As trusted professionals in the eyes of the public, health providers are considered stewards of public health and safety.
Health providers are ethically bound to advance health holistically, and with climate change, this means translating information into advocacy. The effects of climate change call for the many roles that medical providers take on: first responder to disaster, risk educator of patients and public, and — in an almost exact reenactment of Florence Nightingale’s work — defender of clean water, nutritious food, and sanitation.
The scope of climate-related effects on human health is simultaneously as broad as global drought and as specific as increased incidence of skin cancers. Health providers are uniquely positioned to address the health implications of climate change, providing education within the context of direct patient care and speaking with authority on policy decisions that affect public health.
Climate Change and Human Harm
Scientists are still working to understand the full impact of climate change on human health; however, there are existing studies that show severe effects on human health as a result of environmental hazards. According to the National Institutes of Health, there are several key areas of concern regarding climate and health, and many opportunities for health providers to offer prevention and education.
THREATS TO RESPIRATORY HEALTH
Implications: Lung disease, allergies, and asthma will be worsened by longer allergy seasons and deteriorating air quality.
Health Provider Recommendations: Support staying inside on poor air quality days and remind vulnerable populations to adhere to medical treatment plans and medication.
Implications: Ticks and mosquitoes will be more active for longer and range farther.
Health Provider Recommendations: Encourage people to use bug repellent when outdoors or in any areas with insects. Monitor and record reports of disease outbreaks. Inform others about signs and symptoms of diseases and when to call a health care provider.
WEATHER-RELATED ILLNESS AND INJURY
Implications: Extreme temperature fluctuations affect outdoor laborers, children, pregnant women, and older adults and can cause pulmonary and cardiovascular problems and dehydration. In addition, increased particulate matter, ozone concentrations, and extreme weather events may trigger stress and respiratory issues that lead to heart disease.
Health Provider Recommendations: Educate about the risks of heat exposure. Ensure access to air conditioning for vulnerable or older adults and homeless populations. Also, encourage people to drink enough water throughout the day and not just when they feel thirsty.
MENTAL HEALTH AND STRESS DISORDERS
Implications: Extreme weather can be destructive to property and quality of life, often resulting in the loss of homes, belongings, and loved ones. Prolonged exposure to these stressful experiences can manifest psychologically as people try to navigate grief and loss with interrupted access to care.
Health Provider Recommendations: Encourage others to speak openly about their grief to reduce stigma. Identify gaps in mental health literacy and teach patients about signs and symptoms of mental health risks. In addition to educating, refer at-risk patients to a mental health provider as soon as possible.
Spreading the Word About Disaster Preparedness and Dangers
In a 2018 World Health Organization report on climate change and health, experts state that “globally, the number of reported weather-related natural disasters has more than tripled since the 1960s.” For this reason, it’s essential that health providers inform their communities about disaster preparedness and dangers. The best time to get involved is before a disaster; therefore, it’s critical for providers to leverage any one-on-one time with patients to address holistic health and emergency concerns. Special attention should be paid to those who may be vulnerable in the wake of disasters. For example, this could include people with chronic conditions, physical disabilities, or respiratory diseases; infants and children; pregnant women; and older adults.
Thin Ice: The Life-Threatening Effects of Climate Change
Air Temperature Change
Increase in heat exhaustion
Spread of disease vectors among animals, insects, and people
Increased movement of airborne allergens and diseases
Higher risk of respiratory illness
Loss of loved ones and pets
Water Temperature Change
Changes to coastal ecosystem health that will affect food supply and erosion
Increased likelihood of extreme precipitation, drought, or flooding
Water contamination due to harmful chemicals and pathogens
Malnutrition, especially for prenatal or early childhood development
A Rising Tide Lifts All Boats: Advocacy for Climate-Related Health Policy
Climate change may be politically polarizing, but illness and injuries seen by first responders and health providers are concrete outcomes and can translate into loss of life on a global scale.
In a 2018 report on climate change and health that accounted for continued economic growth and medical progress, the World Health Organization stated that “climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050.” These fatalities are projected to come from the following climate-related health complications:
— 38,000 due to heat exposure in older adults
— 48,000 due to diarrhea
— 60,000 due to malaria
— 95,000 due to childhood undernutrition
Health providers can draw awareness to this dire need for attention at the policy and community levels. They can also share firsthand experience and research. This is an ethical duty that can result in widespread support of strong public health programs and climate justice.
How to Get Involved in Climate and Health Policy
In addition to in-person education with patients, health providers can do a variety of things to spread awareness about climate and health policy in their communities:
Leverage social media. Share articles with verified, evidence-based information on social channels. Use hashtags related to climate and health that make your posts easier to find. For example, #ActOnClimate, #Go100Percent, #Renewables, #SaveThePlanet, and #ClimateChange.
Continue your education. Request or attend an educational presentation from a trained professional, then collaborate with community organizations to educate people in your area. Volunteer with climate- or policy-focused organizations to gain perspective.
Participate in civic engagement. Call your representatives to let them know whether you support specific legislation. And always, vote in local and national elections.
Organizations for Further Reading or Involvement
If you are a health care provider
looking to learn more about climate and health policy, you may wish to visit
the websites of these organizations.
Extending insurance coverage to immigrant children and pregnant women did not appear to influence whether they crossed state borders (known as in-migration) to acquire care, according to survey data.
Among 36,438 lawful permanent
residents with children, the average in-migration rate 1 year before public
health insurance was expanded to cover immigrants was 3.9% and 1 year after the
implementation, the rate remained essentially unchanged at 3.7%, reported Vasil
Yasenov, PhD, MA, of the Immigration Policy Lab at Stanford University in
California, and colleagues.
Similarly, among 87,418 women of
reproductive age, the in-migration rate 1 year before expansion was 2.7% and 1
year after it was 4.6%, the team wrote in JAMA Pediatrics.
“No Discernable Association” Between In-Migration and Insurance Expansion
“If an expansion of health
insurance coverage was associated with in-migration to another state, the
probability of in-migration would have increased in the treatment group
compared with the control group,” the researchers wrote. “There was
no discernable association between the in-migration from any state among the
treatment group relative to the control group and public health insurance
The authors compared the group of
immigrants with children with a control group of lawful permanent residents
without children. The proportion that migrated among immigrants without
children was slightly higher before and after expansion (4.0% and 5.9%,
respectively), but not significantly different from immigrants with children,
Yasenov and his team reported.
Meanwhile, among a control group of
post-reproductive women, the rate of in-migration was 3.5% and 3.9% in the
years before and after expansion, respectively, which was also not
significantly different than the group of women of reproductive age, the researchers
“We hope policy makers
concerned with spiraling costs and people flooding in from other states will
have the evidence they need to make a decision when thinking about extending
public healthcare benefits for legal immigrants in the U.S.,” Yasenov told
Findings Indicate Immigrants are Fleeing Violence and Corruption, Not Chasing Health Coverage
As of 2016, immigrants with children
were covered by public insurance in 31
states and pregnant immigrants were covered in 32 states. Many Democratic
candidates for the 2020 election support extending healthcare to undocumented
immigrants, a policy that has been suggested will increase the flow of
immigration within the U.S.
These null findings make sense in
the context in which most U.S. immigration takes place, wrote Jonathan Miller,
JD, of the Office of the Massachusetts Attorney General in Boston, and Elora
Mukherjee, JD, of the Immigrants’ Rights Clinic of Columbia Law School in New
York City, in an accompanying editorial.
Namely, many people coming to the
U.S. are fleeing from violence or political corruption in their home countries,
and “do not seek refuge in the [U.S.] because of potential access to
healthcare,” Miller and Mukherjee said.
“Making it easier for immigrant
communities to connect to and seek care from physicians will not radically
shift migration patterns. Instead, allowing access to the basic human right of
health care shows a common commitment to human decency for all who are in the
[U.S.],” the editorialists stated.
Immigrants Sampled Were Below 200% of Fed Poverty Thresholds
For this study, data were collected
from individuals residing in the U.S. from 1 to 6 years — but who were not
born in the U.S. and were not citizens — from the American Community Survey. Notably, the sample
was restricted to individuals who were below 200% of the federal poverty
thresholds to identify people who would qualify for public insurance if it were
extended, the authors noted. Immigrants on student visas, veterans, or those
married to U.S.-born citizens were excluded because they qualify for other
healthcare benefits, the team added.
The data were controlled for
personal characteristics like age, race/ethnicity, and marital status, as well
as things that varied by state and time such as cash assistance and economic
In total, 208,060 immigrants — mean
age of 33 years, 47% of whom were female — were included. About two-thirds
were Hispanic (63%), and the in-migration rate among the entire sample was 3%.
Overall, the likelihood that lawful
permanent residents would migrate to a state where public health insurance has
been expanded to cover immigrants was practically zero before and after
expansion was implemented (percentage change from -1.21 to 1.78), the authors
The likelihood was also close to
zero among lawful permanent-resident women of reproductive age when compared
with a control group of lawful permanent-resident post-reproductive women
(percentage change from -1.20 to 1.38).
In a model specifically looking at
whether public health insurance expansion would bring in migrants from a
neighboring state, no association was found between policy implementation and
the rates of in-migration of immigrants with children (–0.03 percentage points,
95% CI –0.5 to 0.44) or pregnant women (–0.02 percentage points, 95% CI –0.48
to 0.09), the researchers reported.
The primary limitation of the study,
they said, was the inability to account for time-varying factors that could
undermine the analysis, and it was also not possible to isolate states among
the border and determine whether there was an association between in-migration
and health policy specifically in these states. Lastly, the investigators said,
the association was not analyzed among county-level or city-level programs.
The study was funded by the Stanford Child Health Research Institute.
The authors and editorialists reported having no conflicts of interest.
Federal, private funders bet food-as-pharmacy programs will deliver healthcare cost savings
When low-income patients with high blood pressure fill their “produce prescriptions” at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city’s farmer’s markets.
The city’s “Pharmacy to Farm
Prescriptions Program” has reached more than 1,000 hypertensive SNAP
recipients since it launched in 2017, and has grown from 3 to 16 participating
pharmacies. It is set to report outcomes data next year.
The program is supported in part by
a grant from the U.S. Department of Agriculture (USDA), which is poised to make
an even bigger impact on the food-as-pharmacy programs that have been growing
in popularity. The 2018 Farm Bill established a national Produce Prescription Program
that sets aside millions in grants each year.
With diet-related illnesses like
heart disease and obesity costing hundreds of billions of dollars each year in
the U.S., other funders are also expecting a healthy return-on-investment (ROI)
in these programs, which means more initiatives like New York City’s may find
the means to thrive.
Not Just for SNAP Recipients
USDA has been supporting projects to increase healthy food consumption among SNAP recipients since 2014, under the Gus Schumacher Nutrition Incentive Program (GusNIP, formerly the Food Insecurity Nutrition Initiative). The bill now guarantees GusNIP can administer $25 million in produce prescription grants—not just for SNAP-based programs—for the fiscal year beginning in 2018, jumping to $45 million for the 2019 fiscal year and rising to its cap of $56 million in 2023. The first grants will be awarded in October.
Food Hub in Charlottesville, Virginia, currently receives funding
from local businesses and philanthropies, but has applied for a federal grant.
Its Fresh Farmacy program
provides low-income patients who have chronic disease with produce from local
farmers. Participants pick up their “shares” every other week during
the growing season.
“We have seen first-hand the
impact of incorporating healthy food to manage weight, maintain healthy blood
glucose levels, and reduce the risk of diabetes complications,” said
Patricia Polgar-Bailey, a nurse practitioner at the Charlottesville Free
Clinic, which participates in Fresh Farmacy.
Non-Profit and Private Sectors Pitch In
Federal dollars aren’t the only way to keep food-as-pharmacy programs afloat. Wholesome Wave, a non-profit that was co-founded by Gus Schumacher, has been supporting produce prescription projects since 2010.
Wholesome Wave gets money from
philanthropies and corporate partners – including Target, Chobani, and Humana,
to name a few – to foster such programs.
“There are non-profits and
private-sector supporters trying to prove the model in the interest of getting
insurers and the healthcare industry to really step up,” said Julie
Peters, director of programs at Wholesome Wave.
An example of the organization’s
support: it’s putting money into a produce prescriptions pilot for diabetes at
Community Health and Wellness Partners (CHWP) in Logan County, Ohio, which is
also supported by state and federal dollars.
Healthy Food = Healthier Lives
Once a month, participants attend nutrition classes taught by staff dietitians, and subsequently receive vouchers for up to $120, depending on family size, to purchase produce at local grocery stores or farmer’s markets.
Among those who have completed three
months of classes, HbA1c has already declined 0.6 percentage points on average,
said Jason Martinez, a clinical pharmacist at CHWP who has analyzed preliminary
data from the program.
Will these improvements translate to
reduced healthcare costs? That has been the case at Geisinger Health System’s Fresh Food Farmacy initiative. The program
focuses on patients with type 2 diabetes who experience food insecurity. In
addition to 15 hours of disease and nutrition counseling, participants get
enough healthy food for 5 days of the family’s weekly meals.
Over 18 months, participants’ HbA1c
levels fell 2.1 points on average, compared with declines of 0.5-1.2 points for
those taking two or three medications only. Along with improvements in weight,
cholesterol, and hypertension, that has translated to an 80% drop in healthcare spending for 37 of about
200 participants who were insured by Geisinger, according to early data.
“We know the cost of the program, all-in, for the food and the clinical care is around $2,500, so it’s reasonable to assume that there’s an ROI that we would experience with that,” said Allison Hess, vice president of health and wellness at Geisinger. She’s hopeful that ROI will convince insurance companies “to potentially fund this as part of a benefit package.”
Similarly—albeit hypothetically—a recent simulation study of
Medicare and Medicaid recipients predicted that providing a 30% subsidy on
fruits and vegetables would prevent nearly 2 million cardiovascular events and
save almost $40 billion in annual healthcare costs.
LAS VEGAS — There’s a lot more to
substance abuse disorder than physical dependence, which means that acute detox
treatment by itself isn’t an effective therapy, a researcher said here.
The real key, said Debra Gordon RN,
DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a
relationship with patients so that behavioral changes can be implemented.
Withholding opioids from patients
with substance use disorder will not cure their addiction, she said. Moreover,
providing them with opioids will not necessarily worsen their addiction and may
help them accept behavioral therapies.
“There is no evidence that
detoxing someone in an acute situation or hospital setting is going to impact
that disease,” Gordon said in a presentation. “In fact, the evidence
seems to be they will be more at risk for using at their discharge and having
an overdose, some of that being in the prison system, but you see that in
Patients with substance use disorder
continue to use drugs despite recurrent problems in their social, workplace, or
familial spheres that occur because of their use. Many take multiple substances
and have underlying mental health disorders, both of which need to be screened
for, Gordon said.
Clinicians should also anticipate
that patients with substance abuse disorder may have had negative experiences
with the healthcare system previously, Gordon said, and asking open-ended
questions without judgment may mitigate feelings of shame or fear that prompt
them to withhold information.
Seemingly obvious physical comforts,
like turning off the lights or keeping a room quiet, also go a long way as
well, Gordon said. Cognitive behavioral therapy can also help patients change
their perception of pain and help with sleep, mood, and anxiety issues
co-occurring with substance use disorder.
Still, some patients may not be
willing to change, and others may try to use within the hospital. When
encountering patients who deny having a problem, or who recognize the disorder
but are unwilling to change, providers should focus on helping them transition
out of the hospital when the time comes and providing naloxone emergency
overdose kits to patients who may return to illicit drug use.
“Failure to engage in treatment
is not a failure,” Gordon said. “It’s part of the process and it’s
part of the disease.”
But despite the treatment options
available for patients with substance abuse, some providers may be unaware they
exist, or may be unsure of what they are authorized to provide, Gordon said.
“There are barriers in the
healthcare system in terms of the way we’ve traditionally been trained and
traditionally work in silos, and to care for this population we have to really
have a team approach,” Gordon told MedPage Today. “It’s one
thing to say stuff on paper and another to try and find out how it works in the
The Massachusetts Nurses Association (MNA) is trying a
second time to establish patient limits in state legislation. This comes six
months after losing a ballot question in the November 2018 state election.
As reported by the Boston Business Journal, the current legislation being reviewed now would hire an independent researcher to study issues affecting nurses, such as staffing, violence, injuries, and quality of life. The data collected by the researcher will then be used by state legislators to determine healthcare staffing needs and acute care patient limits.
The original measure from this past election was defeated
largely because of lobbying from the Massachusetts Health & Hospital
Association (MHA), who spent $25 million to defeat the ballot. This current
bill would be revisiting the same legislation, which raises points for state
consideration regarding nurse staffing measures.
MNA has been working to get nurse-to-patient ratios at all Massachusetts
hospitals for several years, including a ballot measure in 2014 that was removed,
after Governor Deval Patrick passed a law patient limit law. Markman said this
study is necessary to convince voters, after the 2018 election.
From New Years’ Day 2019 through April 11th, the United States has reported 555 cases of measles in 20 states—the second largest measles outbreak reported since the disease was eliminated in 2000. Keep reading to learn the 10 things nurses need to know about the measles outbreak:
1. Measles is brought into the U.S. by travelers who’ve been in foreign countries where the disease is prevalent—countries in Europe, Asia, Africa, and the Pacific. It is then spread in U.S. communities via contact with pockets of unvaccinated populations.
2. Measles outbreaks, defined as three or more reported cases, are currently ongoing in Rockland County New York, New York City, New Jersey, Washington state, Michigan, and the counties of Butte County California. In addition, new cases have recently been identified in New York’s Westchester and Sullivan counties.
3. Once a person is exposed to the measles virus, it may take up to two weeks before symptoms begin to show. A person is contagious four days before the tell-tale rash appears and for four days after. Measles is an airborne virus that can be shed by those infected long before the symptoms arise.
4. There is no available antiviral therapy to cure measles—only supportive therapy for the symptoms, among which are those similar to the common cold: fever, cough, runny nose, sore throat, followed by conjunctivitis and body rash. Measles can sometimes lead to more serious and life-threatening complications such as pneumonia and encephalitis.
5. New York City Mayor Bill de Blasio has declared a health emergency in the neighborhood of Williamsburg, Brooklyn and is mandating unvaccinated residents to become vaccinated. Those not complying could receive violations and fines of $1,000.
6. Mayor de Blasio has sent a team of “disease detectives” into the Hasidic Community in the Williamsburg neighborhood of Brooklyn, where nearly half of the U.S. cases reported are identified.
7. Coincidentally, the New York State Nurses Association just reached an agreement with the NYC Hospital Alliance to hire more nurses to fill vacancies and add new positions.
9. The role of nurses in these outbreaks is education and the promotion of vaccination.
10. It is critical that frontline health care professionals are vaccinated themselves in order to prevent the further spread of the virus, particularly when treating those patients infected by the disease.