5 Questions: Michele Barry on how climate threatens our health

The director of the Center for Innovation in Global Health explains how the medical community is at the center of the climate change debate.

- By Jamie Hansen

Michele Barry

At the recent United Nations climate summit in Glasgow, Scotland, many diplomats and heads of state asserted that imminent threats to human health create an imperative for addressing climate change.

It’s an approach that senior associate dean of global health Michele Barry, MD, applauds. As a physician to underserved populations around the world, she has seen firsthand the human impact of global warming and environmental degradation. She has also helped lead the effort to address climate change as “the ultimate global health crisis,” including while serving as an adviser on two presidential transition teams.

Science writer Jamie Hansen spoke with Barry, director of the Stanford Center for Innovation in Global Health, the Drs. Ben and A. Jess Shenson Professor and professor of medicine, about how the stakes are higher than ever, and how the medical community can respond.

1. You built your career as a tropical disease doctor. What did you see in your work that prompted you to focus on planetary health?

Barry: On my way to clinics in Madagascar, I’ve driven through slash-and-burn fires that cause respiratory problems and pollute the water and soil. I’ve seen commercial fishing destroyed by the erosion of soil caused by deforestation in Haiti. With my colleagues in biology and the Emmett Interdisciplinary Program in Environment and Resources, we have shown how deforestation in Kenya creates habitat for rodents, which carry far more human disease pathogens than large animals. The environment impacts health — most often in the communities with the fewest resources.

As a tropical disease doctor, I’ve seen how vectors are changing their location. Mosquito-borne illnesses are showing up where they’ve never been seen due to drought, flooding and heat: We’ve seen nonendemic dengue fever and Zika in the United States, for instance, and malaria in new areas where drought has created stagnant mosquito breeding waters. We have seen the sequelae of extreme weather globally.

It became obvious that climate and planetary health needed to be a priority of global health — that we can’t have global health unless we have a healthy planet.

2. What are the advantages of focusing on climate change through the lens of human health?

Barry: Climate’s impact on health allows us to put our arms around a problem, whether it be pollution causing premature deaths from cardiovascular disease; living near polluted roadways, which some of the newer evidence suggests contributes to dementia; or, more locally, wildfires causing respiratory disease and potentially contributing to cancer. When you bring health into the equation, all of a sudden, people can focus on the impact — the very real impact — on their lives.

3. What role can Stanford play in addressing this health crisis?

Barry: Many efforts are afoot at Stanford, including plans for a new school of climate and sustainability — the first new school in 70 years. In close collaboration with the Woods Institute for the Environment and the Program for Disease Ecology, Health and the Environment, we’ve convened a group of faculty and stakeholders at Stanford to conduct research, train our students and develop solutions.

The momentum and expertise here are amazing. We are now in the process of defining our vision and a strategy and are holding a series of workshops on advancing health, climate and environment at Stanford.

At the Center for Innovation in Global Health, we’ve been laying the groundwork for this, having made human and planetary health one of our focus areas since 2017. We aim to convert academic findings into real-world impact through our Action Lab for Human and Planetary Health, which uses research conducted at Stanford to develop white papers for policy influencers.

4. What role does the health care industry play in contributing to climate change — and how should it respond?

Barry: Worldwide, the health care industry is responsible for 4.4% of global emissions, which is more than entire countries such as Brazil and Japan. In the U.S., our health care system is responsible for nearly 10% of national emissions. We need to green our hospitals and decarbonize health care.

Even more importantly, we need to help communities withstand the health threats of climate change and extreme weather. We need to improve heating, cooling and ventilation in schools and community centers so people have public places to withstand extreme heat and wildfires. Doing so will require an enormous public investment, but it is necessary to prepare ourselves for these challenges.

We must also understand and respond to the emotional impacts of climate change. Young people are very anxious — a problem our planetary health postdoctoral fellow Britt Wray, PhD, has shown to be pervasive. I hear this from my own children, and I worry for my grandchildren — the impact that extreme weather events, climate change and the loss of biodiversity will have on them.

5. Health equity has long been a priority for you. How can we best incorporate health equity into our climate change response?

Barry: When we talk about climate and health, we also have to talk about environmental justice. I can’t help but notice that a great deal of the climate impact on health occurs in some of the poorest areas, while a few large companies in wealthier countries are contributing the most to the problem. We need to address these inequities. The Biden administration’s new Office of Climate and Health Equity, which I had the privilege of working on, is a promising start, but we need far more on a global scale.

A recent report revealed that the world’s top five polluting corporations contributed 60% of global emissions in 2019. China alone generated the same amount of carbon emissions as the next four countries combined, while its own farmers are witnessing the worst flooding in 40 years decimate their crops. In the United States, our migrant farmworkers and Native American population pay some of the highest costs of climate change, while U.S. oil companies continue to see record profits.

We need to listen to the people in the areas most affected by global warming and environmental degradation. I first experienced the power of this approach when a student of mine, Kinari Webb, understood what it might take to help a Madagascar community end logging practices that were destroying the local ecosystem. Through 400 hours of discussions with community members, she learned they were forced to log and sell trees to pay for medical care. To change this dynamic, the organization she founded trained residents in sustainable agriculture and offered discounted health care in exchange for no logging.

Over the years, they’ve been able to reduce logging by 72% and at the same time diminish incidents of diarrhea, tuberculosis and malaria. When we addressed the cost and availability of health care, it was a win-win swap for health and conservation. This approach can be used in communities around the world to help meet their needs in adapting to climate change.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.

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