What did you do to avoid the climate disaster? A call to arms for health informatics

The effects of human-induced climate change on our planet are already largely irreversible for many centuries¹ and may remain so for at least 1000 years.² If emissions continue to grow, their effects will trigger multiple critical tipping points and event cascades that will amplify climate effects in unpredicted ways.³ Just in 2022, we have seen flooding cover one-third of Pakistan, affecting 33 million people.⁴ India and Pakistan’s heatwave was the hottest yet on record.⁵ Recent years have seen historically extreme forest fires across North America, Europe, Asia, and Australia. Low-lying Pacific nations are slowly starting to disappear as sea levels rise, fed by melt waters from disappearing glaciers and sea ice, and coastal cities everywhere are at risk.⁶ The same emissions driving climate change are also affecting our health. Particulates in air pollution are likely responsible for around 300 000 lung cancer deaths globally,⁷ and the list of climate-induced health problems leading to poorer outcomes is depressingly long.^8,9 Humanity is in trouble, and our way out is uncertain to say the least.

In September 2021, Editors of over 200 medical journals from across the world, including JAMIA, published a joint editorial calling on governments around the world to take emergency action to tackle the “catastrophic harm to health” posed by climate change.¹⁰ The editorial called on health professionals to do all they can, “to aid the transition to a sustainable, fairer, resilient, and healthier world,” recognizing that health systems will need to rapidly adapt and transform to become more environmentally sustainable. The accompanying editorial by JAMIA’s Editor-in-Chief called for advocacy and informatics solutions.¹¹ As noted in the additional editorial in this issue, ahead of the 2022 COP27 Climate change conference, journal editors from across the African continent have added their voice, calling specifically for climate justice for African and other vulnerable countries—countries that have contributed least to the problem but are most impacted.¹²

While these changes affect us all as individuals, to many they may seem far removed from the daily focus of our professional lives in digital health and health informatics. Grappling with electronic health records, information standards, consumer apps, or artificial intelligence for clinical decision-making seems worthy and all-consuming enough. Yet our world is about to change, and dramatically so. Hospital information systems crash when they have not been equipped to deal with extreme heat¹³ and can be taken out by massive floods triggered by events such as Superstorm Sandy or Hurricane Katrina.¹⁴ Indeed, climate events like floods, fires, and storms will disrupt, paralyze, and even dismember the very health services we so diligently seek to support. The problems we solve in informatics, how we solve them, where and for whom we solve them—all these are going to change.

So, what can we do, either individually, or collectively as a profession (Box 1)? The many papers in this JAMIA special issue on health informatics and climate change offer us a blueprint for action on a national and global scale. While health informatics and digital health solutions are fundamental to addressing both the causes as well as the consequences of global heating,¹⁵ this is not widely understood. In a scoping review of the current research literature, Rahimi-Ardabili et al¹⁶ describe the many ways in which digital health can both contribute to addressing the causes of global heating, as well as respond to its health impacts. They find much to do and little yet done. The “research remains preliminary with little real-world evaluation.” They call for significant and urgent acceleration in the quality and quantity of digital health and informatics climate change research, given the enormity of the global challenge.

Box 1. What can a health informatician do about climate change?

1. Educate yourself about the environmental and health effects of climate change.

2. Make personal choices that minimize your carbon footprint.

3. Recognize that your professional duty of care to do no harm to those you care for in the healthcare system extends to climate change.

4. Ensure that the digital health projects you are commissioning, designing, implementing, or using have a net zero impact on GHG emissions.

5. Reduce wasteful deployment and decommissioning of software and hardware. Minimize engagement with low-value projects that do not make genuine contributions to healthcare delivery or climate response.

6. Embed climate resilience into the design of information systems and health services that you are responsible for, and aim for the sustainable use of technology, doing more and better with less.

7. Engage in local decarbonization efforts at the place you work or live and ensure there are appropriate mitigation and response plans for climate-triggered disruptions.

8. Prioritize climate informatics research, ensuring the work you support has the requisite funds, scale, focus, and organizational buy-in needed for success.

9. Ask questions of your professional organizations. Are they addressing climate change and are they doing enough?

10. Turn up and sit at the table when priorities for your organization or program are discussed and use your voice to prioritize the climate change response.

The overarching priority for all nations right now is to reduce greenhouse gas (GHG) emissions and reach net zero, as soon as 2030 if possible.¹⁷ We know that the healthcare sector is a major emitter, accounting globally for about 5% of GHG emission, and 10% in the United States.¹⁸ Finding ways to reduce those emissions and decarbonize the business of heath is therefore not a marginal issue, but critical to achieving our common planetary net zero ambitions. Yet in 2020, only 1 global healthcare system had committed to a net zero target—the English National Health System (NHS).¹⁹ That commitment extends beyond the health system to those who wish to supply the NHS with medical devices, equipment, or services. Thankfully, many health systems globally are now also moving to decarbonize the business of care.²⁰

For our part, we must start by reducing the contributions of digital health to global heating. Digital technologies are responsible for healthcare emissions associated with the design, creation, and use of IT.²¹ Computational resources such as cloud computing are energy intensive and data center energy use represented 1% of global energy usage in 2018.²² The energy cost of developing multibillion parameter AI models is also not inconsiderable.²³ Sarabu et al report that health informatics professionals are keen to engage with, and have a general awareness of, the impact of climate change on health. However, they are unfamiliar with the ways information technology contributes to, and can be used to reduce, climate impacts. They highlight the need for informaticians to be educated about the intersection between climate change and informatics and to engage in institutional decarbonization efforts.²⁴

In a scoping review, Lokmic-Tomkins et al²⁵ take a carbon emission lifecycle approach to identify the urgent need for us to develop the standardized frameworks, methods, and tools needed to evaluate the carbon footprint of health informatics interventions. Such frameworks are starting to appear. In this issue, Sittig et al²⁶ propose their i-CLIMATE framework to articulate how clinical informatics can reduce the environmental footprint of the information technology it uses. Sijm-Eeken et al²⁷ develop and test the Green-Mission framework for modeling green informatics healthcare solutions, so that our digital systems are green by design.

Informatics is also critical in helping the health system reduce its significant GHG emissions. Computational tools can help us monitor and manage the process of care delivery and are likely to be instrumental in tracking our trajectory as we decarbonize healthcare and get to net zero. Smith et al²⁸ identify potential informatics methods and tools that we can employ to monitor the carbon footprint of healthcare systems and to support climate-change decision-making for clinicians and healthcare policymakers. The great volume of data that will need to be collected and analyzed to determine and then track our pathways to net zero is very likely to require that human decision-making is augmented by artificial intelligence.²⁹

When it comes to climate change impacts, we must prepare to “battle harden” our information systems, and health services more broadly, to survive major climate events with resilience. Some of this is already part of disaster planning^30,31 and should be second nature to anyone operating health services and the digital infrastructure supporting such services. Crisis Informatics is an emerging area of research and practice and will have much to teach the health informatics community.^32,33

However, we must move from seeing large-scale and disruptive climate events as one-off rare problems to them becoming commonplace. Building a health system that is purpose built to be resilient and agile enough to adapt from one crisis to the next is a challenge we now have to face.⁷ We must prepare the health system to survive climate “turbulence.”³⁴ Phong et al³⁵ examine how we can move from reactive incident response to natural hazards like floods and fires, ramp up preparedness for clearly worsening case scenarios, and call for novel methods to project healthcare needs in the wake of such hazards. All of this will take resources, and current efforts designed to help healthcare providers avoid low value, unnecessary or unsafe care could help free the resources needed for the changes that need to be made.

The consequences of global heating on human health are also significant. Climactic changes bring changes in the distribution of infectious disease vectors, exposing new populations to diseases like malaria.³⁶ Climate-induced disasters such as air pollution from mega-fires in forests, heat stress events, and crop failures from flooding or drought, will translate into massive shocks to the health delivery system and the population.³⁷ We have seen the challenge health systems have faced in dealing with the COVID-19 pandemic, and a changing climate is likely to mean we see more, not less, of this type of challenge.

Informatics will thus be central to managing disease outbreaks, and mustering resources to respond to population-level disasters when the air cannot be breathed for the smoke, or our bodies cannot be cooled for the heat. In their scoping review, Rahimi-Ardabili et al¹⁶ identify a broad set of tasks where informatics solutions can help manage climate-driven health impacts, including data sensing, monitoring, electronic data capture, modeling, decision support, and communication. In a thoughtful piece Abdolkhani et al remind us that we must think of informatics as much more than technology. They explore the power of empowering women, who most often make health decisions for their family, with the digital health literacy needed to take advantage of the many information tools that will soon come to help navigate a hazardous climate-changed world.³⁸

The work ahead of us is urgent and hard, and the time left to avoid the worst of projected climate change impacts is narrowing quickly. Health informaticians will need to change the speed with which research is done and systems are implemented, and may need to let go of projects that, for all their interest, are not going to help the bigger cause. We will need to work closely with government, industry, and most critically the community, recognizing we are only one part of the solution, and not always the most important part. For researchers, if ever there was a cause shouting out for open science, then climate change is it. We must resist the urge to treat climate change as an academic opportunity for self-advancement, instead of the planetary emergency that it is.

CONFLICT OF INTEREST STATEMENT

None declared.