Our Patients With Disabilities Face Unique Environmental Risks

In 2018, I was a young medical resident working on a spinal cord injury unit at the Palo Alto Veterans Administration (VA) when the fast-moving Camp Fire decimated the town of Paradise, California. The unit was filled with veterans with varying degrees of severe physical disability, some dependent on ventilators for breathing, others entirely bedbound. As the wildfire swept through the Sierra Nevada mountains, smoke filled the VA campus. As a medical team, we rushed to protect our patients from this new (to us) threat, closing windows and administering breathing support, hoping the smoke would not be the straw that broke their already tenuous respiratory status.

Yet, in many ways, we were lucky. Escaping a fast-moving fire is risky for the most healthy and able-bodied person. For someone paralyzed from the neck down and dependent on healthcare professionals or cumbersome medical equipment, this feat can be herculean — if even possible.

People with disabilities constitute 16% of the world’s population. As every disability is unique, people in this population are as diverse as they are vulnerable to the many health consequences of climate change.

Heat

People with neurological disability, such as spinal cord injuries (SCI), multiple sclerosis (MS), traumatic brain injuries (TBI), or stroke, have impaired ability to regulate their body temperatures. This population often suffers from mobility or communication deficits that make it challenging to access cooled spaces or communicate symptoms of overheating. This can lead to heat stroke and even death. For example, people with MS have a higher resting body temperature at baseline, and higher ambient temperatures are associated with MS exacerbations.

Smoke

Due to climate change, which is being primarily driven by the burning of fossil fuels, wildfires are increasing in size and frequency. Indeed, as I type this in my Montana home, a wildfire rages only miles away. The same is true in many places across the world.

Respiratory disease is a leading cause of death for people with certain disabilities, such as SCI or amyotrophic lateral sclerosis (ALS). Exposure to particulate pollution from wildfire smoke increases the risk of respiratory infections and chronic obstructive pulmonary disease (COPD), which can prove devastating for this population.

Wildfire smoke also increases the risk of heart attacks and strokes, which is particularly concerning for people with disabilities, who already have an accelerated risk of cardiovascular disease, possibly related to their decreased mobility.

Natural Disasters

Other natural disasters, such as hurricanes and floods, are also increasing in frequency and severity due to climate change. One doesn’t need much imagination to understand how evacuating from these fast-moving and unpredictable disasters would be hard or even impossible for people with some disabilities. Debris-strewn or flooded streets can stop a wheelchair-dependent person in their place. Power outages can threaten the equipment that they depend on for survival. Broken elevators can trap people in high-rises. Caregivers can become separated from their charges. Medical clinics that care for this complex population can face extended closures.

In fact, as climate change accelerates, we face the daunting likelihood that it will induce more disability. Natural disasters cause physical trauma, and heat and smoke contribute to increased disability from heart attacks and strokes, thus compounding an already challenging situation.

Solutions

Unfortunately, healthcare is a carbon-intensive industry, contributing nearly 10% of carbon emissions in the U.S. One important solution is to clean up our own act by reducing waste and striving for carbon-neutral practices. This can be done at every level, from the individual practice up to state and national advocacy. Physicians are trusted voices which we can leverage to highlight the health consequences of climate change in our clinics and in our communities.

On a smaller scale, physicians can work with their patients to develop strategies to ameliorate climate risks, ranging from simple interventions such as cooling vests and heat-related education to developing tailored disaster evacuation plans that emphasize the procurement of critical supplies and equipment.

Medical schools and residencies can incorporate climate-smart education that highlights the particular vulnerabilities of people with disabilities, emphasizing their unique physiology. And researchers can study the specific effects that the climate is having on people with disabilities, which remain theorized but mostly unquantified, and develop best practices to combat these effects.

Since my time on the VA spinal cord unit, disasters like the Camp Fire have become almost routine. But that doesn’t mean we can become complacent. Now is the time to take ambitious action to secure a healthy future for all of us.

Anita Lowe Taylor, MD, practices as a full-time physiatrist in Montana. She serves on the board of the Montana Health Professionals for a Healthy Climate, where she aims to incorporate climate change into education and advocacy for people with disabilities. She also serves on the Public Policy Committee of the Association of Academic Physiatrists as a representative of the Medical Society Consortium on Climate and Health. She spends her free time hiking, backpacking, skiing, and spoiling her three rescue cats.

The views of the author do not necessarily reflect those of the Medical Society Consortium on Climate and Health or its members.

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