University of British Columbia – Doctor of Medicine – 2020
Icebergs and Inflammation: Why Climate Change is the Next Frontier in Preventative Medicine
In 2014 I was in the coldest place on Earth, studying some of the tiniest organisms on Earth, to better understand how climate change, one of our greatest challenges on Earth, will affect human health. It might seem odd that a neuroscience major would be sampling icebergs in Antarctica. Nevertheless, I lived on a research vessel sailing throughout the icy waters of the Antarctic Peninsula doing just that. Nature is my passion but medicine is my calling, and somewhere between high school and that balmy -20°C day of that Antarctic summer I learned that human health and environmental health are inseparable.
When I wasn’t studying the brain, I was sitting in environmental science classes learning the calculus of radiative forcing and atmospheric energy transmission. Outside class, it was my experience as a delegate at the United Nations COP20 Climate Change Conference that really highlighted the enormous global push to get environment-human health issues appreciated. The strains being placed on our natural world are affecting our social determinants of health such as gender equality, access to education, and increasing poverty gaps. Examples such as increased heat-related mortality, reduced air quality, and safe water shortages (as evidenced by the Cape Town water crisis) are affecting many realms of human health such as respiratory disease, infectious disease, and malnutrition. The list goes on.
Now halfway through medical school, I am meeting individuals affected by climate change, and am more motivated than ever to prevent illness in the first place. Specifically, I hope to combine my love for the environment and the brain to help prevent neurologic disease. It is common knowledge that neurological disorders in our aging population are a leading cause of disability. An unprecedented amount of money goes towards research to prevent, moderate, and eliminate neurological morbidity every year. This said, we continue to struggle with prediction and prevention of these complex diseases.
What if we could prevent strokes, slow dementia, and even increase grey matter in the developing brain with cleaner air? Seems like a tall order? The Lancet Neurology recently published an article reiterating that “pollution…is the world’s largest environmental cause for poor health, responsible for about 9 million deaths in 2015 – 16% of deaths globally” (1). Direct connections between brain health and environmental health have already been made. Particulate matter from air pollution contributes to oxidative stress and inflammation in the brain, and is linked to ischemic stroke rates (2). Even if this is a small effect per person, multiply it by the 7.4 billion people breathing the growing air pollution on Earth and the result is monstrous – specifically, 30% of all strokes may be related to pollution (1,3). It seems like a dramatic point, but in my experience with local and international climate initiatives, it is the sheer magnitude of the problem and a loss as to how we should approach it which slows the adoption of the environment-health connection. And it isn’t just stroke rates that have been connected to pollution. Dementia rates, while the mechanisms aren’t clear, have been linked to poor air quality (1,4). Fetal brain development has also been shown to be affected by air particulate matter, with decreased grey matter thickness in children exposed to higher pollution levels in utero (5). This inflammatory mechanism applies outside the central nervous system as well. Researchers in Calgary found that rates of appendicitis increased during times of poor air quality (6). It isn’t a far reach to connect pollution induced inflammation to appendicitis considering a top cause is an inflammatory reaction in nearby lymphoid tissue.
So where does this leave us? If pollution can get through the protective blood-brain barrier, what else is being affected that we are not aware of and how can we mitigate the effects? This is where I hope I can make a difference in preventative medicine during my career. My experience working at the UN COP20 conference highlighted the sheer effort it takes to get the world on the same page when it comes to climate factors whether they be economic, social, or political. What everybody can agree on though, is health. This is our opportunity to make a difference with community-led initiatives.
I hope first to inspire my fellow medical colleagues to mobilize against one of the largest health challenges and causes of disease we will face in our careers. Many doctors, while aware that climate affects health, do not fully understand how pervasive it is in every disorder we are trained to treat. My goal is to encourage and increase physician participation in consultation processes and support for decisions in other aspects of society that affect health but are not always associated with healthcare. Initiatives such as green roofs are known to improve air quality and decrease the effects of urban heat islands, and public transport funding curbs gas emissions into the atmosphere. While they are removed from a clinical setting, they affect our patients’ health all the same. A professional standard in medicine as well as to advocate for our patients. I believe as a medical community we should increase advocacy for city initiatives like the Vancouver Climate Change Adaptation Strategy. This strategy, among other programs, is strategically planting trees to reduce the effect of heat islands, and implementing biodiversity strategies to maintain local food security. By tackling looming climate change effects on health, we have a huge opportunity to prevent disease, doing the ultimate service for our patients.
It is a daunting task as it doesn’t come in the convenient form of a prescription or an exercise program but the opportunities for physician involvement are endless. As I progress in my career I hope to continue facilitate conversations about why physicians, for example, should be concerned about climate changes in Antarctica, and why everybody from family doctors to surgeons should be part of the same conversation as we enter a new age of climate medicine.
This is just the tip of the iceberg.
1. Air pollution and brain health. The Lancet Neurology. 2018 Feb (17): 103. Editorial.
2. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017 Oct; 390: 1345-1422.
3. GBD 2013 Risk Factors Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015 June; 386: 743-800.
4. GBD 2015 Risk Factors Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct; 388: 1459-1544.
5. Guxens, M., et al. Air pollution exposure during fetal life, brain morphology, and cognitive function in school-age children. 2018 Aug; 84: 295-303.
6. Kaplan, G., et al. Effect of ambient air pollution on the incidence of appendicitis. CMAJ. 2009 Oct; 181: 591-597.