How Should We Respond to Health Sector Emissions That Exacerbate Climate Change and Inequity?

Abstract

A warming climate poses substantial risk to public health and worsens existing health inequity. As a contributor to greenhouse gas emissions and air pollution, the health sector has obligations and ample opportunities to protect health by decreasing waste and motivating more system-wide sustainable clinical practices. Such efforts will have important ethical implications for health equity. The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case City Y has ambient levels of particulate matter (PM) of 2.5, a rate 25% higher than most American cities. The American Lung Association had flagged Y as 1 of 2 cities that fail State of the Air evaluations 1 in ozone and PM pollution. Y's air pollution is due to wood burning, which is common in nearby rural communities; its geographical location downwind from plants that power and process solid waste for 4 larger metropolitan regions in nearby neighboring states; and 3 major academic health centers. Thirty percent of contemporary illnesses (eg, diabetes, asthma, cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer) in Y are attributable to poor air quality. In the United States, communities of lower socioeconomic status are at risk of exposure to higher levels of air pollution than those of higher socioeconomic status, 2 and, worldwide, low-and middle-income countries are most at risk. 3 Moreover, diseases caused by pollution were estimated to be responsible for 16% of global mortality and 268 million disability-adjusted life years (DALYs) worldwide in 2015. 3 CommentaryThe evidence is clear that fossil fuel combustion is driving global temperatures upward through the emission of greenhouse gases (GHGs) and worsening air quality via air pollution, both of which pose a major threat to human health. 4 Higher levels of GHGs trap excess heat energy within the atmosphere, which has contributed to an