Lifestyle Medicine and Climate Change: The Role of Providers in Addressing a Public Health Challenge

Abstract

Climate change threatens to undermine efforts to improve human health through lifestyle modification. Lifestyle medicine providers, however, may be well positioned to help patients create new healthful and climate-friendly habits, such as adopting a plant-based diet and limiting or eliminating car travel. Through each provider’s own example and patient engagement efforts, as well as though new technology and the collective action of the American College of Lifestyle Medicine, the broader lifestyle medicine community can play an outsized role in addressing climate change.

As 2021 begins and the rise in global carbon emissions continues unabated, ¹ the impact of climate change on human health is clear and the future foreboding. ² Physicians rightly see climate change as a health emergency. ³ The Centers for Disease Control and Prevention has identified the impact on human health, including increased respiratory and cardiovascular disease, injuries and premature death related to extreme weather events, infectious diseases, and threats to mental health. ² The World Health Organization emphasizes that everyone everywhere is at risk from climate change. ⁴

The American College of Lifestyle Medicine (ACLM) has signed the U.S. Call to Action on Climate, Health, and Equity: A Policy Action Agenda, which identifies climate change as the “greatest public health challenge of the 21st century” and outlines broad steps to mitigate climate change. ⁵ An ACLM resolution is also under review stipulating it is the responsibility of all members to address planetary health with patients. There remains an opportunity, however, at this point, to reflect on how individual lifestyle medicine providers may guide mitigation strategies, at the bedside and beyond.

Of the many pressing mitigation strategies, 4 strategies are considered most widely applicable, evidence-based, and highest-impact with the potential to contribute to systemic change and substantially reduce carbon emissions in developed countries. ⁶ These include having one fewer child, living car-free, avoiding airplane travel, and eating a plant-based diet (beef, dairy, poultry, and eggs contribute more to carbon emissions than plant-based protein sources, with beef by far the greatest contributor).^6-8 These strategies, or actions, show much greater potential to reduce carbon emissions than commonly promoted efforts like recycling or changing household lightbulbs; buying a more efficient car helps, but will have substantially less of an impact than going car-free. ⁶

Naturally, in the course of a patient encounter, some of these actions may not be relevant (having one fewer child or avoiding airplane travel), but the others may be, given that they are part of daily routines (living car-free and eating a plant-based diet). As such, lifestyle medicine providers may be well positioned to help patients change behaviors to create new healthful and climate-friendly habits (eg regularly cycling to work).

But what of those instances where healthful and climate-friendly are at odds? For instance, a provider may recommend regular aerobic and weight-bearing exercise, but the only (or most convenient, or accessible, or supportive, etc) option for a patient is to drive to a gym. Or the only way for a particular patient to get a variety of fruit and vegetables is to drive to a supermarket. Car travel is necessary for many not just to access health promoting activities but also for livelihood, socialization, transportation, and a host of other activities, especially in suburban and rural areas. For others in whom car travel is not a necessity, its avoidance may be time-consuming or isolating. ⁹ And yet, beyond its benefit to the climate, reduced car travel may lead to increased physical activity and reduced mortality. ¹⁰ Moreover, the lifestyle medicine community strongly endorses a whole foods plant-based diet, which may present similar challenges. Alongside diet counseling, might there then be a place for lifestyle medicine providers to endorse—in a way that respects each patient’s uniquesituation—limiting, or eliminating, car travel and to help them create new habits?

While there appears little research into how a provider might frame such a recommendation, it is noteworthy that ethicists support this type of recommendation: they point out that while a clinician’s duty to meet the needs of the patient is undeniable, these needs must be balanced against a moral imperative to minimize the impact of a clinician’s actions on the environment, other community members, and future generations. ¹¹ Given that Americans are largely not aware of the health implications of climate change, emphasizing potential health benefits of specific mitigation-related actions or focusing on the health impact to the patient’s community can be motivating.^12,13 In addition, as lifestyle medicine providers know well, engaging patients in behavior change may be more easily accomplished when the provider stands as an example. ¹⁴ In response to patients who ask, providers should be ready to talk about their own experiences and help patients navigate the creation of healthful and climate-friendly habits. Providers should be sensitive to the cultural and structural barriers and disparities patients may face in trying to follow recommendations (for instance, some may live in areas without healthful foods or not have disposable income to pay for healthful foods—or have access to contraception should the conversation about having fewer children arise). Clinicians should also be ready to discuss that although actions around diet and transportation are most impactful, there are others that individuals can also take to reduce their carbon footprint (for instance, purchasing green energy or washing clothes consistently in cold water ⁶ ), and that while shifting all behaviors in the right direction is best, shifting any behavior in the right direction is good, and one can track the trajectory of impact with online calculators such as those from the United Nations ¹⁵ or University of California, Berkeley. ¹⁶ Notably, continuing medical education materials are being developed by ACLM to help clinicians acquire content knowledge and inform their counseling.

Beyond the clinical encounter, digital technology will have a role to play in both assessing where patients stand (eg, in terms of diet, physical activity, and psychosocial stress) and in engaging them in new habit formation. Unfortunately, to date, lifestyle-focused digital health technology has not yet shown that it can modify personal behaviors, health, and climate impact. ¹⁷ Mobile lifestyle platform technologies, although not without risk (chiefly by providing poor quality information), ¹⁸ do hold the benefit of being able to provide coaching, problem-solving, reminders, updated content, and peer-support, all to collectively help reinforce behavior change.

While digital technology also offers the potential for scalability, individual actions do matter immensely, especially when done conspicuously, in and of themselves, but also because they can help motivate others, change cultural norms, and inspire political and corporate leaders to action. ¹⁹ Humans are social animals and use social cues to recognize emergencies: as it has been said, “People don’t spring into action just because they see smoke; they spring into action because they see others rushing in with water.” ¹⁹ We must not lose sight of needed and complementary large-scale policy changes and the fact that by addressing policies and systems which contribute to greenhouse gas emissions, we can help all patients. Yet through example, patient engagement efforts, new technology, and the collective action of ACLM, the lifestyle medicine community can stand at the clinical vanguard of addressing climate change.