Abstract
Super Typhoon Rai (Odette) follows others in the region in recent years, including the 2018 Super Typhoon Mangkhut in Hong Kong and Haiyan in 2013, which also greatly affected the Philippines.1,2 On the heels of the COP26 in Glasgow, the typhoon is a reminder to all coastal populations that the growing frequency and intensity of hurricanes and floods, attributed to our changing climate, imperils the lives and livelihoods of hundreds of thousands every year.
The impact of climate change on human health goes beyond the effects of extreme weather or rising sea levels. Changes in vector ecology are expected to impact population health.3,4 Prior to the COVID-19 pandemic, it was already postulated that Hong Kong would become more susceptible to vector and water-borne diseases, such as dengue fever, malaria, cholera, and others, because of climate change.3,5 Many other implications including heat-related illness, the effect of temperature on non-communicable diseases and mental health impact associated with extreme events were also mentioned in the 2016 policy brief on climate change published by the Hong Kong Jockey Club Disaster Preparedness and Response Institute. 5
What then, as part of the global community of emergency physicians, must clinicians in Hong Kong do to prepare for, adapt to and ameliorate the impacts of climate change on the health of the people of Hong Kong? It is our generation and those that follow that will be increasingly affected by the changing climate. What must then be our responsibility to ourselves and those that we mentor? There is significant precedent for physicians to shape and lead public opinion on other seemingly intractable challenges, ranging from nuclear disarmament to the banning of landmines, by successfully demonstrating the devastating and unjustifiable destruction to life and earth wrought upon by such vile means of warfare. 6 Given the suffering to both human and non-human life that climate change is expected to bring about, physicians play a critical role in helping their communities prepare for what is to come.
The Lancet now publishes an annual report on health and climate change, wherein the latest edition of ‘The Lancet Countdown’ warns governments about the consequences of ignoring climate change and related healthcare crises, and underscores the need for climate action when planning for the recovery from COVID-19 pandemic. 7
Many Emergency Medicine Colleges around the world have taken up this challenge to mitigate the effects of climate change, in myriad ways. The Australian College for Emergency Medicine published an environmental strategy referring to the latest UN Intergovernmental Panel on Climate Change (IPCC) Climate Report, taking a stand to ‘embed sustainable practices in the College and to support emergency departments (EDs) to also strive for sustainability’. 8 The American College of Emergency Physicians issued a policy statement titled ‘Impact of Climate Change on Public Health and Implications for Emergency Medicine’ in June 2018, 9 supporting the following activities related to climate change: raising awareness, engaging in research, advocating for policies, expand regional surveillance systems, reducing carbon footprint of EDs, and educating patients on appropriate precautions of the health effects.
A determined healthcare sector should be more than capable of leading societal change, and can do so by example. In recent years, we have begun to see fledgling changes being put into action in Hong Kong as well. Following the Hospital Authority’s 10 year Hospital Development Plan released in 2016, there will be redevelopment and expansion of 11 existing hospitals, along with a brand-new Kai Tak Hospital. With many of these projects now underway, this is an opportune time to plan environmentally friendly facilities. By requiring that the new projects meet sustainability standards such as LEED, BREEAM, or BEAM Plus, 10 hospital design, energy consumption, and water efficiency can all be substantially improved. Incorporating these targets early in the planning and building process would ease the path to final certification. For older buildings and those that have already been rebuilt, one could improve sustainability by retrofitting rainwater harvesting tanks, heat-resistant windows, electric car chargers, and rooftop solar panels, among other such green amenities. Internationally, there are several EDs with certification in progress or already certified as listed on the LEED and BREEAM websites. Prominent examples include the Leicester Royal Infirmary Adult ED in Leicester, the new St. Paul’s Hospital currently under construction in Vancouver, and Huntington Hospital ED in New York.
Apart from engineering innovations, one can also literally ‘greenify’ hospitals. There is an increasing amount of research supporting the positive relationship between hospital greenery and both patient and staff wellbeing. Horticultural therapy has been known to improve outcomes in paediatrics, care of the elderly, spinal injury, psychiatric care, and even hospital visitor’s satisfaction. Some have even suggested that healing gardens can reduce length of stay and the use of analgesia. 11 In Hong Kong’s tropical climate, it should not be challenging for healthcare facilities to embrace nature.
A particular characteristic of Hong Kong’s healthcare system that begs improvement for several reasons, is the use of paper medical records. Other than the urgent need to make health information more interoperable and accessible to patients, the impact of current wasteful practice of maintain paper charts in the emergency department (and the rest of the hospital) must be aborted expeditiously. Despite the rollout of electronic patient records in 1995, EDs began the transition to electronic records as recently as 2017. 12 However, even in hospitals where the transition has been completed, paper records remain ubiquitous. Many departments find it easier to retain such printed records for communication purposes. Electronic progress notes, lab results, discharge summaries, and many others continue to be printed out for filing purposes.
While these practices signal intent and commitment, the harder and more sustaining demand on us is that of educating current and future members of our profession. Setting standards in educating the physician of the future could be the first step to this important task. 13 With the impact of climate change, EDs will need to be prepared for surge in patient volume with climate emergencies. 5 Medical students and young physicians need to be trained to communicate the risks and impact of climate change to the public, and the health policy community in general. Patient interactions are an opportunity to communicate the impact of our inaction on an individual’s or a family’s risk of asthma, or heat stroke, or novel diseases.
We must participate in multidisciplinary research and policy work with public health specialists, environmental scientists, ecologists, biologists, and others. Such integration can only be achieved by purposeful incorporation of new core skills into the existing curricula, as is being increasingly done with topics on diversity, inclusion, and equity, for example, in US medical schools. 14 Emergency departments at the University of Colorado and Harvard’s Beth Israel Deaconess Medical Centre offer Climate and Human fellowships to train the next generation of physician scientists to lead research and advocacy on the health impacts of climate change. 15 Government agencies, civil society and the private sector will be better served by integrating a cadre of well-trained climate physician scientists in their decision making and planning, to allow the formulation of responsible and reasoned responses to protect human health from the impact of climate change.
Emergency Medicine, society’s threshold to the healthcare system, has long prepared for the unpredictable. As a specialty equipped to care for those in extremis, we are well positioned to rise to the greatest challenge of our times. Will we?