Mimi Guarneri, MD: The Connection Between Climate and Health

Integrative Medicine: A Clinician’s Journal (IMCJ): You played a key role in a workshop organized by the Pontifical Academy of Sciences called “Health of People, Health of Planet, and Our Responsibility: Climate Change, Air Pollution and Health” on November 2 through 4, 2017, at the Vatican. How did the event come about?

Dr Guarneri: For many years, I have been a private physician for Veerabhadran Ramanathan, PhD, who is one of the world’s leading scientists on climate change over at the Scripps Oceanographic Institute. He has served as a chief scientific advisor for His Holiness, Pope Francis, and is a member of the Pontifical Academy of Science, or PAS.

He and I, for many years, have been discussing planetary changes, including increased flooding in some areas, increased heat stress in other areas, and so on. He has always talked about it from the planet perspective, while I have always talked about it from the human perspective.

I represented both the Academy of Integrative Health and Medicine at the conference, and the Miraglo Foundation, which is a private foundation that helped to support bringing the conference together, along with the World Health Organization and the University of California, San Diego, or UCSD.

IMCJ: How did Pope Francis get involved?

Dr Guarneri: He wrote a book called Care of Our Common Home¹ and draws interest in this is from the Jesuit perspective of caring for the underserved and the poor. Of course, the poorest 3.1 billion will be the ones to be most affected by the climate crisis. Dr Ramanathan brought back a proposal from the PAS to do a summit with world leaders on topics such as air pollution and sustainable agriculture. Scientists, clinicians—like myself—the World Health Organization, and UCSD converged to talk about the impact of planet health on human health.

IMCJ: Were there other stakeholders at the workshop?

Dr Guarneri: Yes, Nobel Laureates and research scientists.

IMCJ: Were politicians represented?

Dr Guarneri: California was represented by Governor Jerry Brown, who talked about everything that has occurred in California. I don’t know if you remember in the 80s, Los Angeles was like New Delhi in terms of breathable air. Changes have been made to affect California air quality, so Jerry Brown presented from California. Senator de Leon presented. Congressman Scott Peters, from San Diego, also presented. Ministry representation from Chile, from China, from the Amazon, and from all over the world, were talking about what they have done. If you read about Chile, for example, it is unbelievable. They are going to be running on 100% renewable energy resources.

IMCJ: Why would adverse effects of climate change disproportionally affect the poor?

Dr Guarneri: For example, we saw in Karachi, Pakistan, temperatures hit 120 degrees Fahrenheit, claiming about 2000 lives from dehydration and heat stroke in 2015. In 2017, 41 million people were displaced from flooding in Nepal, Bangladesh, and India. Of course, the poorer you are, the less likely you are to have a house, the less likely you are to have an air conditioner or place to go during crisis, and so on. That is where His Holiness Pope Francis is coming from, in part.

I think from a clinician’s standpoint, since IMCJ is a clinician’s journal, it would be very valuable to have clinicians realize that changing climate patterns—not weather patterns—are associated with huge implications for human health. For example, at the meeting, the World Health Organization pointed out that air pollution is now recognized as the number-one cause of stroke and is an independent risk factor for cardiovascular disease, which is huge. For the first time ever, air pollution is being put in the category of noncommunicable diseases.

IMCJ: What are the primary aspects of health that climate change will affect?

Dr Guarneri: As the climate warms up, we start to see vector-borne illness that is typical in the tropics moving up north. What do I mean by that? Zika virus, Lyme disease, dengue fever, and West Nile virus are moving northward. We are starting to see longer periods where these mosquitoes are hatching, because of the warmer weather. This results in a much larger crisis. For the first time ever down south, women are being advised not to get pregnant during certain months when Zika virus is high. That is how extreme this is.

We have the pollution issue that I mentioned previously. We have a vector-borne illness issue. We have the issue of drought in areas like California, the Gulf, and the extreme conditions in northern Africa, where it has been so extensive and severe that the ability to produce food for millions of people is in question. That is why places like Bahrain are looking for other ways to grow food—for example, aqua farms that grow food out of water, and things of that nature.

Then you have, of course, what we witnessed in California: extreme heat followed by fire. Fire strips the whole land bare of its vegetation. Then you get rain, which has triggered mudslides that claimed many lives in the Los Angeles area.

IMCJ: You went out of your way a moment ago to distinguish between weather and climate. Is there an issue with that?

Dr Guarneri: People observe weather—“gee, it’s 78 degrees today; tomorrow it’s going to be 79, so what is the big deal if we have a 2-degree-centigrade increase?” They need to look at the big picture: The hottest days on record on the planet have occurred in 2017. The storms and events that we are seeing, whether it’s Katrina, Hurricane Irma, the destruction of the Caribbean, Puerto Rico, and so on—all of these are related to warming temperatures in the ocean. All of this is connected.

As clinicians, we have to understand it. We have to do everything we can to educate our patients to understand it so that we can all start to take, and continue to take, collective action.

There are some very good Web sites you could look at to help you understand the problem. Start with the World Health Organization Web site. If you just type in human health and planet health, you’ll see a couple of other good sites come up. If you go to YouTube, you can see the presenters from the conference speaking about air pollution, agriculture, temperature, heat, drought, food production, and starvation. Just type Health of People, Health of Planet in the search bar. One of the crazy statistics, for example, involved El Salvador farmers; 25% now have chronic kidney disease because of the dehydration. They are simply not getting enough water when working in the fields. This was never the case for thousands and thousands of years.

IMCJ: Beyond being a driver of stroke, what ways are clinicians going to see air pollution effects show up in their practices?

Dr Guarneri: Asthma, allergies, and every conceivable respiratory condition. The American College of Cardiology just published a study showing how air pollution increases stress hormones. Stress hormones then increase blood pressure, diabetes, coronary constriction, and so on. Rising temperatures manifest in more pollen, because we are going to have a longer season for things to grow. Not only are the mosquitoes going to be around longer, but the longer growing season will trigger a marked increase in allergies, asthma, and all respiratory-related conditions. Vector-borne illness will increase as well, and so will psychological stress from people who have gone through climate crisis traumas: having your house burn, being displaced from your home, having to move to a whole different city, deaths in the family, family separation, and separation from pets. The psychological implications of these disasters that are occurring right now persist. That is the cycle for humans. So, these are the kinds of things that clinicians are going to see in their offices.

Dr Pizzorno lectures all the time on environmental toxins, the effects of which we encounter right now. Lead, mercury, cadmium, and arsenic presenting in our food chain, water, and air. The obvious one is fish contaminated with mercury, but we have arsenic and lead in water, so we are going to see more heavy metal toxicity. That is an important one. More cancers will manifest related to pollution and cancers related to heavy metals. These are all some of the pretty obvious ones. Lead, mercury, and cadmium are linked to cardiovascular disease and hypertension.

IMCJ: Are there more indirect effects that clinicians should be on the lookout for?

Dr Guarneri: I think the most important thing is the need to recognize that air pollution is an independent risk factor for stroke and heart disease. Clinicians need to recognize that air pollution triggers a rise in stress hormones. They need to recognize that people who have been in areas that have had some of these events, whether it’s just north of me here in Los Angeles or in the wake of tropical storms, experience emotional turmoil. And they need to recognize the vector-borne illness piece. As a clinician, it is time to starting teaching people about the value of water and food, growing their own food, and so on.

IMCJ: What were the results of the workshop?

Dr Guarneri: The conference ended with a declaration. You can read it on the Vatican Web site.² Other resources exist for clinicians to get more information on the scope of the issue. The Medical Society Consortium on Climate and Health is composed of 20 medical groups; the Academy of Integrative Health and Medicine is a member.³ There is also Physicians for Social Responsibility.⁴ Its Web site also contains a lot of good information.