This story is co-published by The Xylom, Atlanta Community Press Collective, and 285 South.
From debunking fad diets to dispelling vaccine hesitancy, primary care providers are no strangers to having tough conversations with their patients. In Atlanta, climate change is increasingly becoming one such topic. Leveraging trust built over time, doctors hope to depolarize the issue and break through misinformation.
“I try to make [talking to patients about climate] a habit, and I actually teach the residents that I work with to try to do the same,” said Mehul Tejani, a primary care doctor in Atlanta who also serves on the steering committee of Georgia Clinicians for Climate Action.
The efforts of Tejani and other clinicians are not unwarranted. Though climate change might seem like an issue outside the realm of healthcare, there are several interrelated factors such as the effects of heatwaves and other extreme weather, allergies and the spread of infectious diseases, and malnutrition due to changes in food production.
Studies show that many Americans trust their primary care providers more than any other source for information on global warming. A joint study by Yale University and George Mason University found that those who are disengaged, doubtful, or dismissive of climate change tend to highly trust healthcare providers on the subject. They rank their primary care providers as their first or second most trusted source for climate change information — even higher than public officials from agencies like NASA and news organizations.
“I have developed a relationship with these folks over the years, so whatever they’re seeing in the news that might happen sort of as a new piece of information for them doesn’t always transcend the many years of trust that I hopefully have built up with them,” Tejani said.
Building trust with climate skeptics
Climate misinformation, like vaccine misinformation, has been spreading rampantly across social media channels in the United States and worldwide. Despite a 97% consensus from climate scientists that human-caused climate change is happening, public opinion remains less than settled on the issue. According to the most recent Yale Climate Opinion Maps estimates released in mid-March, only roughly 55% of metro Atlantans understand that there is a scientific consensus on global warming and that the trend is mainly human-caused rather than natural, both lower than the national average.
“For everyone who’s more towards the middle and the lower end of engagement on climate change, the primary care doctor is an incredibly important source,” said Kathryn Thier, a postdoctoral research fellow at the George Mason University Center for Climate Change Communication.
Research shows that this holds true even across the political divide. Conservative Republicans rank primary care doctors as their second most trusted source for information about global warming, with friends and family being their most trusted source.
Quratulain Syed, an Atlanta-based primary care physician who mostly treats older adults, said that patients don’t see any potential conflicts of interest when doctors talk to them about climate change.
“When we talk to people about medicine [or] vaccines, they assume that we are getting some money in return,” Syed said. “People assume that we have some conflict, while you may have no conflict. With climate change, the doctor has nothing to get out of it.”
This helps doctors build relationships with climate skeptics and start depolarizing conversations about climate change. Thier said this relationship is necessary because climate change affects people regardless of their political beliefs.
“Our research shows that when people learn about climate as a health issue, it’s depolarizing.”
Climate change can impact health through many pathways: increasing rates of injury and mortality from extreme weather events, increasing the frequency of animal-to-human disease transfer and vector-borne diseases such as Lyme disease, increasing malnutrition resulting from food supply changes, and decreasing the efficacy of medications through rising humidity levels and temperatures, among others.
“Our research shows that when people learn about climate as a health issue, it’s depolarizing,” she said. “So, not only are primary care physicians effective messengers, but the topic of health is something that people can understand and it allows them to approach the issue of climate change in ways that aren’t polarized or colored by all their viewpoints or identities that they hold.”
Thier said that climate change can also impact the healthcare system, making it harder to access facilities.
“Maybe your home is destroyed, and maybe your local hospital can’t run as effectively, and then maybe when your home is destroyed, you lose your job because you have nowhere to live,” said Thier. “That’s an extreme example, but the fact is that these systems, they all work in tandem... The people who are most vulnerable tend to have their vulnerability increased and compounded by the ongoing effects. It’s very alarming from a health standpoint.”
Screening for climate risks
Healthcare providers interviewed for the story said they often talk to patients about climate issues reactively rather than proactively, connecting conditions like asthma to local air quality, for example.
This is because there is no standardized procedure to screen for climate risks. Some providers expressed a desire to standardize these discussions and screen for climate change risk but also said that it would add to the overwhelming amount of responsibilities that physicians already have.
“The primary care doctor has a whole bunch of things on their plate,” Syed said. ”There has been a constant debate since I’ve been a doctor as to how long the appointment time should be.”
Tejani said that climate interventions need to be built into the system so that healthcare providers “don’t even have to think about it.” For example, online portals could automatically send patients links about heat waves and hurricane preparedness in the summer.
Risk information that is specific to the patient can also be gathered through screenings that are given before or at the beginning of appointments, as well as during annual health visits, where personal factors that put individuals at risk, such as tobacco use or lack of physical activity, are generally assessed. These assessments can include questions about environmental factors such as proximity to sources of pollution and access to air conditioning, providing primary care doctors with more information to protect the health of their patients.
Shaneeta Johnson, a practicing surgeon and associate professor at Morehouse School of Medicine in Atlanta, agrees that climate risk screenings should be standardized in healthcare.
“When I see a patient with obesity or a patient with asthma, it’s not routine to ask them, ‘Well, where are you living? Are you near highways or factories? Are you within an urban heat island?’ We don't do that. And so there really needs to be a groundswell and more action to get us as physicians, as nurses, to put this at the same level of asking a patient about their diabetes and high blood pressure,” she said.
Training more doctors to have climate conversations
A 2019 survey of 58 doctors in Wisconsin found that 71% of physicians believe that climate change is relevant to primary care, but only 17% feel comfortable talking about it with patients. Both Tejani and Syed, who attended medical school in the United States and Pakistan respectively, said they never learned about climate change in medical school. Without the training, how can doctors feel comfortable approaching this controversial subject?
That’s where local and national organizations come in. The Medical Society Consortium on Climate and Health and its 30 state-level affiliates, including Georgia Clinicians for Climate Action, are training healthcare providers on climate communication through fellowships, advocacy work, and educational materials.
Tejani, who has led climate and health education for medical students and practicing physicians in Georgia, said that effective conversations require a lot of nuance related to the particular patient.
“There are definitely patients who I’m thinking of who I would never say ‘climate change’ to,” he said. “I would just leave it at, ‘Hey, it’s really hot’ or ‘There’s a hurricane coming.’” This allows patients to focus on the preventative actions that need to be taken rather than get caught up in wording.
In 2020, the National Academy of Medicine launched the multi-year Climate Grand Challenge, a commitment to improve the communication of climate change as a health issue as well as to address systemic issues such as the carbon footprint of the health sector. The American Board of Pediatrics has also officially recognized climate change as a health issue that requires dedicated education, implementing two modules on the topic that pediatricians can take as part of maintaining their board certification.
“We get a lot of refugees and other immigrant populations [in Clarkston, Ga.], many of whom are from Asia as well as Africa. I have to believe that, whether it’s direct or indirect, some of the reasons why they have immigrated to the US are climate-related.”
With the recent federal funding freezes across the United States, organizations are concerned about how climate and health research and education initiatives may be affected. Kimberly D. Williams, the director of operations and strategic initiatives at the Medical Society Consortium on Climate and Health who also serves on the steering committee of Georgia Clinicians for Climate Action, said that while some of the organizations’ funding is connected to federal sources, the ultimate outcome of recent executive orders is unclear.
In Atlanta, immigrant communities are already suffering from climate change-related trauma, Tejani said. Yet, there is not enough research being done on how vulnerable communities may face more severe environmental health impacts.
“We get a lot of refugees and other immigrant populations [in Clarkston, Ga.], many of whom are from Asia as well as Africa,” Tejani said. “I have to believe that, whether it’s direct or indirect, some of the reasons why they have immigrated to the US are climate-related.”
Even as the future of climate communication funding for physicians remains unclear, more and more physicians will be forced to address the environmental aspects of health especially as the effects of climate change worsen over time, especially for more vulnerable communities around the country.
“There’s obviously potentially a lot of trauma if they happen to experience a natural disaster,” Tejani said.“So that, I think, is something we could probably do better from an educational standpoint.”
