Climate Change Poses Serious Risks to U.S. Health Care System

Donna E. Shalala, Ph.D., University of Miami, and Alfred Sommer, M.D., Johns Hopkins University

July 8, 2014

During July 1995, Chicago was gripped The views expressed in this commentary are by a heat wave that still ranks as one of the those of the authors and not necessarily of deadliest in U.S. history.1 the authors’ organizations or of the Institute Estimates vary, but more than 700 of Medicine. The commentary is intended to people, many of them elderly and isolated, help inform and stimulate discussion. It has may have died as a result of the heat, which not been subjected to the review procedures soared as high as 106 degrees.2 The federal of the Institute of Medicine and is not a government dispatched refrigerator trucks to report of the Institute of Medicine or of the store the deceased, hospitals shut down National Research Council. emergency rooms (ERs) for lack of space, roads buckled from the heat, and the Midwest, the Rocky Mountains, and the Chicago Fire Department had to hose down Pacific Northwest will see declining mortality 3 children who were overcome by dehydration. rates due to warmer winters. But the Now, imagine if we experienced Southwest, Southeast, and lower Midwest multiple Chicago heat waves every summer, could see sharply higher mortality rates from in cities all across the country. That is the extreme temperatures. The elderly and infirm direction we are headed unless we change will be especially vulnerable. course and take strong, decisive action to Overall, by century’s end, the combined curb climate change. results of the decline of extreme cold and rise We have precious little time to do so. in extreme heat due to climate change is According to a new study commissioned by likely to kill approximately 12,000 to 65,000 the Risky Business Project, to which we additional people every year, based on 2012’s served as advisers, if we continue business population. At the high end of the estimate, as usual, in only 35 years the average in less than 10 years the casualty figure American will experience an additional 12 would roughly equal all U.S. battle deaths to 35 days every year during which since our country’s founding. temperatures will reach 95 degrees. By that One often-ignored aspect of climate time, the average summer will be hotter in change is the potential for extreme heat days Montana than it is now in New Mexico. By to overwhelm our existing hospital facilities. the end of the century, Oregon, Washington, During the Chicago heat wave, hospitals and Idaho could well have more days each were suddenly faced with an additional year above 95 degrees than currently occur 3,300 ER admissions. Numerous hospitals in Texas. simply closed their ER doors, unable to Different regions will experience handle additional patients. We have one of different impacts. New England, the upper the world’s finest emergency response

Copyright 2014 by the National Academy of Sciences. All rights reserved. systems, but in its current configuration it The U.S. health care and public health cannot be expected to manage the additional systems have repeatedly taken steps to morbidity and mortality from dramatically safeguard human health, from installing higher heat. public sanitation and implementing mass The same can be said for another climate vaccine programs to protecting our air and impact, flooding due to “storm surge” from a water from disease. Now it is time for the combination of higher sea levels and frequent health care sector to step up to the rapidly hurricanes. During Hurricane Sandy, several emerging challenge of climate change. The New York City hospitals were forced to health of our country depends on it. evacuate due to flooding and power issues, thus putting burdens on other city hospitals Donna E. Shalala was the U.S. Secretary and emergency response facilities. The total of Health and Human Services (HHS) under cost for the New York hospital and health the Clinton administration for 8 years, care system of dealing with the aftermath of becoming the longest-serving HHS Secretary Sandy was more than $3 billion. in U.S. history. She currently serves as the The most sobering concern is something President of the University of Miami. called wet-bulb heat, which reflects the combined effect of temperature and Alfred Sommer, M.D., is a Johns humidity. A person can’t survive a wet-bulb Hopkins University Distinguished Service temperature much more than 95 degrees. Professor, Dean Emeritus and Professor of We’ve never seen a wet-bulb temperature in Epidemiology and International Health at the United States higher than 92 degrees. the Johns Hopkins Bloomberg School of But that may change. By mid-century, a Public Health, and Professor of quarter of the U.S. population will likely Ophthalmology at the Johns Hopkins live in areas where wet-bulb temperatures University School of Medicine. exceed 92 degrees at least one day each year. By century’s end, half of our population could References be exposed to a full week of 92 degree wet- 1. Dematte, J. E., K. O'Mara, J. Buescher, C. G. bulb days, and a third of the population will Whitney, S. Forsythe, T. McNamee, R. B. Adiga,and I. M. Ndukwu. 1998. Near-fatal heat stroke during experience at least one dangerous 95 degree the 1995 heat wave in Chicago. Annals of Internal wet-bulb day each year. Medicine 1998;129(3):173-181. Emergency services across the United 2. Angel, J. State Climatologist Office for Illinois. States, in both coastal and high-heat regions, 2009. The 1995 heat wave in Chicago, Illinois. must become more resilient just to meet the http://www.isws.illinois.edu/atmos/statecli/general/19 95chicago.htm (accessed June 23, 2014). challenges that will occur as a result of the 3. University of Chicago Press. 2002. Dying alone: climate change that is already baked into our An interview with Eric Klinenberg, author of Heat atmosphere. It’s an open question whether wave: A social autopsy of disaster in Chicago. they can be made resilient enough to deal http://www.press.uchicago.edu/Misc/Chicago/443213 with the potential impacts if climate change in.html (accessed June 23, 2014). is left unchecked, especially since many emergency rooms already have difficulty providing care during unusually high demand. Suggested Citation: Shalala, D. E., and A. That’s why we believe that in addition to Sommer. 2014. Climate change poses preparing for climate change, the United serious risks to U.S. health care system. States also needs to take strong, decisive Commentary, Institute of Medicine, measures to stop it. Washington, DC. http://nam.edu/wp-content/ uploads/2015/06/climatechangehealthcare 2