This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

According to the 2019 Natural Resources Defense Council (NRDC) report "Climate Change and Health in Michigan," Michiganders face a number of negative health outcomes from climate change, including heat-related illnesses, breathing and heart troubles, food and water contamination, mental health challenges, and infectious disease.

Juanita Constible.

"As temperatures rise and rainfall becomes more extreme, you have things like heat-related illnesses and death, mosquito- and tick-borne illnesses such as West Nile virus and Lyme disease, waterborne illnesses like giardia, and mental health challenges like PTSD and anxiety," says Juanita Constible, the author of the report and a senior advocate at NRDC. "And there's probably a lot more."

Michigan physicians are taking note of climate change impacts on their patients' health, and they're taking action. Members of both Michigan Clinicians for Climate Action (MiCCA) and the Michigan State Medical Society (MSMS) are working to address and raise awareness of climate change's adverse health effects.

In 2014, MSMS adopted its Climate Change Resolution, which states that "climate changes will create conditions that affect public health, with disproportionate impacts on vulnerable populations, including children, the elderly, and the poor." The resolution also recognizes that physicians can take meaningful action to advocate for state and federal policies to mitigate climate change.

MiCCA also focuses on climate policies at the local, state, and federal level. Dr. Elizabeth (Lisa) Del Buono, a physician advocate with MiCCA, practiced as a surgical pathologist at Munson Medical Center in Traverse City for more than 20 years.

"Climate change is a threat multiplier," she says. "For example, we're dealing with a pandemic, a time when staying at home is the right thing to do. Then you have these climate events that displace people and force them to leave their homes. Climate change takes something that is already bad and multiples that threat, forces displacement at a time when it is very risky."

Extreme heat, extreme weather, and extreme health concerns

Higher temperatures, one of the most noticeable effects of climate change, are already a trend across the nation. Here in Michigan, average maximum temperatures have risen by more than 2 degrees Fahrenheit since 1895. While extreme heat fuels wildfires on the west coast, rising temperatures in Michigan are also taking a toll, especially in urban areas. Lack of green space coupled with the built environment's capacity for absorbing heat makes cities like Detroit and Kalamazoo literal hotspots.

"Heat can exacerbate many chronic conditions, for example, congestive heart failure," Del Buono says. "And every year we lose young athletes because of heat. That will increase over time."

Larry Junck.

Del Buono's colleague at MiCCA, Dr. Larry Junck, concurs. Junck is a neurology professor at the University of Michigan Medical School and a sponsor of MSMS' Climate Change Resolution.

"We can expect to see more heat-related health problems in the future," he says. "These could especially affect urban areas where people have less resources to deal with extremely hot weather. There is more violence when there is hot weather, and it has an effect on people with preexisting health conditions."

Hotter temperatures also exacerbate air pollution's impact on Michiganders' health. Urban areas near busy highways or coal-fired power plants suffer the most.

"Air pollution is an unrecognized and large cause of death and illness in this country and in Michigan," Junck says. "Complications include heart disease, stroke, chronic lung disease, asthma — especially in children — and other major health consequences. The people of Michigan and the physicians of Michigan underrecognize the importance of air pollution as the cause for health problems."

Last, as the number of warmer days increase, so do risks for insect-borne infectious illnesses like West Nile virus, Lyme disease, and, in the future, malaria. These warming trends also heat the Great Lakes, inland lakes, and rivers, causing more algae blooms that contaminate the waters and cause skin irritation, diarrhea, vomiting, and liver damage for swimmers.

A warmer globe also means a wetter Michigan. According to the NRDC report, from 2010 to 2014, 17 Michigan weather stations recorded more extreme rain days per year than ever recorded before. In addition to causing floods, the stormwater runoff overwhelms the state's aging combined stormwater and wastewater systems. That results in raw sewage contaminating rivers and lakes, making them hotspots for bacteria like E. coli and hepatitis A.

Del Buono notes that while Michiganders may not be hit as hard by hurricanes or wildfires, those disasters' impacts on the economy, agriculture, and supply chains reach all 50 states and beyond. And when extreme weather damages hospitals and medical facilities, even more people will feel its health consequences.

"In Michigan, we are seeing more and more heavy precipitation events that lead to flooding. Last year, we saw quite a few in the Traverse City area and Midland," she says. "Even here in Munson [Medical Center], in Traverse City, the first floor of the hospital flooded during the pandemic."

Climate change and Michigan's vulnerable populations

"It is important to remember that the climate change isn't happening in a vacuum," Constible says. "It magnifies the existing health threats in under-resourced and marginalized communities, communities of color, low-income communities, the very old, the very young. Increasingly we're finding more evidence that workers, whether outdoors or folks that work in conditions that aren't climate-controlled, are among the most vulnerable groups."

As with COVID-19, climate change-related illness is taking the largest toll on Michigan's most vulnerable populations.

"We are in the midst of two public health crises right now," Del Buono adds. "One is very acute and fast-moving. The other is building up and has the potential to dwarf what we're seeing today with the pandemic."

Lisa Del Buono, physician advocate for Michigan Clinicians for Climate Action.

While mental health has not been at the forefront of climate change concerns, Constible explains that experiencing one severe disaster or multiple smaller ones puts everyone at risk for PTSD and anxiety, but it can be especially hard on those with existing mental health conditions.

"We still are learning of more links between climate change and mental health," she says. "Even extreme heat can aggravate mental health. Heat affects the way our brains function. Extreme heat, over multiple days, can increase violence and even the ability to do small motor tasks, to learn, and to stay safe."

Climate action for public health

"It used to be that if you Googled 'Michigan and global warming,' a 'Popular Science' magazine video popped up about where to live in America with climate change. It concluded that everyone should move to Michigan," Constible says. "But no place is completely safe. Michigan is facing more frequent heat waves, floods, and droughts which have health impacts as well."

That's why Junck, Del Buono, and their colleagues at MiCCA are taking action. They believe medical professionals play a key role in halting climate change. First, as respected experts, they have influence with state and federal policymakers.

"We need government action to lead us all down a good path to using less fossil fuels … and deriving our energy from sustainable sources. That transition will generate jobs and be good to the economy. Right now, our leaders are invested in protecting technology from the last century," Junck says. "Our government can lead us in other ways, as well."

Second, as practitioners, providers can share the health impacts of climate change with their patients and colleagues. And third, as key players within health systems, they can leverage their power to reduce the carbon footprint of the health care sector, which generates 5% of worldwide greenhouse gas emissions.

"We are able to frame the issue of climate change not solely as a polar bear issue, but as a human health issue," Del Buono says. " … [It's] not a political issue, but a matter of science and health. Climate change should not be an issue that divides us. It should be an issue that brings us together. The technology is here. We absolutely can address this issue."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Lisa Del Buono photos by John Russell. Juanita Constible photo by Rebecca Greenfield for NRDC.