Mr. A came to our appointment with a laundry list of issues he wanted to address in our 20 minutes together, including typical primary-care complaints like high blood pressure and lower back pain.
As our visit progressed, he revealed that he recently moved to Denver from Syria and was seeking asylum. He had run out of blood-pressure medication years ago, unable to recall when he last saw a doctor. His back pain was due to one leg being shorter than the other, the result of bomb shrapnel in his youth. And like many other displaced individuals, he struggled to navigate the asylum-seeking process.
As a family physician caring for numerous displaced families in a safety-net clinic, I have learned to support my patients by educating myself on the complicated processes refugees and asylum seekers go through when coming to the United States. It seems these days, primary care is as much about addressing social and environmental determinants of health as it is about treating diabetes or performing cancer screenings.
While not immediately apparent, one environmental determinant threading through Mr. A’s visit is climate change.
In Syria, multiyear droughts and rising temperatures led to the devastation of agricultural land and water scarcity, amplifying the economic and political crisis there. Warming of the global climate increases the number and severity of disasters like wildfires, floods, and hurricanes — which all lead to mass population displacement and have a significant effect on the health outcomes of individuals.
Approximately 20 million people are displaced per year due to climate change. This is not a problem for the future; we are already seeing its direct effects today. Degradation to the climate affects people living in poverty and those from the most fragile and conflict-affected countries the most, which means black, indigenous, and other people of color disproportionately feel the consequences of our global failure to address this issue.
It’s also important to understand these issues are not too different from the dry, temperate conditions we experience in America’s Mountain West. Temperatures have risen 2.5 degrees Farenheit in Colorado since the beginning of the 20th century and severe droughts have led to record-breaking wildfires seasons. I’ve personally seen countless patients with worsening respiratory disease during smoggy days with “poor air quality” alerts. It’s disheartening when the best I can do is counsel patients to stay inside during the worst days and to use an air purifier, if they can afford to buy one at all.
Did Mr. A escape one country plagued by droughts and violence only to settle in another area where the rapidly deteriorating climate is creating unlivable conditions?
We are already seeing the health impacts of climate change in our patients, and we as health care providers need to be prepared to address it. We must better train our physicians in medical school and residency to diagnose and treat the health impacts of climate change. From a spreading geographical range of Lyme disease to increasing rates of heart disease from air pollution to worsening mental health due to trauma and displacement, there is much to learn and do to improve patient outcomes.
We have a responsibility to advocate for our patients outside of the exam room, as well.
There are no legal protections for people displaced due to climate change; while they resemble refugees they do not legally qualify for the same protections as people who flee due to persecution “for reasons of race, religion, nationality, membership of a particular social group or political opinion.” We need to treat relocation as a necessity in our changing climate and ensure displaced people are not harmed by isolationist migration policies.
We should also invest in climate-change solutions so that people will not be forced to leave their homes and livelihoods in the first place. The United States is by far the largest emitter of carbon dioxide, which means changes we make to reduce carbon emissions will have global impacts. Some personal solutions include moving towards locally produced clean energy like wind and solar, shifting to an electric or hybrid vehicle, or decreasing meat consumption.
We should advocate for elected officials to support policies that reduce greenhouse-gas emissions, especially in light of the recent Supreme Court decision restricting the U.S Environmental Protection Agency’s power to mandate carbon emission reductions. Additionally, healthcare can lead the charge and work towards decarbonization and sustainability in hospitals and clinics – keeping our communities healthy.
We have a powerful voice to uplift our patients, and we can and should collectively invest in healthier communities at both the local and global level.
Jennifer Camello, M.D., of Denver, is a family medicine resident at the University of Colorado. The opinions expressed in this column are hers and do not necessarily represent those of the University of Colorado or the School of Medicine.
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