As more extreme weather events, such as heatwaves are occurring more frequently during the summer, physicians are paying close attention to their impact on the human body. Dr. Abigail Hankin-Wei is an emergency medicine doctor in the Shenandoah Valley and a board member of Virginia Clinicians for Climate Action. WMRA's Calvin Pynn asked her about the health impacts of climate change that she’s seen in her patients.
Dr. Abigail Hankin-Wei: Yeah, so I guess I'll take it back a little bit to when I started caring and thinking about this issue, the summer I finished my medical training, was the summer that Hurricane Katrina hit New Orleans. and to be quite honest, that was also the summer that my mom, who was a lifelong employee at The Food and Drug Administration, keeping the food supply safe, was dying of lung cancer. After a discussion with her, I ended up leaving while she was in hospice and going and volunteering in New Orleans to help people who had been affected by the loss of everything, their homes, their medications, their health system, to help them recover from Katrina.
And we had all been told that that was a once in a century climate event and climate disaster, affecting that population. But as we've all seen since that summer when we were all struck by the devastation in New Orleans, due to Katrina, these once in a century events are happening everywhere we go.
Every population I have served has been affected by some sort of disaster where climate events have unexpectedly affected the health of the population in a way that they'd never been affected before. Right? The wildfires that destroyed part of a Shenandoah National Park, Hurricane Helene that affected part of Virginia - all those are examples that things we thought would happen extraordinarily rarely, where the climate events that might impact our health are now common.
WMRA: Which populations, when it comes to the impacts of climate change, do you think will be most at risk?
Hankin-Wei: I think there are a number of groups that are most vulnerable to the effects of climate change in health. There's no population that is going to be able to sustain immunity, right? We will all be affected, but the populations that we generally think of as being most at risk are folks with any chronic illnesses. That is maybe because climate, chronic lung or cardiac disease, especially heart illnesses, because we know that extremes of heat and exposure to pollutants travel first to our lungs and from there to the cardiovascular system. Other chronic illnesses may either be exacerbated by climate events, or we can have concerns that people who require medication for chronic illnesses.
Both may be more vulnerable to events like extreme heat or exposures to pollution because of their dependence on medications, they are most at risk if a climate event such as flooding or fires disrupts their ability to get to their local health clinic or even may disrupt the ability for ambulances to arrive to help people having emergencies.
So, people with chronic illnesses are high risks. People at the extremes of age, people who are very elderly or very young, we worry about them for related and also different reasons. Both may be populations that can't communicate if they're too hot, or otherwise, feeling if their breathing is bothering them.
It may be harder for those populations to communicate that. Elderly patients are often on multiple medications. Various medications may affect your ability to perceive that you're too hot or exposed to too much heat. Or may affect your ability to sweat, or you may be limited in your mobility such that you can't take off the extra layer that you would like to take off otherwise.
A baby can't necessarily take off a too hot onesie. An elderly patient may be limited in their ability to take off another layer of covers or a layer of clothing. Another reason we have a real concern about children is that I recently heard that children have a long shelf life.
So, children will be around longer and therefore will bear those consequences longer. And we also know children breathe more times in a minute than an adult due to their smaller sizes. And so, if an adult and a child spend a certain amount of time outside that the child may actually be exposed to a little more of those pollutants. They’re growing and changing and building their nervous system. So, exposures may place them at more risk. They accumulate those harms over time, in a way an adult who may have grown up during a time with less air pollutants, or less extreme summer heat, didn't have to experience. And I'm a parent of a teen, one teenager, one tween, who is almost a teenager. And we know, we as parents, we as health providers, know that we want kids to be outside. We spend a lot of time messaging to kids to not be indoors so much. Being indoors too much is connected to risks from screen time, connected to concerns we have about childhood obesity. So, getting kids outside is important and critical to their development in so many ways.
And yet when we allow the outdoors to be becoming more unhealthy due to extreme heat due to poor legislative regulations around air pollution, or water pollution, then we're ultimately showing them that both indoors and the outdoors are unsafe for them, and that doesn't leave them with lots of places to be safe and healthy.
So just other populations that are at risk are anyone who, you know, earns their money, that for which by who supports their family by either being in, doing work outdoors, regardless of the heat or their conditions of what they're breathing, or folks who make their living in an indoor warehouse that is not air conditioned and doesn't have great ventilation. Those are patients that I often will see right in the extremes of summer. And I can't help them because I can't control the conditions they have to go into work in. I've worked in places where there were many migrant farm workers who had to work in the south outdoors, in the fields picking.
And the crops have to be picked and the crops have to be tended to regardless of the heat. Or people who have to go into work every day in a factory where the machines are making a lot of heat and there's not good ventilation. And those people will come to their local emergency department, often due to feeling lightheaded or feeling weak, or feeling dizzy when they're standing.
And all of our workup and treatment will not show a problem, because the problem is not with how their lungs are working, not how their cardiac system is working, and not how their nervous system is working, but our bodies have fail switches that if you're getting too hot, if you're overheating, our bodies will tell us by making us feel dizzy, woozy lightheaded, hearing ringing sounds or feeling weak or lethargic.
Those are all our body's ways of putting the brakes on before we get overheated and end up in hyperthermia, which is extremely dangerous and deadly.
WMRA: Like wet bulb conditions can do that.
Hankin-Wei: Yeah, the sickest patient I've cared about in 20 years was a roofer who passed out due to heat.
And then his colleagues saw that he was having an emergency but had to get him down safely and carefully, which delayed his time to get to the hospital. He arrived with a body temperature over 104 degrees. And when that happens, every body system starts to shut down.
So, we can try to evaluate the patient once they're overheated. We can try to resuscitate them. But ultimately, there's no medical fix if the way you need to take care of your family is to go day after day into a space that is too hot to be safe.
WMRA: That’s something that I know has been a conversation I've heard a lot in the last year or two at the policy level.
Dr. Abigail Hankin-Wei: And it’s such an issue. Our Virginia Clinicians for Climate Action has been really involved in collaborating with labor organizations and other conservation organizations for heat protections for workers. Through that process, I learned that there are only five states across the US that have legislated any rights for workers, to have access to water shade or breaks when working in very hot conditions.
WMRA: I would love to learn some more about the work that you all are doing with Virginia Clinicians for Climate Action.
Hankin-Wei: Yeah. There are really three key areas that we focus our energy. We are focused on education, and we think of our health professionals talking to other health professionals about places where climate events and climate change overlap with health and also speaking with our community, which is local, Virginia community based organizations, and especially when they represent in a vulnerable groups, we want to align with them and lend our health professional voice to amplify their communication, and their fights for climate justice and climate equity.
We are always looking for opportunities to work with Virginia legislators about places where climate issues and health issues overlap. We've been involved in advocating in support of renewable energy, school-based, heat, education for student athletes, supporting folks who have to labor outdoors or indoors and hot conditions and making sure that legislation supports their health. And making sure that they are able to be as healthy as possible and work as much as possible and be as efficient and productive as possible.
Our third focus is on healthcare itself. Providing healthcare sometimes can be toxic to the environment of the community we serve. Health systems can have a pretty large carbon footprint. We can create significant emissions. There are certain, anesthetic gases, for instance, that actually have a pretty significant greenhouse gas footprint. And so folks across Virginia and engage with Virginia Clinicians for climate action include individuals at the forefront of the sustainability committees and sustainability directorships. I know that we have health systems across Virginia taking wonderful steps towards replacing Styrofoam with low emissions and renewable materials for the cafeteria, reducing printing when we don't have to print, especially as people have more access to their health records.
We can encourage electric vehicle use by putting electric chargers in our hospital and health system, parking lots, and their health systems replacing their own shuttle fleets and vehicle fleets with electric vehicles. Health systems are also moving to more renewable energy, which also provides them some protection from system outages. So solar on the roof, or solar on the health system grounds, can both reduce emissions by using solar energy and also provides a layer of protection for disaster planning.
Calvin Pynn: In your professional opinion, how prepared is the medical community to address climate change?
Dr. Abigail Hankin-Wei: I think we are doing better. One thing that really gives me a lot of optimism has been watching medical students and health professional students across the US who have been advocating to their own administrations to increase the amount of course content in the basic sciences year in which they learn about climate and health issues. I think one of the spaces where I think we can grow as a profession is thinking about how we talk to our patients about climate and health, and where climate change touches our patient's health. It is my very sincere belief that there is nothing partisan, and nothing ideological about being concerned about how we take care of our planet, how we take care of our air we breathe, and the water we drink, and the nature that surrounds us. But because other people have used it as a partisan issue, every health professional I know does not want to bring partisan issues into their clinical space because they don't want to create distance in their health professional, patient relationship.
I have found times when I do find it useful to bring up climate change in my direct patient interactions. For me, one of those times when I simply can't help myself is I really hate ticks.
I am seeing more and more people coming in to see me in the emergency department who have embedded ticks or are concerned after a tick bite where they pulled the tick out themselves.
If I'm seeing a patient and it's February and I'm pulling a tick out of them, I will mention, gosh, you know, we never used to see this in February. This is one of those things we're going to see more of as this region heats. I will say that comment has never been met with resistance or the patient appearing to be offended. I think that's something we're recognizing, We, all of us who've had the good luck of being residents of this planet for a few decades have probably observed. The winters are different.
I will mention sometimes when we have especially bad air quality days, from forest fires. I'll mention that this is a climate change effect because I think patients should understand that there are larger forces that are changing and are going to make these risks more frequent and more significant for them.
Calvin Pynn: Is there anything that I didn't think to ask that you have on your mind while I have you here?
Dr. Abigail Hankin-Wei: I'll tell you something that I always think about. About climate health. I'm an emergency physician and so I have a career of often working while everyone else is asleep and then sleeping while everyone else is awake, so I think a lot about sleep and sleep quality. One data point that I've been tracking and found really interesting and taken very personally as somebody very concerned about sleep is that what we are seeing across this region especially, is that nights are heating faster than days.
If you take a night being very hot above 75 degrees, we know that sleep quality and sleep depth is best far lower than that versus days defined as hot at 95 degrees. We're going to start seeing more hot nights ahead of seeing more hot days, and we'll see a higher proportion of that the same groups that are vulnerable, but especially people who are energy insecure, who might be unhoused are going to see that effect sooner. And so we'll see people suffering from poor quality sleep, especially because I work in a rural area where many people have farm animals. Where much of what I love about being in that area is the exposure to nature and the outdoors and wildlife. Some of us are lucky enough to be able to afford and have capacity to air condition our homes. But the people who deserve, who rely for their food security or their income on livestock, or for the people who rely for their own wellness on time, outdoors, observing wildlife. We can't air condition the outdoors. And so those plants, those animals, people's livestock, will be exposed also to those extremely high hot nights.
Calvin Pynn: And there could be effects down the line from that. Well, Dr. Hank, and thank you so much for talking about this reality.
Dr. Abigail Hankin-Wei: Thank you. I really have enjoyed having the opportunity to go on and on about this topic with you. Thank you for giving me that time.
