Lena Bichell, UVa School of Medicine, 2023 and Leah Reichelle, UVa School of Medicine, 2022, co-leaders of the UVA Chapter of Medical Students for a Sustainable Future interviewed Bob Kitchen, MD, Vice-Chair of Advocacy for Virginia Clinicians for Climate Action. Their questions and answers reflect the initiative and the potential impacts of clinical leaders.
Question: Virginia is among the minority of states that have a planetary health-focused advocacy organization for healthcare providers. How did the VCCA come to be, and how did you get involved?
(Excerpted from: Health Professionals and the Climate Crisis: Trusted Voices, Essential Roles; Edward Maibach , Howard Frumkin , and Samantha Ahdoot; https://onlinelibrary.wiley.com/doi/epdf/10.1002/wmh3.421)
The voice of the health community was historically absent from the climate policy discussion in Virginia. Virginia Clinicians for Climate Action (VCCA) was formed in 2017 to fill this void. Since its inception, VCCA has helped build a network of health partners and over 450 clinician advocates for climate solutions. VCCA doctors, nurses, and allied health professionals write opinion pieces, attend hearings, issue statements, and positions, collaborate with medical societies on climate and health programs, meet with legislators, hold monthly educational webinars, and partner with hospital systems to hold climate and health conferences and lectures. VCCA's experience in Virginia demonstrates the power of a unified health voice to overcome barriers blocking the necessary transition to a clean energy economy. Health professionals and health organizations are becoming a powerful voice in climate and energy policymaking in the state.
Question: The Clean Cars bill, the Virginia Clinicians Climate Action’s top legislative priority, was recently passed in the senate and will likely become law in Virginia. Virginia's Governor, Dr. Northam, is a physician himself. How does navigating a legislation with a physician leader alter your approach to climate health advocacy?
As clinicians, VCCA members recognize that the adverse health impacts of climate change are a powerful and motivating message. It has been said that “Health Is the Human Face of Climate Change.” What could be more important to an individual than a threat to the health of themselves and their loved ones? Physicians are committed to protecting health and welfare. As a physician, Dr. Northam brought this healing mission to his consideration of the merits of legislation. This better enabled him to prioritize the health impacts of climate legislation alongside economic and other considerations.
Question: A 2018 Gallup poll listed healthcare providers among the most trusted professionals (in contrast, Members of Congress were the least trusted). How do you think this public trust affects healthcare provider’s effectiveness in advocacy? Conversely, do you think healthcare providers’s involvement in advocacy and legislation will affect this public trust?
The trust in healthcare borne by patients is time-honored and hard won. That trust enhances healthcare providers’ effectiveness in advocacy.
When we take our patient’s history we ask (among other things) about smoking, exposure to allergens, diet and exercise. We ask about those things because they affect health. Increasingly we know that the climate in which we live affects our health too. It is not a stretch for us to tell our patients--and our elected officials--that air quality affects respiratory function, high temperatures inhibit our ability to exercise, and extreme storms bring damage to communities, healthcare systems, schools and mental health.When we think about climate change it is appropriate and necessary to talk about health. When we talk with elected officials about climate change and its effects on their children or grandchildren, they become more interested. I’ve seen it!
There is a minority of people who don’t believe in climate change and therefore won’t believe in its effects on health. They may disagree with our advocacy. We as healthcare providers have to, above all, continue to listen to our patients and to provide them excellent care. We have to work to build and maintain our patients’ trust. Maybe we agree to disagree? But, we hope that our patients will see that if nothing else, it’s hard to mount a compelling, lasting defense against efforts that promote clean air and water for their children and grandchildren.
Question: In 2018, the NRA 2018 responded to a position paper from the American College of Physicians about reducing firearm injuries and deaths by telling doctors to “stay in your lane” - asserting that firearm access, regulation, and injury prevention is outside the scope of physicians’ practice and experience. Climate change is similarly highly-politicized. What is the role of healthcare providers in discussions about these highly-politicized issues, and how should healthcare providers approach them?
Health professionals have a clear calling to prevent disease and improve public health. We fulfill this mission when we vaccinate populations or advise the public about nutrition or exercise. The climate crisis will impact the health of every current and future person. Dr. Neelu Tummala, a VCCA Steering Committee Member recently wrote in an op ed for The Hill that, “While politics may not belong in the exam room, policy that impacts health does.” This highlights the distinction that VCCA tries to focus on in our advocacy work.
Climate change is undeniably harming the health of people today, and these health harms will become more apparent as the planet continues to warm. It is vital that healthcare providers understand the intersections of climate and health if they are to adequately care for and protect their patients. Similarly, to protect human health and welfare we must preserve a safe and stable climate. Advocating for climate solutions is therefore not only appropriate, but essential to our healing mission.
Question: For people who are not physicians, could you talk a little bit about VCCA’s efforts to start interdisciplinary discussions, and who has the “authority” to engage in discussions about planetary health?
Interdisciplinary can take on all sorts of meaning: 1) interdisciplinary between different types of physicians; 2) interdisciplinary between various types of health professionals such as physical therapist, respiratory therapists, nurses, physicians, etc.; 3) interdisciplinary between health professionals and environmental experts such as soil scientists, stormwater management experts, plant ecologists, etc.; 4) interdisciplinary between health professionals and community members.
I think that the key to working in an interdisciplinary fashion is to recognize that everyone brings expertise to the table (This includes community members. See the discussion about authority.) Physicians are socialized to take the lead. In this work, we need to figure out how to accept the knowledge base and leadership capacity of anyone with in the ecosystem within which we are functioning. That leader may be a teen activist, a professional with a very heavy accent, someone with a different color skin, someone who uses a mobility aid or a communications aid, etc. Knowledge trumps degrees, skin color and other identifiers.
In most of its teaching activities and in most of its advocacy activities, VCCA has encouraged the voices of those who are not physicians or even other health professionals. Many of our webinars have been led by scientists without medical backgrounds and some have been led by community members. Our advocacy work is undertaken in consultation with organizations like the Virginia League of Conservation voters. We have, for example, used the work of people with expertise in modeling the impact of air pollution on communities to formulate advocacy positions.
Question: Who has the “authority” to engage in discussions about planetary health?
Because planetary health is all encompassing, I believe that anyone who has studied its principles and practices has the authority to discuss the topic. Every individual who engages in the study of PH will develop a specific point of view that the person will bring to the discussion. PH will not be the same for the storm water runoff expert, the prairie grass expert, the veterinarian or the community activist. If all have studied PH, there will be enough common vocabulary to allow for useful exchange, broadening of individual understandings, and making decisions. It is, however, important to understand and hew to the dictum of "Nothing About Us Without Us!" While, in the US, this notion is an outgrowth of the abilities-rights movement, it applies in all planetary health discussions. Decisions should not be made without the equitable and active participation of those whose lives will be influenced by that decision. The cumulative knowledge and wisdom of indigenous communities and of front-line communities must be incorporated into decision making. “Experts” cannot be the sole drivers of the discussion. Expertise is necessary but not sufficient to have the authority to lead in environmental health discussions.
Question: What advice would you have for individuals, particularly clinical trainees, who want to become involved in climate advocacy? What is the best use of their time and energy?
It can feel daunting to get involved in activism around an issue as complex and far-reaching as climate change. I suggest that people start by learning about local environmental issues. This often means partnering with people outside the healthcare field, such as local officials, activists, and lawyers. Once you’ve learned about the issues facing your local community, ask what would be the most helpful contribution you can make. This might look like writing an op-ed from your perspective as a physician or trainee about the potential health effects of the issue at hand, contributing your expertise to a legal or policy brief, speaking up at a city council meeting, leaving public comments or speaking in person on state legislation that will have an environmental impact, engaging with local news media, and more. Finally, getting involved in organizations like Virginia Clinicians for Climate Action is a great way for physicians to connect with like-minded colleagues and stay in the loop about local and regional climate issues. As clinicians we have a unique perspective because we directly care for people who are impacted in many ways by climate change. Remember that when it comes to changing hearts and minds and getting legislators to support policies that fight climate change, stories are often more powerful than data. Even if you are a student just beginning your career, your stories are important - share them!
Question: Climate change has largely been driven by the pollution of developed nations, but developing nations will bear the largest burden of its health effects. In addition to “acting locally,” what is our responsibility to our global communities?
Climate change is a global problem, and as stated above, affects the less resilient populations most, both internationally and nationally. Combating climate change will require international cooperation as well as national policies. The United States, currently the second largest emitter of GHGs can both significantly reduce its emissions through national policies, but also help lead global action to do the same. In addition to reducing global GHG emissions, the US can lead on global adaptation measures to reduce the impact of climate change on less resilient nations and communities.
National policies to combat climate change require both citizen support and interest. Clinicians are the second most trusted voice on climate change, after scientists. By using our trusted voice locally, VCCA can have outsized effects on community attitudes about climate change. Through public fora, OpEds and town halls, VCCA can continue to educate and inform our citizens about the negative health consequences of climate change and the positive benefits of national policies to address this.
VCCA, secondly, uses its voice in public fora to educate clinicians and health professional students on climate change, its consequences and its solutions. Studies have demonstrated that health education on climate change can empower climate change issue engagement, and that health professionals so educated are often inspired to become advocates for policy change on a national level. VCCA is actively engaged with the state’s health professional schools already.
Thirdly, Healthcare in the US accounts for 10% of national GHG gas emissions. If healthcare were a country, it would be the 13th largest GHG emitter in the world, emitting more GHG than the UK. VCCA is working to reduce the GHG in our state hospitals.
To conclude, The Lancet calls, “climate change is the biggest global health threat of the 21st century, responding to this threat, and ensuring this response delivers the health benefits available, is the responsibility of the health profession; indeed, such a transformation will not be possible without it.” VCCA is working for this transformation.
Question: Climate change can feel like an overwhelming beast to tackle. How do you stay motivated?
The easiest way to stay motivated is to surround yourself with a network of climate activists that inspire and energize you through their own passion and climate work. The climate crisis can feel like an overwhelming uphill climb, but each advocacy step, however small or large, is a win for the planet. Being a part of a network like Virginia Clinicians for Climate Action constantly allows one to be surrounded by this positive environment, where every member of the group is motivated to make an impact on public health by taking action to address the climate crisis.
Question: What have been some of the biggest wins for the VCCA? What have been some of the largest obstacles? What lessons have you learned?
Since our inception in 2017, VCCA has transformed from a small group of dedicated clinicians to a powerful health voice for climate solutions in the state. We are very proud to have joined the coalition of voices that is bringing a clean energy future to the Commonwealth.
Having heard from VCCA members across Virginia, State Health Commissioner, Dr. Norman Oliver established a Climate Change Committee at the Virginia Department of Health in 2019. The work of this committee has been delayed by the COVID pandemic, but we hope it can resume activity in 2022.
In 2020, a circuit court overturned and vacated the permit for a proposed Atlantic Coast Pipeline compressor station, citing the health based impacts on the local, majority AfricanAmerican community. The pipeline was ultimately canceled, successfully concluding years of campaigning by impacted communities and environmental justice advocates.
VCCA is proud to have brought the health voice to major climate legislative successes over the past two years. In 2020, VCCA was joined by Healthcare Without Harm, Kaiser Permanente, Bon Secours Mercy Health, and the Virginia Chapter of the American Academy of Pediatrics, in support of landmark climate legislation, the Virginia Clean Economy Act (VCEA). This bill passed in 2020, making Virginia the first southern state to commit to 100 percent clean electricity by 2050. Furthermore, Virginia joined the Regional Greenhouse Gas Initiative (RGGI) in 2021. These policies will be enacted with a focus on equity—50 percent of the revenue generated by participating in RGGI will be allocated toward energy efficiency programs for low income communities. RGGI was the first climate legislation ever supported by a Virginia medical society, the Virginia Chapter of the American Academy of Pediatrics, in 2015.
In 2021, VCCA joined partners to address transportation, the leading source of carbon pollution in the state. VCCA developed a report, webpage, and videos on the health effects of vehicle pollution in Virginia, and the health benefits of stronger vehicle emission standards. This report was cited in a press release from nine Virginia cities and counties supporting clean transportation. We launched a social media campaign, through which our videos were viewed over 113,000 times. We are delighted to have ensured that the health community brought our unique perspective to the chorus of voices that successfully made this bill into law.
A unified health voice is proving its value in advancing climate policy in Virginia. VCCA continues to face the challenge of engaging health professionals and students who are also dedicated to direct patient care. With growth, we are developing support systems to engage busy, working professionals.
Question: What advice would you pass on to climate-aware medical (or clinical?) students? How can we best use our passion and momentum despite lacking in professional experience?
It is an exciting time to be a health science student these days. Most of the physicians that are active in the realm of climate change and health were not aware of the connection between planetary health and human health until well after training or even after years and decades of practice. In the age of Greta Thunberg and other youth leaders, health science students have ample leadership opportunities in advocacy, community engagement, and medical education. Medical Students for Sustainable Future and other student led organizations will be critical forces in ensuring that medical training includes the knowledge and skills to tackle the climate crisis as a clinician in order to better the health of the patients we serve. Even without being an environmental scientist yourself, you are the expert of your patient's health experience and how that might have been adversely affected by climate change. With just a little bit of training from various organizations like VCCA, you are more than ready to tell your patients' powerful stories as trusted messengers of society.