A stubborn heat wave settled over southern Michigan this past summer. At the hospital emergency room where she works, Mahshid Abir soon saw the effects: older patients with diabetes or heart disease, overheated, dehydrated, their conditions worsening.
Abir had treated countless patients like this before, every summer. But she’s also a senior physician policy researcher at RAND—and this time, she was working on a study about how climate change could exacerbate diseases and drug shortages. “I really started to connect the dots,” she said. “These patients were signs of a bigger problem that we’re starting to see around the country.”
Abir focuses as a researcher on improving emergency care and rethinking the American health care system for the challenges of the future. Her work has identified strategies to help more people survive cardiac arrest; to help states address health care workforce shortages; and to help hospitals prepare for a surge of sick patients in the opening weeks of COVID-19. As a doctor, she has worked in emergency departments for more than 20 years.
Your most recent study provides the first national model of how disease prevalence might change with the climate. What did you find?
We looked at four of the biggest killers in the United States: cardiovascular disease, asthma, Alzheimer’s disease, and end-stage renal disease. We found that, under many different climate change scenarios, the prevalence of those diseases goes up, mortality goes up—and, for the most part, demand for the drugs that treat those diseases goes up. That’s concerning, because those drugs are already experiencing shortages.
The one exception we found was with cardiovascular disease. Its prevalence goes up, but our models showed demand for metoprolol, one of the first-line medications to treat it, coming down. That’s because deaths are so high that the related demand for cardiovascular medicines is going to go down.
Did anything surprise you?
I was really surprised by how little we understand about how climate impacts health. What we do know is all bad. But just the low number of studies, the quality of studies, the fact that ours was the first national model—I was surprised by that. And I was surprised by the fact that, even where studies have shown adverse effects, we don’t really understand the underlying mechanisms. There’s just a massive knowledge gap. And if we don’t understand these associations and mechanisms, then how are we really proposing to fix it or mitigate it?
What are some of the adverse effects you’re already seeing?
Pollution from wildfires has gone up. People with lung disease and cardiovascular disease are going to be at high risk of poor outcomes and death because of that. We’re seeing heat waves in places that never used to have them and that aren’t equipped to keep people cool. Lyme disease is spreading in places it never existed before. Other vector-borne diseases like Valley fever, a pretty aggressive fungal infection, are becoming endemic in areas they didn’t used to be in. It’s not going to be enough to try to reverse what we’ve done to the planet. We need to really start coming up with solutions very quickly to protect people from the effects that are already here.
What made you personally want to be part of this study?
I do my ER shifts in Michigan, which has very hot, humid summers. We’ve had wildfires just over the border in Canada, and there were days when people were told not to go outside due to the smoke. And I would see patients coming into the ER, particularly patients who have chronic diseases, who are already frail. Maybe they’re diabetic, or maybe they have heart disease or lung disease. This kind of extreme weather really impacts them. Perhaps it affects the immune system and makes people more likely to pick up infections. I used to think, oh, it’s another summer, it’s hot and people are just not staying cool. But there are all sorts of connections between high temperature, humidity, ground-level ozone—and they all seem to work together in a compounding way to worsen the effect on health. It’s extremely important that we do more to understand those connections.
How does this study fit in with the rest of the research you do at RAND?
I realized before the pandemic—but this was very much solidified for me during the pandemic—that the U.S. health system is not prepared for the future. We really need to ask, What should the health system look like, given the hazards that people are facing now and that they’re going to face in the future? What happens if people start to migrate because of climate change? Many health systems are already struggling to keep up with the demand they already have. The population is aging, too, so that’s going to further strain capacity. What we need, really, is an entirely new blueprint for the future of the U.S. health system.
– Doug Irving, Published courtesy of RAND.
