life.
TG: What’s your biggest concern in the relationship between climate change and health?
MS: The greatest concern is that, unless many more people connect the dots between climate change and the more and more blatant phenomena on the landscape, we may fail to act fast enough. The phenomena include excessive rain storms accompanied by flooding, larger more destructive wildfires, increased frequency of dangerously hot days, and the dramatic spread of ticks and mosquitos that carry illness.
It concerns me that people who are in excellent health may find it difficult to understand that not everyone is like them; in fact, other people are experiencing health harms because of climate change. But luckily, people tend to believe their doctors. Many physicians are very clear about what they are seeing. This explains is why we could get 18 medical societies, including all the largest ones, to come together as a group and send a clear message to the public and policymakers about the health harms of climate change and the health benefits of climate solutions. The Consortium represents well over half the doctors in the U.S. We are clear that climate change is harming health today—including mental health–and will be more harmful tomorrow if we don’t act.
TG: Can you speak to the mental health impacts of climate change?
MS: More attention should focus on the mental health impacts. To quote a psychiatrist colleague, “When the place we call home is burned down, blown away, flooded … when we lose our possessions; maybe our pets, our livelihood; see injuries, illness, and death; the mix of fear, anger, sorrow, and trauma can bring on a full range of psychiatric disorders.”
People with pre-existing mental health problems may be even more vulnerable; so may children. Children in Louisiana after the torrential rains and thousand-year flood of 2016 became afraid every time it rained because they thought there was going to have another flood. Following a disaster, therapists see the effects—anxiety, depression, substance abuse, domestic violence, child abuse. Since physical conditions often have a psychological impact, many people will visit a primary care physician first. They must be prepared.
There is also a well-known connection between rising heat and human aggression. This has been detected across cultures and countries. Conflict produces refugees who are fleeing for their safety. This leads to the type of problems that we see so clearly on the world stage that have resulted from the war in Syria. The United Nations has already said that the current refugee problems are the tip of the iceberg. Doctors who responded to our survey, gave descriptions of people with PTSD resulting from personal violence they endured in the aftermath of Hurricane Katrina. There are stories of substance abuse and domestic violence associated with family dislocation. The stress is real and depending on the individual it can become emotionally debilitating.
People should learn from doctors how they can protect themselves from polluted air, dangerous heat, and perilous storms.
TG: How should we be talking about climate change under a science-hostile administration?
MS: A conversation about health can break through many constraints. Doctors and nurses have stories to tell that people can relate to. They are highly trusted by the public and policymakers because their professional role is to take care of others. They commit their lives to that. They are sounding the alarm about this danger to health and sharing stories about how climate change endangers the people they care for. People should learn from doctors how they can protect themselves from polluted air, dangerous heat, and perilous storms. People look to their doctors and often take their advice. Most people don’t know a scientist; but almost everyone has contact with a doctor and a nurse. We hope more people will become aware of what doctors know about this.