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Climate Change

The link between climate change, health and poverty

For the poor and vulnerable, the health impacts of climate change are already here, says physician Cheryl Holder. Unseasonably hot temperatures, disease-carrying mosquitoes and climate gentrification threaten those with existing health conditions, while wealthier people move to higher ground. In an impassioned talk, Holder proposes impactful ways clinicians can protect their patients from climate-related health challenges -- and calls on doctors, politicians and others to build a care system that incorporates economic and social justice.

Excerpt From

Transcript

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]