Climate Change
What Florida Physicians Can Know and Do

Todd L. Sack, MD, FACP

The world’s climate is warming as the result of human activities. This statement was until recently highly controversial and even a pariah within Florida’s medical community. Now climate change is widely accepted as fact, ratified by every sector of our society and by institutions that generally hold the respect of physicians, including the National Academy of Sciences, the American Medical Association, and each living American President. What remains hotly debated is what America should do to help prevent climate change and to mitigate its effects. I believe Florida’s physicians should prepare to engage in this debate.

This year, the Florida Medical Association’s Board of Governors took strong steps in this direction by adopting new policies on climate change (available at www.fmaenvironmentandhealth.org). The FMA is building on its 2005 policy positions concerning the health hazards of coal and petroleum-powered electricity generating plants, and policies urging statewide energy conservation. The FMA now calls upon government at every level, the AMA, and individual physicians to take meaningful action on global warming.
As Floridians we are especially vulnerable. We are graced with warm sunshine that is the envy of our northern neighbors. As the temperature warms in the coming decades, we will experience more seriously hot days and seriously violent storms. The world’s oceans have risen just a few centimeters over the past century but are expected to rise by another foot, and possibly by several feet, by year 2100.

Florida’s current population of 18 million will grow past 30 million by mid-century. Approximately 80 percent of us live at low-lying elevations within 20 miles of the ocean where we are highly susceptible to rising sea levels and to more fierce tropical storms. Rising seas have already led to saltwater intrusion into fresh water wells and may threaten the Florida Aquifer in the future, the principal source of our drinking water. Other environmental concerns include the losses of our coral reefs and fisheries as the seas become more acidic, the extinctions of species of great natural beauty and with potential pharmaceutical benefits, and the emergence of tropical diseases such as Malaria and Dengue Fever.

Just The Facts
The facts for a changing world climate come from direct temperature measurements collected over the past two centuries and from indirect assessments taken from historical records, from tree ring widths, from stalactite composition, and from arctic and Antarctic ice cores. The ice core measurements offer the most definitive long-term record. Atmospheric carbon dioxide is trapped in polar ice when snow falls. The trapped carbon dioxide can be measured by today’s scientists to chronicle the levels of atmospheric carbon dioxide and world temperature across 650,000 years.

The world’s climate data has been catalogued by an international organization, the Intergovernmental Panel for Climate Change (IPCC). The IPCC reports its findings every six years; the Fourth Assessment Report is being released in three parts in 2007.

The key conclusion of the IPCC current report is the concentrations of climate warming gases, the so-called “greenhouse gases” (GHGs), are increasing due to human activity (Figure 1). The major GHGs are carbon dioxide (released primarily from the burning of fossil fuels), methane (from garbage dumps, natural gas leaks and domestic animals), and several industrial
hydrocarbon and nitrate gases. Carbon dioxide, by far the most important GHG, persists in the atmosphere for decades, where it traps the sun’s heat and prevents heat from radiating back into outer space. The fact of climate change is a matter of simple chemistry: as CO2 rises, the temperature also will rise.

The 4th IPCC Report indicates that for 620,000 years prior to the Industrial Revolution there were natural fluctuations in carbon dioxide between 180 and 300 parts per million (ppm). Since 1800, carbon dioxide levels have gradually increased, reaching 380ppm in 2005, far beyond the highest levels spanning many geological eras, ice ages, and previous warmings. Most worrisome is the Industrial Revolution’s 1.1 percent annual growth in carbon dioxide atmospheric levels leapt for 2000-2004 to a 3 percent annual growth, according to the Proceedings of the National Academy of Sciences. The world’s annual CO2 release rose from six billion tons in 1995 to nearly eight billion tons of carbon in 2005.

The average world temperatures rose 0.76 ° C between 1850 and 2005, and the IPCC predicts by 2100 a 1.8 - 4.0° C rise over 1850 values. To place this in context, the last time the world was 3-5° C warmer than present, about 125,000 years ago, the polar ice sheets melted and sea levels rose 4-6 meters. Most of peninsular Florida was submerged for millennia.

Our Nation’s Response
Serious scientists, economists, and public servants no longer doubt the fact of a warming global environment, its causes, or its consequences. The real debate is over how extensive and how expensive should be mankind ‘s collective response to what is unfolding. The Federal government has long recognized that warming is real. We led the negotiations, which produced the 1997 Kyoto Treaty to limit greenhouse gases that was signed by 160 nations but never ratified by the Senate. At that time, US leaders were skeptical of the climate problem, concerned about the costs of treaty compliance, and disturbed that Kyoto does not regulate the GHG’s of emerging industrial giants such as China and India. The Federal government has continued to study the phenomenon of climate change but has offered little leadership to the States.

States and Cities Take Action
On July 13, 2007, at a meeting of world experts in Miami, Florida Gov. Charlie Crist unveiled a broad program to curtail greenhouse gas release in Florida. He recognized Florida’s important role as part of the problem -- considered as a nation, Florida would be the world’s 26th worst GHG emitter -- and Florida’s role as a trendsetter. He pledged our carbon dioxide emissions would reduce to the levels of year 2000 by 2017, to 1990 levels by 2025, and to 80 percent of 1990 levels by 2050. These changes, if adopted by most countries, would not stop climate change immediately but would slow it down and would avert the dire predictions of climatologists.

With this proclamation, Florida joins the 160 nations, 22 other US states, and 650 US cities that have pledged to Kyoto-like changes. Even China, the world’s largest producer of GHG’s, has recently announced striking energy efficiency standards that begin to move that economy in a more responsible direction.

Governor Crist’s July Executive Orders require each state agency to document its GHG emissions and to develop plans for substantial reductions. This will apply to new building designs, conservation efforts at existing buildings, vehicle use, and land use. Each department will have employees responsible for its energy use plan. Gov. Crist intends to “lead by example” to use the financial clout of state government to help create markets for energy-saving innovations and entrepreneurial investments in Florida. Innovation will be essential because we will not reach Gov. >>>

Crist’s ambitious GHG targets without significant technological breakthroughs in the coming decades.

The Florida Legislature, together with the Governor, will decide over the next several years how to begin to implement the GHG reductions. Changes to be proposed will affect every facet of our economy, including the appearances of our cities and homes, and the vehicles we drive. Floridians will think about energy, use energy, and pay for energy much differently than we do today.

4 Steps Physicians Can Take
Climate change and its causes are so daunting that it is tough to know how to begin to tackle it. Florida physicians are no different from other citizens in this regard. We are different, however, in several aspects. Our practices and our families likely produce more GHG’s than those of most people. We do so through the burning of fossil fuels needed to produce energy for our busy, productive and affluent lives. We are also community leaders admired and emulated by our friends, neighbors, and patents. What we do undoubtedly influences what others do. From the environment’s standpoint, what happens in your office does not stay in your office!

“Step One” for a physician is to take a personal interest in climate change. There are plenty of fascinating things to read and to observe that will capture your attention and secure your interest in this pressing problem. Some useful resources are listed at the end of this article.

“Step Two” is to make the commitment to change your use of energy and other natural resources. Even simple steps, such as changing all of your home’s incandescent light bulbs to compact florescent bulbs, will save you money and make a difference.

“Step Three” is to make greenhouse gas action plans for your homes and businesses. These plans can be written down or not, depending on how complex you want them to be and how much you wish to save. Anyone can start by taking just ten minutes to calculate his or her annual household GHG “footprint” at www.ghgprotocol.org.

Most Florida physicians can save 20 percent on their monthly home utility bills by making minor adjustments that will not alter their lifestyles. This represents a large amount of money saved each year, plus big GHG reductions. A family’s planning can go on to consider whether to recycle, how to travel, what to buy, and even what to eat. What sorts of cars and trucks we purchase can make a difference for the environment and for air quality. Plus, our choices influence the decisions of others. If every American for their next two new cars chose vehicles that deliver fuel efficiency of 30 miles-per-gallon or better, the United States would no longer need the petroleum imports of the Middle East and Venezuela. What begins as a question of environmental and human health has become an issue of economic and military security.

An energy plan for the medical office can begin with simple money-saving measures and expand with the interest and enthusiasm of the doctor and the staff. Most local utility companies offer a free energy use consultation either online or by an expert who visits the practice. An office can create a Climate Action Team to develop the climate change action plan, collect ideas, communicate the plan, and help with its implementation. Some of the possible elements of a “green office” plan are listed in Table I (See tables at end of article). A beginning plan might include energy and water conservation efforts, the decision to recycle, an inventory of office chemicals including cleaning products, and efforts to educate your office staff and patients. The climate change action plan is intended to be an evolving methodology that changes with time and technological improvements.

The FMA’s Environment & Health Section is hoping to develop a free Web-based module to help each office perform a GHG self-assessment, to develop a climate change action plan, and to earn a “Green Office” certificate from the FMA.

“Step Four” is for the physician to become a community advocate for greenhouse gas reduction. This can begin at your hospital. The Florida Hospital Association and other organizations offer abundant resources for hospital administrators to evaluate and improve their environment practices, yet only a handful of Florida hospitals have been certified for their action plans. Asking questions of the CEO and of Board members is an easy step.

Physicians can ask to be appointed to their local environmental boards or planning commissions where important decisions are made affecting community resource uses and greenhouse gas emissions. Your county medical society or FMA often can help secure these appointments. Physicians learn a lot, contribute significantly, and find great personal satisfaction at these venues. Any public institution or business can have a climate action plan, and likely save money while helping the environment. Physicians can ask questions and get involved at their churches, mosques or temples; at their children’s’ schools; and at their local clubs-- anywhere energy is used.

What’s Next
Already the world is experiencing environmental changes resulting from air pollution over the past 150 years, and further changes are inevitable. But experts believe we can avert the worst effects of global warming if over the next 50 years we reverse the current massive worldwide releases of greenhouse gases. To do so will not be easy. It will require rethinking how we use energy in our homes, our businesses, and our lives. It will be dependent on technological innovations and discoveries by our >>>
finest engineers and scientists. It will require tough decisions by our policy makers and politicians. Florida’s physicians have a unique perspective as guardians of the health of our patents. Our role now should be to take an interest in climate charge, to make the personal commitment to change, to develop greenhouse gas action plans for our homes and practices, and to engage in the current climate change debates.

Web Resources:

www.ccap.org
Center for Clean Air Policy, Washington, DC. Climate planning resources for policy makers in government & private sectors.

www.centurycommission.org
Reports on Florida’s future.

www.chge.harvard.edu
Health impacts of climate change from the Center for Health and the Global Environment. Its President, Dr. Eric Chivian, spoke at the FMA Annual Meeting in 2006.

www.energyguide.com
An energy use self-assessment tool.

www.energystar.gov
Resources and certification for small businesses, from the US Dept of Energy.

www.epa.gov/climatechange
Comprehensive global warming documentation by the US Environmental Protection Agency.

www.fcec.ucf.edu/en
Proposals on alternative energy, conservation, transportation and urban planning from the Florida Solar Energy Center, a major research center.

www.floridaenergycommission.gov
Florida Energy Commission’s 2007 presentations on many topics of climate change and options for Florida.

www.fmaenvironmentandhealth.org
Policy positions of the Florida Medical Association, web links, and resources for how physicians, their families, and their staffs can get involved.

ww.gghc.org
Green Guide for Health Care, 2007, is a free, comprehensive planning document for architects, engineers, and community planners.

www.ghgprotocol.org
Calculate your family’s greenhouse gas footprint.

www.ipcc.ch
Reports of the Intergovernmental Panel on Climate Change,

www.jea.com/business/services/smallbus/index.asp
Online tools for small businesses, including physicians’ offices, for energy & cost savings.

www.noharm.org/going
Green A resource kit for pollution prevention in health care.

www.publicpower.com
Useful perspectives from the Florida Municipal Electric Association.

www.together.com
Climate change information for consumers from The Climate Group, a UK & Florida-based non-profit.