How Can Health Informatics Help Overcome the Impact of Climate Change?

December 18, 2023 - In this episode of Healthcare Strategies, Assistant Editor Hannah Nelson chats with Titus Schleyer, DMD, PhD, Regenstrief Institute research scientist, about how health informatics can help address the impacts of climate change on public health. The conversation focuses on the need for organizations to integrate data systems to enhance preparedness and response to climate-related health challenges, including heat waves, floods, and wildfires. Schleyer discusses the challenges to creating a robust informatics infrastructure to mitigate the impacts of climate change on health and emphasizes the role cross-industry collaboration will play in achieving this goal.

Hannah Nelson: Hello and welcome to Healthcare Strategies. My name is Hannah Nelson, assistant editor for EHRIntelligence.com. After years of discussing the future consequences of ignoring climate change, the time to address its impact on public health is now. Could health informatics be key to achieving this goal? Recently, Regenstrief Institute co-hosted a mini-summit at the AMIA [American Medical Informatics Association] annual symposium to discuss just that. Joining us today is Dr. Titus Schleyer, research scientist at the Center for Biomedical Informatics of the Regenstrief Institute and Professor of Biomedical Informatics at the Indiana University School of Medicine. Thank you for joining us today, Dr. Schleyer.

Titus Schleyer: Thank you for having me. It's great to be here.

Hannah Nelson: Now, starting off, I would love to know what prompted Regenstrief to co-host this event regarding climate change and health informatics?

Titus Schleyer: So the event was co-hosted by the Regenstrief Institute, the American Medical Informatics Association, the International Medical Informatics Association, and the International Academy of Health Sciences Informatics. When we realized we were all going to New Orleans for the annual symposium of AMIA, we thought, "Well, what better place than New Orleans for talking about climate change?" As we prepped for our meeting in New Orleans, we realized that New Orleans--and Louisiana in general--is a microcosm of climate change effects. So Louisiana has wildfires, it has floods, it has heat events, and something most people don't know, it actually has saltwater intrusion into the Mississippi [River].

So we started the event with a panel discussion with Dr. [Sundée] Winder from the Louisiana Department of Health, and Dr. [Melissa] Gonzalez from the Tulane University School of Public Health and Tropical Medicine. And both individuals took us through kind of the real-life experience of having to deal with some of the climate impacts in Louisiana. They talked about coping with disasters, predicting where events such as heat events and wildfire-associated disease or respiratory events would take place. So that gave us a real flavor for what is it like to live with the effects of climate change. We had 42 people in the audience, which was 22 people more than we had planned for. And everybody was simply spellbound by the stories from doctors Winder and Gonzalez.

We then followed up with an exercise where we asked people to brainstorm on post-its their ideas for what healthcare can either do right now to adapt to or mitigate climate change, or what research informatics could contribute to being able to do so in the future. And after people wrote post-its we put them all on the wall, we sorted them, and we came up with this early chart of an action framework and a research agenda for climate health and informatics.

So there were a lot of events around climate change at the AMIA fall symposium, the mini-summit was only one of them. So on the day of the mini-summit, during the day, there was a half-day workshop on climate health and informatics. And then, a couple of days later, there was a panel discussion. So the encouraging thing is that more informaticians are thinking about climate change. And we know, and this is from my personal experience over the last couple of months, if not years, that a lot of people are very interested in this topic.

Hannah Nelson: That's fascinating. And having the event taking place in Louisiana, I'm sure it really lended itself to having productive and interesting discussions about this topic. So in terms of the discussion itself, in these post-it notes, what were the main takeaways in terms of how public health and healthcare systems can better integrate existing data systems to enhance preparedness and response to climate-related health challenges?

Titus Schleyer: Yeah, so as your question already implies, data are really important to both understanding and then also mitigating climate change. As you know, medical informatics is working at the intersection of data and health. So we work with data all day long in order to understand disease and so on. And so, one key takeaway from this discussion was that we need to do more to integrate data with each other, both at the data about people level.... For instance, who are the people who are at risk during a heat event? If you knew that, you could direct the resources in your community in a much more targeted fashion than without that knowledge.... And at a bigger level in terms of integrating environmental data with data about people and their health. So, for instance, if I knew where the wind blows during a wildfire, I would know which areas would likely experience a decrease in air quality. And then, I would have to focus on the people with asthma or other respiratory diseases in that area so I can make sure that they don't get too sick.

So a wildfire is something very immediate. The fire burns in Canada, two days later we have the smoke in Indiana, as happened last summer. Something more gradual is the migration of diseases into new areas. So with the shifting weather around the globe, what's happening now is that the climate for certain species of mosquitoes becomes more friendly in certain areas. And so we for instance, see or anticipate the return of malaria, dengue, or Chagas into areas where it hasn't been or maybe where it has never been. And so part of what we can do is actually monitor electronic health record databases for the appearance of those diseases. Because then we can track those diseases, we can help physicians and other clinicians with advice on how to diagnose chagas. Most people have not seen a case of chagas in their lives. And so there [are] lots of different things that we can do with informatics that help either adapt to or mitigate climate change.

Hannah Nelson: Thank you for giving me the example of how this kind of data exchange could really be leveraged to improve public health outcomes. Dr. Schleyer, in what ways can data systems be leveraged for the inter-agency communication and effective allocation of resources in disaster response and public health planning in general?

Titus Schleyer: So if we had a magic wand and could, in an instant, connect all the data systems we want to connect to each other, I think the impact would be huge. It reminds me a little bit of total information transparency, which we rarely have. Because as you know, the owners of data are all very different. It's healthcare systems, it's local, regional, and state departments of health. It's emerging response systems like the fire department. And so one thing that is very clear we need to work more on is the ability to integrate these data and integrate the data much more in real-time. As you probably remember from the COVID pandemic, gathering real-time data about patients' experience or people's experience and exposure to COVID was very difficult. And I remember stories of health departments faxing data sheets to, for instance, state health departments. And clearly that's not very scalable, it's very slow. So we need to work on systems that exchange data much more fluidly. That means we need to get the people who own the data and who collect the data together. And that's probably one of our biggest challenges going forward.

Hannah Nelson: Yeah. Could we expand on that challenge in terms of establishing an informatics infrastructure to work to address the impact of climate change on health?

Titus Schleyer: Yeah, I think that's a good question. And I think our recent experience with COVID-19 gave us some really important lessons. So people realized that this was going to be a very significant public health problem. And what I hear from my hospital colleagues and healthcare system colleagues is very often they say COVID-19 made things happen in a matter of days and weeks that would've taken us years and decades without it. And I think that is something really important to keep in mind. We can actually act in concert, we can pull ourselves together. We can build bridges where there were no bridges and we can put data together to solve a problem. But we are best when there's a real crisis. And COVID was a great example for that. I don't think people consider the climate crisis as an urgent matter, at least some people don't. And so I don't see the sense of urgency, the sense of, "Hey, we got to work on this." And so I think getting more of that view into our general consciousness would galvanize action better. Because, as we know, climate change is real and it's happening right now. And the people in New Orleans can tell you all about it.

Hannah Nelson: Yeah, that is such a good point. Dr. Schleyer, having the impetus of COVID-19 and having that kind of advanced data exchange and the fact that a lot of people do not see climate change as a pressing issue at this time, I could definitely see how that would be a challenge for establishing this kind of infrastructure. So Dr. Schleyer, at this moment, what can healthcare organizations and healthcare do to reduce the carbon footprint?

Titus Schleyer: Yeah, so what most people don't know is that healthcare in the United States produces about 10% of the nation's greenhouse gas emissions. Worldwide the percentage is 4.4%. So those are not trivial numbers. And when you look at healthcare as an industry, we certainly see where it creates greenhouse gas emissions. Clinicians and patients have to drive to hospitals. We have to create products, drugs, single use products to deliver healthcare. We administer anesthetic gases, which are actually very potent greenhouse gases. We run computer systems, they need electricity. And so all of these activities, they create our healthcare carbon footprint.

And so, one of the things we can do is we can start measuring that footprint. And quite a few health systems have started to do that already. How much electricity are we using for heating and cooling? How much carbon is generated by people traveling? And then we can start to think about, so can we adjust how we operate to reduce that carbon footprint? So, for instance, we could say, well, certain visits could be instead of in-person visits, they could be telehealth visits where at least the patient doesn't have to travel, and sometimes the physicians doesn't have to either. So we already can reduce the footprint a little bit. How up to date are our heating and cooling systems? If it's a very old set of units, they tend to be not very efficient. Newer units tend to be much more efficient. So does it make sense to upgrade them? And last, what's the consumption of all our electronics? What a lot of people don't know is that a single query to something like ChatGPT consumes a lot more energy than an equivalent query to let's say the Google search engine. And so I think we should become conscious of how much greenhouse gases do many of our activities emit and how we can reduce them.

And one bonus in all of this is some of the measures we can take to reduce our carbon footprint actually save money. So for instance, switching out an old air conditioning unit in a big healthcare system or old air conditioning technology for newer technology might be kind of a big capital investment, but it's going to pay dividends down the road because the new units are going to function a lot more efficiently and effectively.

Hannah Nelson: So now, what next steps is Regenstrief taking to keep this conversation going?

Titus Schleyer: Yeah, good question. So the good news is we're not alone. What I'm finding is that lots of people really open up and volunteer for things once you start talking to them about climate health and informatics. And so that in part gives me hope. So we're going to work with our partners to create more awareness, to communicate more things. So one very concrete thing that's going to come out of that mini-summit is that we will write an editorial for a major journal in which we'll summarize what were the ideas generated and what were the issues discussed during the summit. I then want to follow up with a larger conference that will develop a much more robust action framework and research framework for this area. So that's maybe my one, one and a half year plan. I have the AMIA discussion forum on climate health and informatics, which now includes about, I think 35 people, up from zero four months ago. So there's lots of motivated people who are going to help me do this, and then, hopefully, we can make an impact as soon as possible.

Hannah Nelson: I've observed a lot of pessimism around climate change. How can we get out of this mindset and actually work towards improving the future?

Titus Schleyer: Yeah, that's a very good question. It's very easy to get pessimistic and despondent in the face of a crisis that feels very existential. It's worldwide. It really affects every single person on the globe. And we look in the mirror and we ask, "What can I do about it?" And many times the answer is, "Well, I don't think very much." And I don't think that's true. So at the big picture, clearly, we need to keep innovating to remedy some of the problems that climate change is creating for us. So examples are going to greener methods of energy creation, solar panels, wind power, electric vehicles that don't emit as much, or actually no greenhouse gases themselves. So that's one item. Keep innovating, but that's not going to get us out of this quandary all by itself. It will help.

The second thing is we need to work on policy. So a lot of what we do, our way of transporting things, our way of generating energy, our way of eating, those are things which we've obviously done for most of our lifetime. So we kind of think it's natural to use coal-fired plants or oil-fired plants or gas-fired plants to generate electricity. But we need to rethink that and, from a policy level, move away from those things. They're not helping us.

And then the last thing is we have a broad range of individual things that we can do. We can make choices. We can take the bus instead of a car. We can bike to work if the distance is correct, we can adjust our diet. Moving away from a meat-based diet will save greenhouse gases, because growing cattle is extremely resource-intensive. So there are a lot of opportunities.

The last thing I might say is the following: we used to be called people, now we're called consumers. And that's actually a relatively recent phenomenon. But when you think about the word "consume," it means "to use up so it's not there anymore." And so we think of ourselves as the people who use up resources on this planet, and we need to think of ourselves more in a sustainable way.

Interestingly enough, up to about 50,000 years ago, the precursor of today's human race, they lived without any ill effects on their environment. They didn't overly consume resources, they didn't produce too many greenhouse gases. And so everything kind of was in balance. But when you think about the last 10, 20, 50, 100, 200 years, consumption suddenly was the big thing. We connected consumption to economic growth, and suddenly it was something we all had to do.

Well, we need to rethink that. We need to think about how can we make our lives more sustainable and live more within the means of this planet? Because the resources of this planet are finite. There is no one more earth that we have easy access to. There's only so much oxygen in the atmosphere. And so we really need to think about how do we make our lives more sustainable, both in the small as well as in the big picture.

Hannah Nelson: Yes, I love that. Making our lives more sustainable and working on an individual level. I think it's really important that we don't fall to the pessimism of climate change and actually do the things that we can do on a daily basis to drive change. So thank you for reminding us of that. Dr. Schleyer, thank you so much for joining us today. I really appreciate it.

Titus Schleyer: Yeah, and thanks for the opportunity to talk about this subject. If any one of your listeners is interested, please give them my email address. It's actually all over the web, so it's not hard to find. I'm looking for people who are interested in making change here because that is what we need.

Hannah Nelson: Great. Thank you Dr. Schleyer. And to all of our listeners, thanks for joining us. If you're interested in learning more about this topic, visit ehrintelligence.com. If you have thoughts on this topic or if you have any healthcare-related stories that you'd like us to consider for coverage, you can reach out to me at hnelson@techtarget.com. That's H-N-E-L-S-O-N, at techtarget.com. Follow us on Spotify to get more of these conversations and let us know what you think by rating and reviewing the show. See you next time.