Climate Change
Sonya Collins
Without major reductions in greenhouse gas emissions, the global temperature is projected to rise by up to 2.9° C (5.2° F) by the end of the century. The effects of climate change can already be seen in changing weather patterns, an increase in natural disasters, and exacerbations of existing conditions for those who are most vulnerable.
A review published on May 15, 2024, in NEJM calls for clinicians to deepen their understanding of the health consequences that can arise from extreme heat exposure. This will be critical for health care professionals to serve their patients moving forward.
“Pharmacists can recognize the signs of patients who are in need and train their employees to do so as well,” said Georges Benjamin, MD, executive director of the American Public Health Association and a coauthor of the NEJM review. “Pharmacists can also be advocates for their community and take a role in educating the public about preventive efforts.”
Climate change and health
The NEJM review identifies several health conditions that, according to robust evidence, may be exacerbated by extreme heat. They include CVD, kidney disease, respiratory disease, various mental health conditions, and adverse birth outcomes.
“It’s not just that it’s really high temperatures,” Benjamin said. “It’s the increase in temperature over a few days that makes a big difference. Your body needs time to climatize. We start seeing high morbidity and mortality several days into a heat wave.”
Over the last few decades in the United States, heat waves have occurred more often, lasted longer, and reached higher temperatures. Yearly, the United States sees twice as many heat waves as it did in the 1980s and heat wave seasons are three times longer than they were in the 1960s. While heat extremes in general have increased, cold extremes have decreased.
The risk of death and hospitalization from heart disease are higher during heat waves, according to the review. For some heart conditions, a temperature increase of 1° C (1.8° F) raises risk for hospitalization and death. That’s the threshold to raise risk for kidney failure and death from kidney disease, as well.
In 24 countries, death from respiratory disease is most likely in the warmest parts of these countries.
Risk of preterm birth is higher during a heat wave, too. Temperature increases of 1° C (1.8° F) raise risks for stillbirth and preterm birth, the research noted.
As temperatures rise, so too does risk for mental illness–related death and suicide.
“Temperature has enormous implications for well-being,” Benjamin said. “When people are hot, we have more violence, more anxiety. Heat plays a major role in our well-being.”
What can pharmacists do?
It’s important to know which groups are most vulnerable to the health consequences of extreme heat. Besides those with pre-existing chronic conditions, Benjamin pointed to older adults, infants, and individuals in rural areas.
People in rural areas may work outdoors, in factories, or in plants in extreme heat. In many cases, the pharmacist is their only contact within the health care system.
“They’ll come to the pharmacy seeking advice for a whole range of symptoms—fatigue, lightheadedness, anxiety,” Benjamin said. “When someone comes in with a range of particularly vague symptoms, pharmacists ought to include overheating and dehydration in their differential diagnosis.”
People who take certain medications, such as diuretics and medications for mental health conditions, are also vulnerable to the consequences of extreme heat.
“These medications bring down their volume and interfere with the body’s ability to autoregulate and sweat,” said Benjamin.
Pharmacists can counsel patients in these groups—those who have related health conditions, take certain medications, or who are members of these demographics—on the critical importance of staying cool and well hydrated during the warm season. Pharmacists are also encouraged to be on the lookout for, and train their staff to be vigilant about, signs of heat stroke, dehydration, and exacerbations of respiratory disease in their patients.
“We’re going to see more people, both with and without chronic diseases, particularly in the early part of elevated temperature in the community, with fatigue, signs of dehydration, heat rashes, heat syncope, COPD and asthma,” said Benjamin. ■