From floods to hurricanes to extreme heat, there is mounting, incontrovertible evidence that environmental exposures are having an impact on the health of the world’s population.
The exact nature of that impact, and its specific effects on conditions such as asthma and chronic obstructive pulmonary disease (COPD), have been the topics of only limited research, however, impeding the enactment of public health policies that could address the growing health and economic consequences triggered by climate change on a broad scale.
Through two innovative research projects, Mount Sinai is helping to write a new chapter in the science of environmental health. Both efforts—one centered in New York City, the other in the West African nation of Ghana—share a unique framework: weaving highly detailed satellite data on temperature, humidity, and air pollution together with patient medical records and hospital admission data to better understand the relationship between climate change and human health outcomes.
“Clinicians often don’t perform a thorough assessment of environmental exposures,” says Alison Lee, MD, MS, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), Global Health and Health System Design, and Pediatrics at the Icahn School of Medicine at Mount Sinai. “An asthma patient, for example, is routinely asked about household conditions such as mold or pets, but heat exposure and indoor and ambient air pollution exposures are often not investigated as triggers for asthma exacerbations. The data that’s emerging from our group and others can inform clinical practice and educate clinicians around assessment of environmental exposures and recommended behavioral changes to reduce health risk.”
The New York City-based study by Dr. Lee’s team is leveraging data from an electronic medical record of patient admissions for asthma and COPD exacerbations across Mount Sinai Health System hospitals spanning multiple years. Because that information reflects date of admission and patient address, it can be linked to satellite data documenting climate-sensitive environmental conditions, such as heat and humidity. Through statistical modeling, researchers are then able to determine if temperature is associated with risk of hospitalization among patients with respiratory diseases.
While the results of that study are not yet published, Dr. Lee reports they suggest that higher temperatures are associated with a higher risk for asthma hospitalization. Moreover, when demographic data from the U.S. Census are factored in, patients living in neighborhoods where more than 20 percent of residents are below the poverty level experience an even greater respiratory health impact of heat, as compared to those living in wealthier communities. When parsed by self-reported race and ethnicity, the results further demonstrate that lower-income communities of color appear to be disproportionately impacted by heat exposure.
Researchers studying the effects of climate on lung health include, from left, Dr. Lee; Yoland Philpotts, MD, Assistant Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine); Chief Resident Matilda Bartholomew, MD; and Data Manager Kholiswa Tsotetsi, MPH.
Nearly 5,000 miles from New York City, Dr. Lee is partnering with the Kintampo Health Research Centre (part of the Ghana Ministry of Health) to again pinpoint the health sensitivities of climate change and heat exposure. The methodology of this study is similar to the one in New York, where satellite data for temperature and humidity are captured and analyzed over five-kilometer-square grids, then linked to the homes of study participants. In the case of Ghana, satellite information is matched to longitudinal data from that country’s health and demographic surveillance system and other extant cohort studies to examine the impact of climate on morbidity and mortality and on birth and child health outcomes.
Climate research is urgently needed in Africa where, in the absence of locally generated climate research, public health policymakers must rely on data from wealthier countries where population dynamics and exposures differ.
“Africa is underrepresented in climate research,” maintains Dr. Lee, who chairs the American Thoracic Society’s Environmental Health Policy Committee and is a member of the Medical Society Consortium of Climate and Health. “I believe the work we’re doing in Ghana, which includes not only research but also building research capacity and partnerships with policymakers and scientific and health institutions, is critical for the generation of context-specific data and translation of findings into policy.”
Indeed, public health policy intervention is at the very heart of Dr. Lee’s work. She has had multiple discussions with New York City Department of Health and Mental Hygiene officials and community-based organizations to better understand city programs, share research findings, and advocate for more health-protective environmental codes and regulations. There is a current movement to set a maximum indoor temperature level for schools and facilities, for example, for which Mount Sinai’s latest research could provide significant impetus. This research could do the same for efforts to expand the city’s program of air-conditioner and utility benefits to qualified households.
“We need to demonstrate to policymakers and health care systems that lower-income communities are disproportionately impacted by heat and air pollution exposures, making them a costly public health issue through recurrent hospitalizations and lost days of school and work,” emphasizes Dr. Lee. “Whether it’s at the public policy or the physician-patient interaction level, we must work aggressively to ensure everyone is educated and fully aware of the toll of climate change, along with the urgent need for innovative new public health approaches to address the health impacts.”
