“Climate change is the biggest health challenge of our time, yet there are still many doctors and patients who don’t know about it.” This is the idea that prompted pulmonologist Carlos Cabrera to found the Medical Alliance Against Climate Change, an initiative of the General Council of Doctors to “raise awareness” among professionals in the sector and the general public about the impact of the climate crisis on health. EL PERIÓDICO interviewed this expert, who was invited to attend the Lancet Countdown Europe presentation in Barcelona, to talk about how high temperatures affect the health of the population, the arrival of tropical diseases in Spain and the need to train doctors in relevant issues of climate change.
As a doctor, what concerns you most about climate change?
It has a huge impact on almost every aspect of health and no one seems to realize it. We know that we are dealing with a phenomenon that is considered the greatest public health threat of the 21st century, and about which almost nothing is known, neither doctors nor patients.
If you had to explain to a patient how climate change is affecting their health, where would you start?
Given that we are in Spain, I would like to start by talking about how high temperatures and heat waves are behind thousands of premature deaths. Then I would talk about the effects of pollution, which stem from the same effect that is fueling climate change, and say that pollution kills many. He then goes on to explain that climate change brings new diseases, such as mosquito-borne diseases. All this clearly affects our health.
Have the effects of climate change begun to appear in hospitals and health centres?
Yes. I will explain it to you in a very graphic way. In the hospital where I worked, in Gran Canaria, in the summer we had many free beds. But now, as summer becomes more intense, the plants are filling up and even overflowing. When temperatures rise, we see very clearly how chronic diseases worsen, especially for those who suffer from cardiovascular and respiratory problems. This not only leads to increased emergency room and hospitalization rates, but ultimately impacts the mortality rate. The effect is undeniable.
As a pulmonologist, are you also seeing the effects of climate change in your practice?
Unfortunately yes. Respiratory diseases, such as chronic obstructive pulmonary disease (COPD) or asthma, are among the diseases most exacerbated by climate change. Whether due to heat or increased pollution. There are many studies that confirm this. But sometimes you just need to talk to patients so they can confirm this for you. In consultation I also see more and more cases of asthma in children, because the prevalence of this disease seems to increase if the mother has had a pregnancy in a highly polluted area, such as near a highway.
Does climate chaos increase cases of allergies?
Yes. Global warming is causing pollination seasons to become longer and more intense for trees and plants. At the same time, we also know that in big cities these allergens bind to pollution particles and form larger molecular complexes called superallergens. All this is what increases and exacerbates allergy cases in a large part of Spain.
You were talking about the arrival of tropical diseases that were not yet accustomed to occurring in these parts of the world. Are Spanish doctors qualified to diagnose it?
no. Unless you say you have just returned from South America or Africa, most Spanish doctors will never suspect these diseases. In addition, most emergency physicians or internists in Spain are not trained to detect Zika, chikungunya, malaria, dengue, or Nile fever. This is something we need to treat as soon as possible because we know that these diseases will increase.
Should specific training be created so that doctors can deal with the impacts of climate change?
Yes. All doctors should receive specific training on climate change. Given that climate change is the major public health challenge of the 21st century, it is incomprehensible that it is not addressed at a medical level. We don’t need a specific topic on medicine and climate change, we need to discuss it in every clinical specialty. We also need specific training for doctors already practicing so they are better prepared to deal with the impact of climate change in their practice.
The health sector is one of the sectors most affected by climate change, but paradoxically it is also one of the most polluting.
It’s like this. The health sector is responsible for 4.5% of carbon emissions in Spain. This is something we urgently need to change. Doctors work under the oath of primum non nocere, that is, the first thing is to do no harm. Working in highly polluted systems that worsen the health of the general population is a brutal moral struggle. This is why we say that there is no ethical medicine if it is not sustainable. Health care itself, with its emissions, cannot be contributing to a phenomenon that harms the health of citizens. We need to decarbonize the health system.
From what he said, it is clear that we are facing a great challenge.
It’s like this. The solution for me is to raise awareness of the seriousness of this crisis on the one hand, and implement clear procedures to deal with this phenomenon on the other hand. There are many things we can do to combat it.
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