Dr Emily Brigham on the Burden of Climate Change and Urban Lung Health

On the last day of CHEST 2022, Emily Brigham, MD, MHS, a pulmonologist previously at Johns Hopkins Hospital, chaired a session on climate change and lung health. Brigham, now at Vancouver General Hospital and an assistant professor in the Respiratory Division at the University of British Columbia, talked about the disparate health impact that climate change will have on those living in urban environments.

Transcript

How does climate change worsen lung health in low-income urban areas?

In urban, lower-income environments and urban environments, you have a number of different factors that can coalesce to contribute to both the development of respiratory disease, but also the potential increased morbidity among individuals with respiratory disease. There's something called the inner-city-trap, which is just a term that's meant to really describe the coalescing of a lot of these different factors.

You oftentimes in urban environments will have a concentration of air pollution and specific pollutants. Thinking about an example like traffic-related air pollution, you can have a number of allergens in the urban environment. We oftentimes think about allergens out in farmland and of plants and everything else. But in the inner-city environment, we're dealing with pests, we're dealing with mice, and those allergens can contribute to disease as well.

And then there’s things that impact us outside of driving and traffic and so forth. Secondhand smoke, and then pollution from a lot of practices that occur within the inner-city environment, and just, sort of, the factors come together. There may be less green space and less opportunity for us to sort of mitigate some of the issues that come with changes in climate.

I'm thinking more specifically about some of the changes in climate that we're expecting to see in the setting of climate change. We think, of course, about increases in temperature and temperature extremes, and extreme weather events. I know out here in [British Columbia], where I am, we've had some heat waves, which are unexpected to the degree that they've occurred out in the Pacific Northwest, there’s really record-breaking temperatures, which are hard to mitigate on an individual level.

We also think, with the increases in carbon dioxide and these temperature changes, that there may be increased intensity and elongation of allergy seasons. And that may be particularly detrimental to individuals who have underlying atopy, which a lot of our patients with asthma have. And so, they're dealing with that increasing risk as a part of that.

We also know that higher temperatures in general may also contribute to some increases in air pollution, which, you know, a lot of times we're thinking about air pollution and greenhouse gas effects, and then we're thinking about increasing temperatures. But actually, temperature can speed up some of the chemical processes by which air pollution is formed, including ozone formation. And ozone is one of our criteria pollutants followed by the [Enviornomental Protection Agency] that's considered to be causally linked to respiratory harm.

Those are all the potential effects directly of climate change. But climate change comes with a lot of stressors that can impact communities differently and impact individuals differently based on the number of resources that they have available to them to withstand and have resiliency to those effects.

If we think about somebody living with asthma in the inner city who may have lower resources, who may not have sort of a buffer in terms of their income, maybe working in an hourly job and unable to have dedicated time off— that person who has, perhaps, an exacerbation in the setting of heat, now either feels that they have to go to work to keep up their income, or has to take time off from work unpaid. That can have downstream effects on their ability to sustain themselves from a nutritional standpoint, afford rent, or afford their medications, which keep their disease under control. And it's sort of this ripple effect that just continues downward, and can really contribute to the worsening of somebody's health, beyond just the initial event that occurs at the initial heat event.

And so, we see that a lot of a fair number of populations and individuals who do not have the resources available to them to the same degree, to sort of buffer against some of these events that can have effects that continue to trickle in their life and continue on.