乌鸦传媒

With climate change being such a big story in the news this past week, it was a good time to check in with Lisa Patel, MD, MESc, who became the new executive director of the Medical Society Consortium on Climate & Health in January. 乌鸦传媒 (MPT) Washington Editor Joyce Frieden spoke with Patel about how the job was going, what notable wins and losses the consortium has experienced so far, and what she's hoping to achieve in the near future.

This interview has been edited for length and clarity.

MPT: Thanks for taking the time to speak with us today! How are things going so far, and how does this fit in with the clinical work you're doing?

Patel: Thanks for having me! It's been great; this is kind of my dream job. I came into working in advocacy about 7 years ago now as a pediatrician -- thinking about all the threats that children were facing in terms of access to health insurance, violence, and children at the border. So I started doing my advocacy work there and then really came to climate advocacy about 4 or 5 years ago.

I ended up working about 40 hours a week on this job, but technically, this is halftime, and I keep my halftime clinical appointment at Stanford as well -- I'm a pediatric hospitalist at one of their community hospitals, in Pleasanton, California, and I do three 24-hour shifts a month. So that's my halftime job there.

MPT: What has been the most fun and what do you find the most difficult about what you've been doing?

Patel: I have the most fun helping to think about how we get health professionals engaged on the topic, and where the opportunities are to make a difference. And it's actually not that hard to get health professionals activated. There are a ton of health professionals that care very deeply about this issue.

What the challenge can be is helping move all of that energy and that worry and that passion into action. I think that for a lot of health professionals, advocacy skills weren't really taught to them. And so some people come at it with some natural aptitude, and some people become really good at it through practice, but that's where I think the challenge is -- there's a lot of interest and a lot of momentum, but how do we draw the line between that momentum to concrete action?

MPT: How have recent climate-related disasters like the wildfires in Canada and Hawaii affected your job?

Patel: I was an environmental scientist before I was a pediatrician. And I've been thinking about this issue since I was in college 25 years ago -- it was the sort of thing where you're telling somebody not to smoke because they could have cancer somewhere down the line, but now we're kind of living the cancer, right? We have all of these effects, but it's no longer in the future. We're living it right now.

When things felt so distant, it was hard to get people's attention, or build that sense of urgency. But now all of a sudden, I can't even keep up with all the media requests, the requests to weigh in on papers on it. There are very few of us that carry this expertise of climate and health, but there's just a big need right now to build the capacity of as many health professionals as we can to help address all these issues that we were seeing cropping up so quickly.

MPT: How do you make what the consortium does relevant to what practicing physicians do -- something they can use in their everyday practice?

Patel: Well, heat and wildfire smoke are the topics that I know the best, not just from an academic point of view, but from a "living in California" point of view, and as a practitioner. We know during periods of extreme heat and during periods of wildfire smoke that we do see more respiratory complaints, more hospitalizations. We see more kids showing up with asthma exacerbations, we see more episodes of preterm birth, and we see higher incidences of stroke and heart attack.

As individuals, it can start with how we counsel our patients. Often, I'll hear people say, "Well, I don't have time to talk to my patients about climate change." Alexander Rabin and I that climate change will be the greatest determiner of health for a child born today. And so we don't think that it is any longer optional. We think that it is something that every single clinician needs to know about and find ways to integrate into their counseling.

This isn't to say that at every single one of your visits you need to be talking about climate change, but we need to change our systems so that clinicians are thinking about climate change in their counseling. For example, in pediatrics, we have newborn visits at 2 months, 4 months, and 6 months. In each of those visits, we need to look at that anticipatory guidance and start building in little nuggets of climate information, to start building people's capacity and their understanding and their awareness of what these threats are and what they need to do to keep their children safe from these threats.

This can apply across other specialties as well -- working with pregnant individuals in terms of the threats of wildfires, or [talking about] heat to the elderly in terms of their risk. So there are those threats as well. So we need to think about who the vulnerable populations are, where the opportunities are to build on that climate information and do so in a meaningful way.

The second opportunity clinicians can take is [addressing the issue that] healthcare is 10% of the problem in terms of greenhouse gas emissions, and there is just an enormous impetus around this to "green" our clinics and our hospitals. So if your hospital has not yet signed the , your voice matters.

At Stanford, where I work, 5 years ago, we didn't even have a Sustainability Program Office, but by working with our CEO, with faculty and staff all together, we made this a priority for Stanford Health Care, and they signed the HHS pledge and now we have the Sustainability Program Office. So it can be done, but you have to start the dialogue with your leaders on why this issue isn't just important to you, but find out who else in your system it's important for as well. And I promise if you start looking, you'll find them.

On a bigger level, we need to address fossil fuel policy. We live in a system that has made oil and gas cheap because the government subsidizes it to be cheap, and we don't account for all the climate disasters and the health effects. While tobacco kills about 6 to 7 million people prematurely worldwide, fossil fuel pollution kills 8 million yearly. And yet we as health professionals don't learn about that in our medical curriculum. And that to me is crazy -- it's a big missed opportunity if we care about the health of our patients.

We need to be talking to our decision makers and supporting the policies that take us off fossil fuels and towards renewable energy. As a health professional, there are so many organizations that do this work. You don't have to be an expert, you just have to sign up and show up for these organizations.

MPT: What kind of work is the consortium doing on these larger issues?

Patel: We don't lobby at the consortium, so we stay away from taking stances on pieces of legislation. But we've done a number of visits with our lawmakers to talk about very strong rules the Environmental Protection Agency (EPA) [is developing] to help limit various forms of pollution -- a number of rules that could really help save on the scale of thousands to tens of thousands of lives. We've activated our member networks to get people to provide public comments.

For instance, we've got close to 1,000 comments from our physician network on the Power Plant Rule, which would require fossil gas plants to rein in their carbon pollution. The fossil fuel industry mounted their own campaign against the rule, and this is why it's so important for us as health professionals to weigh in because industry, especially the fossil fuel industry, will place their profits over our health. And so it's important for us to deliver that health message to our decision makers.

MPT: How do you think the rest of the administration is doing on climate change issues?

Patel: There, I would count as another victory -- not taking sole credit but being a part of a united chorus -- on [emphasizing] the need for a dedicated office in the federal government on climate and health. Now there's a new office at HHS on climate change and health equity that is doing amazing, incredible work to protect the health of everybody in this country. We were just meeting them earlier this morning, talking about the work they're doing with community health centers, to help prepare them for climate disasters.

On the other hand, President Biden's is a big disappointment. It will be interesting to see how he handles this on the campaign trail because he did make certain election promises about no new drilling on federal lands, and this was a violation of one of the things that he promised.

It has been heartening to see that this administration has taken a lot of action on climate through the EPA, and that they passed two major pieces of climate legislation with the Inflation Reduction Act and the bipartisan Infrastructure and Jobs Act. So I would say in terms of scorecard, Biden is doing well, but he has taken a hit and it is very disappointing.

MPT: Can you talk about the consortium itself -- how many medical society members it has and how much you hope it will grow?

Patel: Yes, we are up to 50 medical societies that have joined us, and we also have within our network 25 state clinician groups, and more than 60 affiliate organizations. There's no governance with the affiliates, but we reach out to them frequently for sign-on letters, for example.

MPT: Tell me a little more about the workings of the consortium -- where is it based, what are its finances like?

Patel: We are based at George Mason University [in Fairfax, Virginia]. We derive most of our funding from foundations; we're looking to change this because I want to move us eventually toward being more member-sustained. We don't really have a membership model right now. Our operating budget is about $1.3 million, and we have four full-time staff and a number of consultants.

MPT: What are your priorities for the coming year?

Patel: It's going to be a little strange because it's an election year and so there isn't much on the legislative horizon, and we don't know who's going to be in power in 2025.

Unfortunately, this issue has been turned very polarized; the Republican Party just put out their 5-year policy agenda on climate change, and it is completely at odds with what we've laid out as what the policy priorities should be. They want to roll back the transition to renewable energy and also take away all the regulations that we've fought hard to put into place to protect the health of Americans. We're hoping to create, in coalition with other organizations, our "top three" wish list for the new administration, and I hope we have an administration that's willing to hear our concerns regardless of what political party it is.

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