Impact of Climate Change on Health and Drug Demand

Short abstract

The authors describe a model for estimating the effects of climate change on the prevalence of four common chronic conditions and the resulting effects on demand for the drugs to treat them. The model can help inform policies for ensuring sufficient drug supply under various climate scenarios.

Abstract

It is anticipated that extreme weather events due to climate change will increase the prevalence of a number of acute and chronic diseases. As a result, the demand for drugs to prevent or treat those conditions is likely to increase. If the anticipated increase in demand for these drugs is not planned for, already strained medical supply chains will be further strained, resulting in poor health outcomes among affected patient populations and additional costs to health systems.

The authors of this study estimated how the anticipated effects of climate change on the prevalence of a sample of four chronic conditions—cardiovascular disease (CVD), asthma, end-stage renal disease (ESRD), and Alzheimer's disease—will affect demand for the drugs needed to treat them (metoprolol, albuterol, heparin, and donepezil, respectively). To generate these estimates, the authors conducted an environmental scan of the peer-reviewed and gray literature and developed a medical condition–specific systems dynamics model. The model can help inform policies for ensuring drug supply under various climate scenarios.

We conducted an environmental scan and found that extreme temperatures, precipitation, drought, and elevated levels of ground ozone and wildfire-associated air pollution adversely affect human health. Many medical conditions are affected by climate change: maternal-fetal health, cardiovascular disease, asthma, chronic obstructive pulmonary disease, water and food-borne infectious diseases, fungal infections, vector-borne illnesses, mental health, cancer, stroke, kidney disease, diabetes, and neurodegenerative diseases, such as Alzheimer's disease.

In this study, we designed a systems dynamics model to estimate the impact of climate change on human health and resultant drug demand, focusing on four conditions: cardiovascular disease, asthma, stage 5 chronic kidney disease (also known as end-stage renal disease), and Alzheimer's disease. When selecting conditions to model, we prioritized those that are among the most common chronic conditions in the United States and on the top ten list of the leading causes of death in the country in 2022.

For each of these conditions, we identified standard-of-care treatments to model future demand: metoprolol, albuterol, heparin, and donepezil. Metoprolol is an antihypertensive drug that is used as first-line treatment in many cardiovascular diseases. Albuterol is an inhaled bronchodilator that is first-line in the treatment of asthma. Heparin is an anticoagulant required for end-stage renal disease patients on hemodialysis. Lastly, donepezil belongs to the anti-cholinesterase class of drugs that are first-line in the treatment of mild to moderate Alzheimer's disease. With the exception of donepezil, these generic drugs have all experienced past or current shortages, hence may be more likely to be susceptible to future shortages.

The model estimates that climate change may lead to an increase in drug demand for three of the four medical conditions. These include asthma, end-stage renal disease, and Alzheimer's, all of which are expected to increase in prevalence due to climate change despite concomitant increases in disease related mortality due to climate change. However, demand for metoprolol to treat cardiovascular disease is expected to decrease as a result of higher cardiovascular disease mortality rates under severe climate change scenarios. These examples highlight the complexity of climate change's potential impacts on health and drug demand.

The model's estimations provide a preview of the potential future drug demand under varying climate conditions. This and future versions of the model can be used to inform policies and innovations for mitigating climate change's anticipated impact on demand by ensuring sufficient drug supply under various climate scenarios. More specifically, these findings can help inform development of proactive strategies for identifying supply chain risks and building supply chain resiliency—for example, through stockpiling and further diversification of both U.S.-based and non-U.S.-based supply chains for high-demand drugs.

This research was funded by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, and was carried out in the Payment, Cost, and Coverage Program of RAND Health Care.