The link between climate change, health and poverty

0:03 [Music] 0:21 I arrived in the u.s. from Kingston 0:28 Jamaica in the sum of 68 my family of 0:31 six crammed into a small two-bedroom 0:33 apartment in a three-story walk-up in 0:36 Brooklyn the block had several children 0:38 some spoke Spanish some spoke English 0:41 initially I wasn't allowed to play with 0:43 them because as my parents said them too 0:46 rambunctious so I could only watch them 0:49 from my window roller skating was one of 0:51 their favorite activities they loved 0:54 hitching a ride at the back of the city 0:55 bus letting go of the rear bumper as the 0:58 bus arrived at the bottom of the block 1:00 in front of my building one day there 1:03 was a new girl with them 1:05 I heard the usual squeals of laughter 1:08 interspersed with Mira Mira Mira Mira 1:10 Spanish for look look the group grabbed 1:13 onto the back of the bus at the top of 1:16 the block and as they rode down laughing 1:18 and screaming Mira Mira Mira Mira the 1:21 bus abruptly stopped the experienced 1:24 riders adjusted and quickly let go but 1:27 the new girl lurched back and fell onto 1:30 the pavement she didn't move did those 1:34 outside ran to help her the bus driver 1:36 came out to see what had happened and 1:38 called for an ambulance 1:39 there was blood coming from her head she 1:42 didn't open her eyes we waited for the 1:44 ambulance and waited and everyone said 1:47 where is the ambulance where is the 1:49 ambulance the police finally arrived and 1:52 all the black American man said ain't no 1:55 ambulance coming he said it again loudly 1:59 to the cop you know ain't no ambulance 2:02 coming they never send no ambulance here 2:05 the cop looked at my neighbor's who are 2:08 getting frustrated lifted the girl into 2:10 the patrol car and left I was ten years 2:13 old at the time I knew this wasn't right 2:16 I knew there was something more we could 2:18 do to something I could do was become a 2:21 doctor I became an internist and 2:23 committed my career for caring for those 2:25 we often call the underserved the 2:28 vulnerable like those neighbors I had 2:30 when I first immigrated to America 2:33 during my early 2:35 years in Harlem in the eighties I saw a 2:38 shocking increase in young men with HIV 2:42 then when I moved from Miami I noticed 2:45 HIV included women and children 2:47 primarily poor black and brown people 2:49 within a few years an infection seen in 2:52 a select population became a worldwide 2:55 epidemic again I got the urge to do 2:58 something fortunately with the help of 3:01 activists and advocates and educators 3:03 and physicians like me who treat the 3:05 disease we found a way forward there was 3:08 a massive education effort to reduce HIV 3:11 transmission and provide legal 3:13 protection for those with the disease 3:15 there was a political will to make sure 3:18 that as many patients as possible 3:20 worldwide regardless of ability to pay 3:24 could get access to medication within a 3:27 couple of decades there were new 3:29 treatments that transform this 3:31 life-threatening infection to a chronic 3:33 disease like diabetes now there's a 3:36 vaccine on the horizon over the last 3:41 five to seven years I've noticed a 3:43 different epidemic among the patients in 3:45 Florida and it looks something like this 3:47 miss Anna Mae a retired clerical worker 3:51 living on a fixed income in opa-locka 3:52 walked in for medication refills 3:55 she had common chronic conditions of 3:58 high blood pressure diabetes heart 4:00 disease and asthma with overlapping 4:02 chronic obstructive pulmonary disease 4:04 COPD miss Anna Mae was one of my more 4:08 adherent patients so I was surprised she 4:10 needed refills of her breathing 4:12 medicines earlier than usual towards the 4:14 end of the visit she handed me a Florida 4:17 power light form and asked me to sign it 4:18 she was behind on her light bill this 4:22 form allowed physicians to document 4:24 serious medical conditions require an 4:26 equipment that would be impacted if the 4:29 patient's electricity was disconnected 4:32 but Miss Anna Mae I said you don't use 4:34 any medical devices of breathing I don't 4:37 think you qualify further questioning 4:40 revealed she had been using her air 4:42 conditioner day and night because of the 4:44 heat so she could breathe needing to buy 4:47 more asthma inhalers lift her 4:49 little money she couldn't pay all the 4:51 bills so it piled up I filled out the 4:54 form but knowing she might be denied I 4:57 also sent her to the social worker then 5:00 there was Jorge such a sweet kind man 5:02 who often gifted our clinic with some of 5:05 the fruits he sold on the streets of 5:06 Miami 5:07 he had signs of worsening kidney 5:10 function whenever he worked days on end 5:13 on those hot streets due to dehydration 5:16 just not enough blood getting to the 5:18 kidneys his kidneys work much better 5:21 whenever he took some days off but with 5:24 no other support what could he do as he 5:27 says 5:27 rain or shine colder heat I have to work 5:31 but the most damning case of all maybe 5:33 miss Sandra fate wigs a Fort Lauderdale 5:36 with COPD 5:37 she was arrested after fighting with her 5:39 daughter over a fan on her release from 5:43 jail she returned to her apartment Koff 5:46 non-stop and died three days later 5:50 here's what else I noticed the data 5:54 showed allergy seasons are starting 5:56 weeks earlier nighttime temperatures are 5:58 rising trees are growing faster a 6:01 mosquitoes carrying dangerous diseases 6:03 like Zika and dengue are showing up in 6:05 air as they didn't exist before I also 6:09 see signs of impending climate 6:10 gentrification 6:11 that's when richer people move into 6:13 poorer neighborhoods that are at higher 6:15 elevation and less subject the flood 6:18 damage from climate change like in my 6:21 patient Madame Marie who came in 6:23 stressed and anxious because she was 6:25 evicted from her apartment in Miami's 6:27 Little Haiti to make room for a luxury 6:30 apartment complex whose developers 6:32 understood that little Haiti would not 6:35 flood because it's ten feet above sea 6:37 level an undeniable clear and consistent 6:42 warming trend is on the way a health 6:45 emergency even bigger than hiv/aids 6:47 seems to be in the works and it was mine 6:50 low-income patients that were dropping 6:51 clues of what it would look like this 6:54 new epidemic is climate change and it 6:57 has a variety of health effects climate 7:01 change impacts us inform 7:02 a ways directly through heat extreme 7:06 weather and pollution through the spread 7:08 of the disease through disruption of our 7:11 food and water supply and through 7:14 disruption of our emotional well-being 7:15 in medicine we've used mnemonics to aid 7:19 our memory and this mnemonic heatwave 7:23 shows the eight significant health 7:25 effects of climate change H heat 7:29 illnesses e exacerbation of heart and 7:33 lung disease a asthma worsening T 7:37 traumatic injuries especially during 7:39 extreme weather events w water and food 7:43 borne illnesses a allergies worsening v 7:47 vector borne diseases spreading like 7:50 zika dengue and Lyme and E emotional 7:54 stress is increasing poor vulnerable 7:56 people are already feeling the effects 7:59 of climate change they are the 8:01 proverbial canary in a coal mine truly 8:05 their experiences are like Oracle's or 8:07 prophecies the guiding light for us to 8:10 pay attention that we are doing 8:12 something to our world first that's 8:14 hurting them first but in a matter of 8:17 time we are next if we act together 8:20 doctors patients and other health 8:22 professionals we will find solutions we 8:26 have done this with the HIV crisis there 8:28 was thanks to the activism of patients 8:30 with HIV that demanded medications and 8:33 better research and the collaboration of 8:36 doctors and scientists that were able to 8:38 control the epidemic and then it was 8:41 thanks to international health agencies 8:43 NGOs politicians and pharmaceutical 8:46 companies that HIV medications became 8:49 available in low-income countries there 8:52 is no reason we can't also apply this 8:55 model of collaboration to address the 8:58 health effects of climate change before 9:00 it's too late 9:01 climate change is here sorry the 9:04 damaging the health and homes of poor 9:06 people like my patient Jorge most of us 9:09 will have to work whether rain or shine 9:12 coal or heat but together these patients 9:16 there doctors hand in hand with some 9:18 basic tools can do so much to make this 9:21 climate transition less brutal for all 9:23 of us these patients inspired me to 9:26 found a clinicians organizations to 9:28 fight climate change we focus on 9:31 understanding the health effects of 9:32 climate change 9:33 learning to advocate for patients with 9:35 climate related illnesses and 9:37 encouraging real-world solutions a 9:40 recent Gallup study showed three of the 9:43 most respected professions are nurses 9:46 doctors and pharmacists so respected 9:48 members of society we have amplified 9:51 voices to influence climate change 9:52 policy and politics there is so much we 9:56 can do as clinicians our many patient 9:59 contacts allows us to see things before 10:01 others and this puts us in ideal 10:03 position to be on the frontlines of 10:05 change we can teach climate related 10:08 illnesses and our health professional 10:10 schools we can collect data on our 10:12 patients climate related conditions by 10:14 making sure their billing codes to 10:16 identify them we can do climate related 10:19 health research we can teach how to have 10:21 green practices and homes we can 10:23 advocate for a patient energy needs we 10:26 can help them get safe for homes we can 10:28 help them get necessary equipment in 10:30 those homes when conditions worsen we 10:32 can testify in front of lawmakers as to 10:35 the findings and we can medically treat 10:37 our patients climate related illnesses 10:41 most importantly we can help prepare our 10:44 patients mentally and physically for the 10:47 health challenges they will face using a 10:49 model of medicine that incorporates 10:51 economic and social justice 10:54 this would mean miss Sandra fate weeks 10:57 with COPD who died after being released 11:02 from jail after a fight with her 11:03 daughter over a fan would have known 11:06 that the heat and her apartment made her 11:08 sick and angry and seek a safer place to 11:11 go for cooling 11:12 even better her apartment would never 11:15 have been so hot from the poor I've 11:18 learned their lives are not only 11:19 vulnerable but are stories of resilience 11:22 innovation and survival like that wise 11:25 old man who loudly spoke truth to the 11:28 cop that summer night 11:29 no ambulance coming and compelled him to 11:33 deliver that little girl to the hospital 11:35 instead you know what listen up if 11:39 there's going to be a medical response 11:43 to climate change it is not going to be 11:46 just waiting for an ambulance it is 11:49 going to happen because we the 11:50 clinicians take the first step we make 11:53 so much noise that the issue cannot be 11:55 ignored or misunderstood it is going to 11:59 start with the stories our patients tell 12:01 and the stories we tell on their behalf 12:04 we're going to do what is right for our 12:07 patients like we've always done but also 12:10 what is right for our environment for 12:13 ourselves and for all the people on this 12:17 planet all of them thank you 12:20 [Applause] 12:22 [Music]