As the World Burns

by David M. Introcaso

1402673266016-cc3-wildfire-TDS-Climate-Change-Day-3-WILDSFIRES-01Over the past several months the White House has taken several significant steps to undermine our nation’s ability to mitigate climate change or global warming. While these policies are being rolled out the increasingly dramatic effects of anthropogenic climate change are taking place before our eyes. Because there has always been a link between climate and health the obviously begged question is what has been the professional medical community’s response to all this?

The Past Few Months

The US is the biggest carbon polluter in history. Regardless, this past March the President Trump issued his Executive Order (EO) On Energy Independence the White House press shop stated, “stops Obama’s war on fossil fuels.” Among other things, the EO allows the EPA to review President Obama’s Clean Power Plan initiative aimed at reducing carbon pollution or greenhouse gas emissions from coal plants by 32 percent of 2005 levels by 2030. (Carbon dioxide, that accounts for approximately 60 percent of greenhouse gasses, has increased by 40 percent since pre-industrial levels and more than half of this increase has occurred over the past three decades.) The EO also lifted a 14 month moratorium on new coal leases on federal lands and it eliminates guidance that climate considerations be factored into environmental reviews under the National Environmental Policy Act (NEPA).

Two months later or on June 1st President Trump announced the US would withdraw from the Paris climate accord signed by 194 other nations and considered by many to be modestly ambitious. US joined Syria as the only non-participant. (Nicaragua also refused to sign because its envoy said the accord was insufficiently ambitious.) Under the accord the US had committed to reducing its greenhouse gas emissions by 26 to 28 percent compared to 2005 levels by 2025. Trump’s decision was made despite the fact the president’s Secretary of State, and former Exxon CEO, Rex Tillerson, opposed the decision. Ironically, in early May Tillerson signed the Fairbanks Declaration that stressed the importance of reversing Arctic warming that is occurring at twice the rate of the global average and has caused to date the disappearance of 40 percent of summer Arctic ice. Following up on the President’s March EO, EPA Administrator, Scott Pruitt, announced in early October his agency would begin the process of repealing the Clean Power Plan. Most recently, or on November 3rd, the Trump administration, surprisingly, released a Congressionally-mandated report assessing climate change. (The report’s release was expected in August.) Authored by 13 federal agencies and considered the most definitive statement on the subject, the report titled, “‘US Global Change Research Program, Climate Science Special Report” (CSSR), stated in part, “it is extremely likely that human influence has been the dominate cause of the observed warming since the mid-20th century.” The White House played down the reports findings stating “the climate has changed and is always changing.”

The Increasingly Dramatic Effects of Anthropogenic Climate Change

While the Trump administration has been rapidly devolving federal climate policy, for the first since we started collecting hurricane records in 1851 the US mainland was hit by two Category 4 hurricanes. Beyond sustained winds at over 130 miles per hour, Hurricane Harvey poured an estimated 27 trillion gallons of water on Texas and Louisiana. Some weather stations recorded over 50 inches of rain. Harvey caused upwards of $190 billion in damages and killed over 80. Hurricane Irma added upwards of another $100 billion in damages killing approximately as many. Hurricane Maria, yet another Category 4 hurricane, destroyed Puerto Rico killing as many as 450. Minorities and the infirm disproportionately account for these deaths. Half of the over 1,800 killed by Hurricane Katrina in 2005, responsible for almost half of hurricane-related deaths over the past 50 years, were over 75 and black adult mortality was upwards of four times higher than for whites. Half of the 147 US deaths from Hurricane Sandy in 2012 were of those over 65. Currently, wildfires burning in seven California northern counties are the most deadly in history. As of this writing they have consumed a land mass the size of New York City. British Columbia has also experienced its worst wildfire season on record.

The intensity of these storms and wild fires is explained at least in part, according to the World Meteorological Association, by increasing global warming. The warmest years globally were, in order 2016, 2015 and 2014. Out of the last 17 years, 16 were the warmest on record globally. For the US, last year marked the 20th consecutive year the contiguous states had an above average annual temperature. Alaska represents the front lines of climate change. Over the last 50 years Alaskan Arctic air temperatures have increased more than twice as fast as the global average. Alaska residents will see the disappearance of summer Arctic ice over the next two decades.

Again, most of this unambiguous warming has occurred in the recent past. Since 1901, 66 percent of the one degree Celsius (1.8 degrees Fahrenheit) rise in temperature has occurred since 1986. Average temperatures have risen faster over the past few decades than any other time over at least the past 1,700 years. This is not surprising since the relationship between the accumulation of carbon dioxide emissions and temperature response is effectively linear. Absent any carbon dioxide in our atmosphere the earth would be frozen. A warming atmosphere, or again one with ever-increasing greenhouse or heat-trapping gases, causes more evaporation causing in turn heavier rainfall. Harvey’s unprecedented rains are explained in part by the fact average sea surface temperature in the Gulf for the first time on record never fell below 23 degrees Celsius (73 degrees Fahrenheit) this past winter. Houston and Galveston had its warmest winters on record. California’s summer heat is contributing to the intensity of its current fire season. The state’s average temperature for June, July and August were the hottest in recorded history.

The abnormal is now normal. The CSSR projects increases in the intensity and precipitation rates for Atlantic and eastern North Pacific hurricanes and western North Pacific typhoons. The CSSR also notes incidences of large forest fires in the western United States and Alaska have increased since the 1980s and projects further increases in wildfires in those regions going forward. The wildfire season today is two and a half months longer than it was just thirty years ago.

The CSSR concludes carbon dioxide concentrations, now beyond 400 parts per million (PPM), last occurred three million years ago “when,” the report states, “global average temperate and sea levels were significantly higher than today.” “The present-day emissions rate of nearly 10 GtC [giga ton of carbon] per year suggests,” the report explains, “that there is no climate analog for this century any time in at least the last 50 million years.” The effects vast emissions of carbon dioxide have on the planet are not unknown to scientists. This past July the journal Palaeogeography, Palaeoclimatology, Palaeoecology published a special issue in which researchers found that great die-offs or mass extinctions, like the one that killed 75 percent of the life on land and 90 percent of ocean life ending the Permian period over 250 million years ago, were caused by drastic changes in atmospheric carbon dioxide concentrations largely driven then by large scale volcanism.

For the US, the CSSR projects contiguous United States temperatures will continue to rise to 1.4 degrees Celsius, or 2.5 degrees Fahrenheit, over the next few decades. Beyond increasingly severe hurricanes, tornadoes and wildfires this means, in part, an increase in the frequency and intensity of heavy precipitation events, a greater increase in the frequency of heat waves, or the number of days above 90 degrees Fahrenheit and reciprocally substantial declines in western snow pack and substantial increases in drought. Mean sea level rise in the US Northeast and western Gulf of Mexico, the report notes, is likely to be higher than the global average. The current rate of rise in Global Mean Sea Level (GMSL) is greater than any time in at least 2,800 years. This means increased rates of coastal or tidal flooding that has already seen an increase of five to ten fold since the 1960s in coastal cities. Sea level rise also will increase the frequency and extent of extreme flooding associated with hurricanes and nor-easters.

The Health Effects of Global Warming

What effects a warming planet will have on human health are reasonably well known. For example, they were detailed at length in another government report published in April 2016. Titled, “The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment,” the 400- page study was prepared over three years by the EPA, DHHS, DOD, NASA, NOAA, the USDA and several other federal agencies. In sum, the report explained why “climate change is a significant threat to the health of the American people,” particularly children, pregnant women, the elderly, communities of color and those with disabilities and pre-existing health conditions. Because President Trump believes global warming a “hoax” and “canard,” the White House replaced the report from its website with the nomination of Ms. Katheleen Hartnett as White House senior adviser on environmental policy. According to The New York Times Ms. Harnett White, a former Texas environmental regulator, has stated labeling carbon dioxide emissions as a pollutant is “absurd” and termed renewable energy “parasitic.” For its part the EPA has deleted related climate change documents from its website that would among other things inform state and local government how to respond to global warming.

Beyond comparatively mild heat exhaustion, the “Impacts of Climate Change” explains the direct effects of higher temperatures also cause heatstroke, hyperthermia, dehydration and causes or worsens cardiovascular, cerebrovascular, kidney, respiratory and several mental health diseases. One study cited in the report concluded future warming, absent any adaptation, will result in an increase of 2,000 to 10,000 deaths annually in each of 209 US cities. Among other effects, warmer winter and spring temperatures means the earlier annual onset of Lyme disease cases that now number 35,000 annually in over 14 eastern states. Higher temperatures also affect vector-borne diseases carried by, for example, mosquitoes, fleas, ticks and rodents. Warmer temperatures vastly speeds up the reproductive cycle of cold blooded mosquitoes. As a result cases of Dengue fever, no longer unknown in the US, have doubled every decade since 1990. Currently there are 14 vector-borne diseases, including West Nile Virus, that are a national public health concern. The Zika virus may serve as the latest example.

Increased heat that contributes to drought and wild fires also causes poorer air quality or worsening ground-level ozone pollution, particle pollution and increasing levels of aeroallergens such as pollen. Combined, these are responsible for tens of thousands of annual acute care episodes. Worldwide, the WHO estimates 800,000 die prematurely each year from urban air pollution stemming from burning coal, gasoline and oil. The “Impact” report states, “future ozone-related human health impacts . . . are projected to lead to hundreds of thousands of premature deaths, hospital admissions and causes of acute respiratory illnesses including increases in asthma episodes in children due in part to a longer ragweed pollen season.”

Again, higher temperature means warmer air holding more water causing greater rains and flooding. This means compromised storm water disposal, waste water treatment and drinking water that in turn, results in increased risk of waterborne diseases caused by pathogens such as bacteria, viruses and protozoa. The “Impacts” report notes between 1948 and 1994 68 percent of waterborne disease outbreaks in the US were preceded by extreme precipitation events. The report also notes further waterborne diseases may be currently underestimated by by as much as 43-fold and by up to 143 times for Vibrio species, for example, Vibrio cholerae. Cases of Legionnaires’ disease, spread by contaminated aerosolized water, have increased by nearly 200 percent between 2000 and 2009.

Severe storm events means also increased food contamination via increases in the transport of pathogens in agriculture such as salmonella and noroviruses. Alternatively, global warming will also cause a vast decline in arable land as well as both reduced crop yield and nutritional value. “Climate change,” the “Impact” report states, “will influence the fate, transport, transmission, viability and multiplication rate of pathogens in the food chain.”

The climate penalty contributes to a long list of mental and behavioral health conditions ranging from anxiety, depression and alcohol and substance abuse to post-traumatic stress and suicide. Following Hurricane Katrina, the report detailed, veterans with preexisting mental illness had nearly a seven times greater risk for developing an additional mental illness. Suicide attempts after Katrina among women living in temporary housing increased 15 times compared to regional averages, and incidences of violent crime including homicide and violence against women increased substantially.

The “Impact” report raises numerous additional or cascading climate change-related health consequences. Consequences that again disproportionally affect pregnant women, children, the elderly and disabled, minorities and the poor. Vulnerability, as the report explained, is a function of sensitivity to change and adaptive capacity to adjust or cope. The elderly are particularly vulnerable since they are

frequently immuno-compromised, are prescribed certain medications that compromise thermo-regulation or block nerve impulses and a significant percent are cognitively impaired and/or socially isolated. African American mortality was two to four times higher than for whites from Hurricane Sandy.

If the findings of “Impact of Climate Change” report were not sufficiently worrisome, in a lengthy New York magazine article published this past July and titled “The Uninhabitable Earth,” Famine, Economic Collapse, A Sun That Cooks Us: What Climate Change Could Wreak – Sooner Than You Think,” David Wallace Wells summarized the apocalyptic consequences of unabated global warming. (Wallace Wells’ article has been downloaded over five million times and has its own Wikipedia entry.) His essay began with the foreboding statement, “It is, I promise, worse than you think.” Among many other disturbing findings, Wallace Wells noted climate scientists recently concluded global warming is occurring at twice the rate scientists had previously thought. This is due in part to the fact that the highly regarded UN Intergovernmental Panel on Climate Change (IPCC) has not fully accounted for the albedo effect where less ice means less reflection or more absorbed sunlight or more warming. Less ice also means melting permafrost. Arctic permafrost contains 1.8 trillion tons of carbon or twice as much as is currently suspended in the earth’s atmosphere. Though how this gas thaws or is released into the atmosphere is uncertain, if released as methane, methane has a Global Warming Potential (GWP) of 86 over twenty years. This means it is 86 times more potent of a greenhouse gas than carbon dioxide.

Concerning wildfires, Wallace Wells notes the US Forest Service has concluded over the next few decades wildfires in the US will be twice as destructive as they are today. Overseas, run away peat fires contribute enormous amounts of carbon as they did during a 1997 Indonesian fire that increased carbon emissions by upwards of 40 percent of total mean annual global carbon emissions. Declining air quality caused by climate change shifting weather patterns caused China’s 2013 “airpocalypse” that was responsible for an estimated one-third of that country’s deaths that year. Beyond rising sea levels of one to four feet this century that would effect at least the 600 million people worldwide living within 10 meters of an ocean, oceans today are substantially more acidic, having absorbed about one-third of carbon emissions, causing coral bleaching that threatens a quarter of all marine life. After talking with “many sober-minded scientists . . . the most credentialed and tenured in the field, few of them inclined to alarmism . . . ,” Wallace Wells wrote, “have quietly reached an apocalyptic conclusion . . . no plausible program of emissions reductions alone can prevent climate disaster.” This means carbon capture or atmospheric extraction would be necessary, a technology Wallace Wells notes is not only untested but would likely cost “several trillion dollars.”

What Has Been the Medical Community’s Response

When President Trump announced the US would withdraw from the Paris accord the news was greeted with widespread criticism. For example, twenty-five major US companies including Apple, General Electric, Goldman Sachs, Google, IBM, Microsoft along with energy giants National Grid, Pacific Gas and Electric, Peabody Energy and Shell, made known their opposition to withdrawing in full page New York Times and The Wall Street Journal ads. This was motivated in part by a 2015 study by Citigroup estimated climate change would cost the US at least $44 trillion in lost GDP over the next five decades. Former Vice President and Nobel Laureate, Al Gore, called the decision “reckless” and “indefensible.” Bill McKibben, the founder of, called it an “incredibly stupid decision,” and wrote the decision undercuts civilization’s chances of survival. Tesla and Space X CEO, Elon Musk, along with others resigned from several presidential councils. Among American voters nearly 70 per cent, including a majority in all 50 states, supported the Paris accord.

Because, again, there has always been a link between climate and health, one would think the professional medical community would have led the chorus of condemnation in protesting the president’s Paris decision. For example, the American Medical Association’s (AMA) website makes no mention of the “Paris climate accord.” The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) websites also made no mention of Trump’s decision to withdraw from Paris. The same is true for AcademyHealth, the American Diabetes Association (ADA) the American Geriatric Society (AGS), the American Heart Association (AHA) as well as, for example, the Association of Health Plans (AHIP), the National Association of Medicaid Directors (NAMD), and other related organizations. Among relevant health care policy journals, Health Affairs, founded in 1981 and advertised as “the leading journal of health policy thought and research,” has never addressed global warming. The nation’s leading medical trade and professional associations were equally indifferent when President Trump signed his March Clean Power Plan EO. There is no mention of the “Clean Power Plan” on their websites. EO is particularly concerning when considering research published in Nature in 2015 showed the present estimate of global fossil fuel reserves are three times higher than the amount of carbon dioxide that can be released to have a 50 percent of keeping warming below two degrees Celsius throughout the 21st century.

To be fair there are a few organizations that mentioned their objections to these policy decisions. The American Lung Association (ALA) issued a three paragraph press release condemning withdrawal from the Paris accord and another three paragraphs in response to the EPA’s recent announcement to revoke the Clean Power Plan. The American College of Physicians (ACP) also posted brief press releases criticizing the March EO and withdrawal from the Paris accord. The latter response was premised on an ACP position paper published a year ago titled “Climate Change and Health” that vaguely recommended “a global effort . . . to reduce anthropogenic greenhouse emissions.” Four of the entities noted in the preceding paragraph, the AMA, AAFP, ACP and AGS, did join with 14 other groups last year to form “The Medical Society Consortium on Climate and Health.” This organization was created to “inform the public and policymakers about the harmful health effects of climate change on Americans.” The organization however does not appear intent on working intentionally to decrease carbon emissions or reform fossil capitalism in any way.

There appears to be one association that has done more than post a press release or a draft a position paper. The American Public Health Association (APHA) condemned the Paris decision by stating it would have “disastrous consequences for human health.” More productively, when the CDC abruptly canceled a three-day climate and health meeting this past winter, the APHA partnered with five other organizations, none of whom were medical associations, and sponsored an abbreviated, one day climate change meeting in February at the Atlanta Carter Center. Among other programming, the APHA has since 2010 produced a climate change webinar series and along with 40, moreover non-medical, organizations, declared 2017 as “the year of climate change and health,” in an effort to increase climate change awareness and mobilize action to protect public health.

Beyond words, it appears the professional medical community and its health care industry partners have not spent any of their considerable lobbying funds in an effort to reduce global warming via federal legislation. (Last year, according to the Center for Responsive Politics, the health care industry spent more on lobby than any other industry at $512 million.) During the 2009 Affordable Care Act debate the industry spent, according to the Center for Responsive Politics, $550 million. That same year the House also passed the American Clean Energy and Security Act, the first and last Congressional effort to address climate change (the bill would have created an emissions or carbon trading plan). Of the 112 “clients” the Center for Responsive Politics identifies having spent lobbying funds under its “environment” category in 2009, none were professional medical associations. Center for Responsive Politics records for 2017 show of the $13 million spent to date under the “environment” category, again not one of the 79 “clients” is a professional medical association.

In a recently published 50 page assessment of the health effects of global warming appearing in The Lancet, over 60 authors examined five inter-related subjects including “climate change impacts, exposures, and vulnerability” and “adaption, planning and resilience for health” and concluded “the trends elucidated in this Report provide cause for deep concern,” because the report also found, “the health impacts [are] far worse than previously understood” and because “the past two decades have seen limited progress” in keeping temperature rise below two degrees Celsius or 3.6 degrees Fahrenheit. A temperate rise the report shows that has caused among other things a 46 percent increase since 2000 in extreme weather events.

We treat our atmosphere, the thin blue band that protects us, as an open sewer. After China, the US is largest greenhouse gas polluter, emitting over 6,600 million metric tons of carbon in 2015. Carbon emissions are today and for the foreseeable future having adverse effects on our health and our survivability particularly since global warming is not a single-system disease and because the consequences of global warming are likely locked in for the next 20 to 30 years. On balance this does not appear to be the professional medical community’s concern. The greatest existential threat to our survival, our children and their children and the professional medical community is largely unwilling to even raise its voice.

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The opinions expressed above are solely the author’s.

David Introcaso is currently Senior Director of Regulatory and Public Policy at AMGA. David moved to Washington, D.C. in the 1990s to work at DC General Hospital. Since then has served as the Evaluation Officer at the Agency for Healthcare Research and Quality (AHRQ), as a Public Health Analyst in the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) and as Healthcare Policy Adviser for the House Majority Leader, Rep. Steny Hoyer. He has also worked as a consultant to numerous clients including the American Heart Association, the American Public Health Association, the Coalition to Transform Care, the National Association of ACOs, the National Hospice and Palliative Care Organization, and United Health Group. This recent work is reflected in over 50 Department of Health and Human Services comment letters and published essays over the past two years. David has taught as an adjunct professor at the University of Chicago, Georgetown and George Washington University. Among other awards David was a W. K. Kellogg Foundation National Leadership Fellow (1993-1996). David earned his BS, MA and Ph.D. degrees at Rutgers and Arizona State.