Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay, and today we're going to talk with Dr. Yvonne Collins, County Care Chief Medical Officer, about climate change and our health. Thank you so much for being here today and joining us, Dr. Collins.

Yvonne Collins, MD, FACOG: Thank you so much for the invitation. It's exciting.

Host: We hear about climate change and global warming, all these kinds of topics, but can you explain to us what is climate change? 

Yvonne Collins, MD, FACOG: Climate change encompasses global warming. Climate change really just describes the long term average changes within a region. So you begin to see more extreme weather, from that, we also know that climate change then indirectly affects our health, our food scarcity, and we could go on on many topics.

Host: How did you get interested in this area?

Yvonne Collins, MD, FACOG: So I'm a gynecologic oncologist by training. I've always been interested in health inequities and healthcare disparities. And as I looked and tried to determine causes of why I would see Black women compared to my white patients who, presented with more advanced disease, didn't respond the same way to therapies, as I began to look at it; several factors came up related to potential environmental factors or carcinogenic factors. When you dig a little deeper, a lot of those are tied to effects of climate change. So as I look at health equity, climate change, is actually an equity issue. So as we look at how we improve healthcare disparities, we have to also address climate change and the impact on health.

Host: I have to admit, I never considered climate change affecting our health. So this is fascinating. How is climate change impacting our health? And who's most at risk of health effects due to climate change?

Yvonne Collins, MD, FACOG: Yes. So the list of those who we consider vulnerable are who you really think of in the sense of vulnerability every day. So our very young, our children, our seniors, those with chronic diseases. our ethnic minorities, those who come from poorer communities, have a lower socioeconomic status, those are who we would all consider vulnerable, in addition to those who have disabilities. 

So when we think about that, we always want to say, let's take a look at how climate change is impacting this community. And when we look at that, we see an array of health conditions that are impacted. Five million deaths annually related to extreme weather events, whether that's too hot or too cold, seven million premature deaths related to air pollution, but our health is significantly impacted by climate change.

Host: So you just mentioned a couple. Are there other illnesses associated with climate change?

Yvonne Collins, MD, FACOG: Yes, how much time do you have? But yes, there, are. So there are infections that are impacted by climate change, whether or not it's changes in our food or in our water, cardiovascular disease, respiratory disease, especially asthma and COPD. There have been associations made with cancers and climate change. 

All the allergic symptoms that sometimes we think are related to allergies, very commonly are related to pollutants in the air as a result of climate change. We also know if we look at reproductive issues, infant mortality, premature births, congenital abnormalities, all of those have been associated with climate change risk.

Host: So if you have patients or somebody who has family members who are vulnerable, how do you guide them? What do you ask them to do and what do you caution them to be careful about? 

Yvonne Collins, MD, FACOG: The first component I think is education, which is why we're here today. I think very commonly our population, a lot of our providers have not made the connection between climate change and health. So we often actually think of climate change as polar bears and ice glaciers, but we know it's much bigger than that.

Folks are dying every day unnecessarily related to climate change. So education, I would say, would be number one. Once you educate, you begin to identify those who are at risk, and then you begin to educate them on what are strategies to decrease that risk. So number one, we know we have to decrease our carbon footprint.

So simple, easy things we often think about, but don't do. So, turning off the lights when you leave a room, unplugging when you're not using devices. If you have your own home, think about your HVAC system, your light bulbs, solar panels. But even bigger than that, we know that when folks are at risk, we can also give them strategies to protect themselves, to decrease that risk.

And we may talk about it a little later, but for example, with air pollution, we know that if we have an asthmatic or a patient with COPD and we know it's really muggy outside, that may be an opportunity where we educate and say, you know what, maybe you go out later in the day when those conditions outside are better, or maybe you should put on a mask depending upon where you live. 

The connection allows us to educate and then equip those within our community to make good decisions for their health.

Host: And how will our health systems, hospitals, primary health care centers, the entire health infrastructure, how will we cope with these impacts of climate change on our health?

Yvonne Collins, MD, FACOG: The healthcare system, when we look at the healthcare sector, is the largest contributor to greenhouse gases. So when we look at it, we have to look at it from the perspective of our workforce. Where does our workforce work? What kind of chronic conditions does our workforce have? What do they know about education in terms of climate and health?

And then our infrastructure. Are we in an area where perhaps we're more prone to flooding? What do we know about our energy use? Are we being good neighbors in terms of decreasing the amount of energy we use? Decreasing the amount of water waste we use? So beginning to think about all those components.

But it all ties into everything that we do every day. We have to begin to think about where we're getting our food and what kind of food are we giving to our patients? How we're serving that food? What kind of gases we're using in the operating room? What kind of medications do we know make a difference in terms of decrease in our carbon footprint, but more importantly, the healthcare system has to understand that climate change, especially related to extreme weather events are going to cause decreases of access to care.

And so we have to be ready for all of those, should they happen in terms of being prepared.

Host: That's a big list and a big overall. Are you, hopeful that it can be reached within a timely manner?

Yvonne Collins, MD, FACOG: If you look at all the literature, the goal is 2050. At the rate we're going, it's really dependent upon what we continue to do today. I think we have a lot of strategies that could get us there, but if you think about our system, we're a government agency, our funding is very limited, all of the strategies that we would put in place to do all of those things I talked about, are very costly. So we have to begin to look at how do we finance it? Who's going to help us finance it? But if we can get all of those pieces of the puzzle in place, I am hopeful that we can make a difference. And that's why I'm here today really to educate so we can move forward.

Host: That's encouraging. The other day I was running with some friends and we were talking about smog. And I grew up in LA and I said, you know, in the 70s, you could just see it. It was thick, like brown air. Now it seems to be better. But let's talk about air quality, indoor and outdoor. How are those defined? And what are the risk factors that people can adjust to decrease their own risk exposure? 

Yvonne Collins, MD, FACOG: Seven million premature deaths every year related to air pollution. When we look at outdoor air pollution, those are the particles that float around in the air that we so very commonly cannot see but impact us substantially. It's the exhaust from cars. It's the smoke emissions that come out from buildings.

Those are what we think about when we think about outdoor pollutants. When we think about indoor pollutants, unfortunately, it's the appliances we use to cook. It's the cleaning agents we use to clean our homes with. It's the radon that may be being emitted into our homes, the carbon monoxide, all of those things we have to think of.

And we also have to remember that things are on the outside, unless you've completely sealed your home or apartment seep into the inside. And we know substantially, again, the vulnerable are the most vulnerable because they don't have the ability to really mitigate in most cases in terms of making those modifications to their homes.

So we recommend, because we know that cardiovascular risk increase. We know the respiratory risk increase. We know that intrauterine fetal demise increases and preterm labor increases. What can populations now do to really begin to equip themselves? And so the recommendation is two things, one a little easier than the other.

So there are some natural ways in terms of houseplants that help absorb some of the pollutants in the air. We can't do that alone but that is one option. We also recommend air filters and purifiers where we're able to catch those things that we can't see and help purify our air. And there are some guidelines around how we do that but those are the two recommendations in terms of what folks can do in addition to being careful about the kind of appliances that you use in your home.

So if you have a gas stove, perhaps if you can afford it, look at how you replace that. Environmentally friendly chemicals and maybe chemicals that you normally clean your house with that you can make, but there are all those things that we can do potentially to make a difference every day.

Host: And why is it important to be aware of the air quality index? 

Yvonne Collins, MD, FACOG: The air quality index is a marker that lets us know the amount of gases that are in the environment. So it lets us know whether the air we're breathing is either unhealthy or healthy and why is that important. It's a numerical system that actually probably everybody has access to now, especially if you have an iPhone.

You're able to see, go on there and see the air quality and it gives you a numerical value. You really want to stay in that green zone. Green is good. If you remember, red, yellow, and green. Green is good. That means that the air outside is healthy for everybody. There's nothing in terms of precautions that you need to take when you go out.

As those colors go down that gradation scale, it tells us how unhealthy the air is. If you are one of those folks that are vulnerable, especially with respiratory conditions, again, it allows you to equip yourself either not to go out, or to mask, and it allows you to be able to operate outside.

Additionally, for our athletes, because we can't forget our athletes are outside, the vast majority of the time, it also helps equip them in terms of if they're at risk when they shouldn't be outside practicing or exercising in poor air quality.

Host: With the recent fires in Los Angeles, Altadena, Pasadena, Palisades, the air quality was so bad. And they said, literally, if you can just stay indoors for days, at least wear a mask. I mean, that's going to be there for a long time. What do you tell people who have to live near sites like that? I mean, there's fires everywhere, but especially these; how do you guide people who have to live near there to decrease their risk of inhaling all those particles that you can't even see?

Yvonne Collins, MD, FACOG: Absolutely. If you can stay inside, number one, that's the most important, stay inside. If you can have an air purifier inside of your house, that's also best. You also want to be careful with vacuuming within your house if you don't have to during that time because the vacuum actually just blows particles, additional particles in the air that may also worsen the air.

If you have the ability to go through and reseal air vents, window sills, et cetera, go ahead and take that opportunity do that during those times. If you have an air conditioner, it's an opportunity to run your air conditioner. Again, realizing all of those ways potentially that you can remove those pollutants from the air.

Host: I think we've answered this one, but I'm going to ask it anyway because I think it's important. Is it true that climate change is impacting lower income communities more than wealthier ones?

Yvonne Collins, MD, FACOG: We know from lots of data that those that have the worst harms from climate change are ones that contribute the least to the problem. The EPA has what they call the Climate Vulnerability Index, which really looks at what populations, based on their education, based on their income, based on where they live, are more susceptible to six factors of climate change.

And really, it looks at flooding, it looks at work risk, it looks at extreme temperature. And we found, as so many other pieces of data have shown, that Blacks and Hispanics, bear the greatest burden in terms of living in flood areas, of having jobs that require them to be outdoors and so they have less access to cooling, and Black communities are more at risk for respiratory diseases, especially asthma.

Host: So what can doctors and patients do to make a difference with climate change?

Yvonne Collins, MD, FACOG: Patients can do all of those things that we talked about just a moment ago, in terms of education, advocacy around the topic, precautions, when you can make those precautions. Doctors, I think, play a greater role in that because of the trusted voice that they are. So really beginning to build into your everyday work balance and history taking is really looking at what we call the climate history.

Knowing when you're having conversations with your patients, where they live, how old are their homes, do they live around industrial industries, do they have hobbies that would potentially make them at more risk for breathing contaminated air? What kind of stoves they have in their homes, what kind of water do they have? 

All of these questions get to potential areas where we can educate on mitigation strategies. It's hard to change and I, I know it's limited time, but if you begin to really think about incorporating maybe one of those, into your history taking, eventually you can get through that entire history and list. And then advocate, advocate, advocate.

Host: All this information has been so informative, Dr. Collins. In closing, any other advice for our listeners about climate change and what you can do about it, how to stay healthy?

Yvonne Collins, MD, FACOG: Two things I just want to put on the radar, we didn't talk a lot about them, but we also have to be cognizant of heat. A significant number of folks die from heat exhaustion and heat related illness every day. It's increased over the last 20 years 800%. So advocacy around breaks, around water, around sunscreen are really important.

And then when we talk about disproportionately impacted communities, flooding, there needs to be additional advocacy, not only around flood insurance, but also, really equipping populations to understand if they're in a flood zone, how they mitigate that, and really teaching our little ones how to swim because we know drowning happens substantially with heat related illness and also in flooding. But we have to act now. There's a lot for us to do.

Host: Thank you so much for shedding light on this important topic that seems to not get discussed often enough. So, I'm glad we got to talk about it and learn some things today.

Yvonne Collins, MD, FACOG: Thank you so much. My pleasure.

Host: Again, that's Dr. Yvonne Collins. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share, and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay, signing off from Total Health Talks. Stay well.