Published: January 15, 2025

Ethics in Practice: Physicians’ Role in Environmental Health

Changing the climate of physician investment in environmental health.


Raisa Tikhtman, MD, on behalf of the Ethics Committee


Ethics In Practice 1500x845 V2No matter your worldview, it is impossible to escape the reality of climate change. The Intergovernmental Panel on Climate Change estimates that 3.3 to 3.6 billion people live in “highly vulnerable” global regions, which face mortality rates up to 15 times that of less precarious environments.1 People living in localities that already suffer from livelihood strains such as political instability, underdeveloped economies, and inconsistent access to basic goods and services are at particular risk of climate-related injury with less likelihood of surviving prolonged droughts or the devastation from a hurricane, for example.1

Even for those living in resourced settings, the specter of climate change persists. In the U.S., episodes of extreme heat have steadily increased in frequency and are projected to induce an at least 134% increase in heat-related deaths by the mid-21st century.2 Similarly, in Europe over 60,000 deaths were attributed to the 2022 summer heatwave which predominantly affected Italy, France, Spain, Germany, and Greece.3 

The increasing regularity and scale of climate events are overwhelming, and mindfulness toward this shared constant in our lives does not translate seamlessly to the practice of medicine. As medical professionals, we are tasked with caring for the patient before us while striving to minimize the potential harms of our interventions. To be successful in these efforts, the context of our patients’ illnesses—including risk factors and the environments to which they will return—must be considered. When addressing a patient with a newly diagnosed larynx cancer, an otolaryngologist knows to elicit any history of tobacco use and encourage cessation to improve their patient’s therapeutic potential.

Emerging literature has demonstrated that multiple constituents of air pollution exacerbate respiratory disease and accordingly exposure levels may function as independent risk factors for allergic rhinitis and chronic rhinosinusitis.4,5 Recent publications have similarly illustrated a direct relationship between fine particulate matter exposure and head and neck cancer incidence.6 With this in mind, how do we as providers communicate these evolving risks to our patients? How can we advocate for protection of their, and our, health on a greater scale?

In the 1970s, medical student members of the American Medical Association (AMA) lobbied for the cessation of smoking on domestic airline flights, resulting in the AMA adopting policy against this practice. As a downstream result of these physician-led efforts, the U.S. Congress passed legislation banning smoking on all domestic flights in 1990.7 There is a strong precedent for physician-directed advocacy in the U.S., and our vocality in the realm of climate health is critically needed. As surveyors of head and neck skin and the upper aerodigestive tract, otolaryngologists are particularly poised for engagement in this space and our patients are uniquely at risk.

Research regarding the otolaryngologic manifestations of climate change is in its nascency; however, several clinicians and scientists are leading the charge. In July 2024, Dr. Amanda Dilger and colleagues across multiple institutions published the first review of the otolaryngologic effects of climate change as well as interventions to optimize sustainability in surgical care.8 Furthermore, the AAO-HNS/F recently established the Environmental Sustainability Taskforce, a novel workgroup committed to elevating the issues of environmental health and sustainability and their relationship to otolaryngologic disease. Although we cannot directly control the environment in which our patients live or the pollutants to which they are exposed, there are ample opportunities to expand our knowledge base regarding the health effects of climate change. Armed with our education, clinical experience, and solidarity in promotion of otolaryngologic health, we as otolaryngologists have a window of opportunity to make a lasting difference for our patients and the greater world.


References

  1. IPCC, 2023: Sections. In: Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, H. Lee and J. Romero (eds.)]. IPCC, Geneva, Switzerland, pp. 35-115, doi: 10.59327/IPCC/AR6-9789291691647
  2. Khatana SAM, Szeto JJ, Eberly LA, Nathan AS, Puvvula J, Chen A. Projections of Extreme Temperature–Related Deaths in the US. JAMA Netw Open. 2024;7(9):e2434942. doi:10.1001/jamanetworkopen.2024.34942
  3. European Climate Risk Assessment. https://www.eea.europa.eu/en/analysis/publications/european-climate-risk-assessment
  4. Zhang Z, Kamil RJ, London NR, Lee SE, Sidhaye VK, Biswal S, Lane AP, Pinto JM, Ramanathan M Jr. Long-Term Exposure to Particulate Matter Air Pollution and Chronic Rhinosinusitis in Nonallergic Patients. Am J Respir Crit Care Med. 2021 Oct 1;204(7):859-862. doi: 10.1164/rccm.202102-0368LE. PMID: 34181862; PMCID: PMC8528530.
  5. Leland EM, Vohra V, Seal SM, Zhang Z, Ramanathan M Jr. Environmental air pollution and chronic rhinosinusitis: A systematic review. Laryngoscope Investig Otolaryngol. 2022 Mar 11;7(2):349-360. doi: 10.1002/lio2.774. PMID: 35434330; PMCID: PMC9008184.
  6. Ochoa Scussiatto H, Stenson KM, Al-Khudari S, Jelinek MJ, Pinto JM, Bhayani MK. Air pollution is associated with increased incidence-rate of head and neck cancers: A nationally representative ecological study. Oral Oncol. 2024 Mar;150:106691. doi: 10.1016/j.oraloncology.2024.106691. Epub 2024 Jan 23. PMID: 38266316.
  7. Hexom, B. Beyond Medical School: The Frontier of Medical Activism. Virtual Mentor. 2004;6(1):51-53. doi: 10.1001/virtualmentor.2004.6.1.msoc2-0401.
  8. Dilger AE, Meiklejohn DA, Bent JP, Tummala N, Bergmark RW, Lalakea ML. Climate change and environmental sustainability in otolaryngology: A state-of-the-art review. Surgeon. 2024 Oct;22(5):270-275. doi: 10.1016/j.surge.2024.06.007. Epub 2024 Jul 6. PMID: 38972805.

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