The Role Of Nursing In Climate Change And Public Health

• Extreme weather cuts off access to care and hits Black, Indigenous, and other communities of color hardest.
• Nurses also have to plan care for other vulnerable groups during these events: older adults, pregnant patients, and children.
• Climate change lowers air quality, raises food insecurity, and drives up allergies and respiratory disease.

Since 1981, the Earth's temperature has risen 0.32°F per decade. That is a large amount of accumulated heat, because the oceans absorb and disperse so much of it.

The result is temperature extremes, heavy rainfall in some regions and drought in others, shifting habitats, and melting polar ice. Those environmental shifts turn into public health problems that land on nurses and their patients. Here is how climate change is reshaping nursing care, and where nurses can step in.

How Climate Change Affects Nursing

Patrice K. Nicholas, DNSc, directs the Center for Climate Change, Climate Justice, and Health at the MGH Institute of Health Professions and codirects Policy and Advocacy at the Massachusetts General Hospital Center for the Environment and Health.

The adverse effects of climate change reach every patient, family, and community, but they hit older adults, pregnant patients, and pediatric populations hardest. One major effect is the rise in natural disasters and extreme weather. These events disrupt care delivery, force patient evacuations, and displace healthcare providers. Patients lose access to care, and the workers who remain carry more stress.

"As the largest group of health professionals worldwide, the nursing profession has a key responsibility in assessment, planning, intervention, and evaluation regarding impacts on health in a climate-changing world," Nicholas says.

With higher ambient heat, nurses have to assess every population for heat-related illness, starting with the most vulnerable. Poor air quality means a closer look at adults and children with asthma and other chronic conditions, who can have cardiac and respiratory exacerbations when the air is bad.

"Pregnant women who experience heat exposure and poor air quality are disproportionately affected by negative pregnancy outcomes including neonates with low birth weight, preterm birth, stillbirth, intrauterine growth restriction, and cardiac anomalies," Nicholas says.

Patients and Their Community

Milagros Elia, MA, APRN, ANP-BC, is an oncology nurse practitioner who works in clinical and community settings. She is a certified climate for health ambassador and sits on the ANA Innovation Advisory Committee for Planetary Health.

Per the Lancet Countdown on Health and Climate, climate events have "the potential to disrupt core public health infrastructure and overwhelm health services." Elia argues nurses need a strong voice inside the system: pushing their institutions to cut their carbon footprint, switch to clean renewable energy, and build climate-resistant facilities.

"Nurses have a tremendous opportunity to protect their patients from the impacts of climate change by working to create sustainable, climate-smart hospitals and health systems," she says.

Nurses are well-positioned to connect patients to their community's decisions on environmental health, which in turn shape that community's health and wellbeing.

Climate change also shifts patterns of disease transmission, straining healthcare systems and raising the risk of outbreaks like malaria and dengue fever. These stressors hit mental health too, for patients and staff alike, raising the risk of anxiety and depression after disasters and other disruptions.

The takeaway: climate change affects nurses and the whole healthcare system, and providers have to be ready to adapt and keep delivering quality care through it.

9 Ways Climate Change Affects Public Health

Climate change widens health disparities because it hits the social and environmental determinants of health. People do not have equal access to clean air, safe water, secure shelter, and food. More frequent natural disasters contaminate water supplies, create food instability, displace people, and raise the risk of vector-borne disease.

"Chronic long-term environmental impacts of climate change like droughts, heatwaves, and air pollution, to name a few, cause short and long-term public health issues and disruption across health system factors that support prevention, screenings, diagnosis, and medical treatments," Elia says.

The consequences fall unevenly. Black, Indigenous, and other communities of color, along with low-income communities, face systematically higher exposure to health-threatening conditions.

1. Extreme weather events. Even small amounts of warming produce more frequent, severe heat waves, droughts, and storms, leading to dehydration, heat stroke, and other heat-related illness. These events also cut off care to marginalized populations and degrade water and air quality.

2. Air pollution. Rising temperatures push up air pollution, which worsens cardiovascular and respiratory disease.

3. Waterborne diseases. Shifting precipitation, flooding, and temperature spread waterborne diseases like cholera and vibriosis. Agricultural and industrial runoff during frequent storms raises the risk of contamination by bacteria, viruses, protozoa, and toxins.

4. Vector-borne diseases. Temperature changes alter the spread of dengue fever, West Nile virus, and malaria.

5. Food insecurity. In 1816, "the year without a summer," cold returned through the summer months and crops failed across Ireland, the U.S., France, and England. It took 100 years to learn that a volcanic eruption the year before had pushed ash into the upper atmosphere and blocked the sun.

6. Mental health. Extreme weather and disruptions like food insecurity and rising disease raise levels of anxiety and stress.

7. Allergies and respiratory conditions. More pollen and air pollution mean more allergies and respiratory problems. Climate change has pushed the pollen season to start 20 days earlier and run 10 days longer than in 1990.

8. Displacement. Longer droughts and monsoon seasons make it harder to grow food, and extreme weather drives people from their communities for good.

9. Skin cancer. High carbon emissions deplete the ozone layer, raising ultraviolet exposure and skin cancer risk.

Elia wants nurses to know they can make a difference individually and as a collective voice. Join an established nursing organization focused on environmental health. Advocate within your own practice. Push your institution to lower its carbon footprint, and support collaboration across disciplines to get there. Nurses need to be at the table where decisions get made, bringing evidence-based practice to the care of people affected by climate change.

The Nurse's Role

Nurses are frontline professionals, positioned to spot and address how climate change affects individuals and communities.

The first step, per Nicholas, is to stay well-read. "Most nursing and health professions journals are increasingly addressing the health consequences of climate change in their professional publications. Nurses must commit to gaining further knowledge about the looming public health threat of climate change," she says.

From there, nurses can teach patients directly: the risks of heat stroke, how to stay hydrated during heat waves, why protecting against mosquito bites cuts vector-borne disease risk. They can advocate for policy at every level, supporting clean energy, protecting natural resources, and backing efforts to cut greenhouse gas emissions.

Closer to home, nurses can push for green cleaning products, public transit and carpooling, and waste reduction and recycling in their workplaces and communities. Inside their own health systems, they can supply the information and support that builds a better response to climate-driven challenges.

Nurses have the knowledge, skills, and influence to make a real difference in the health of individuals and communities. The role they play here is critical.