In a shack that now sits below sea level, a mother in Bangladesh struggles to grow vegetables in soil inundated by salt water. In Malawi, a toddler joins thousands of other children perishing from drought-induced malnutrition. And in China, more than one million people died from air pollution in 2012 alone.
Around the world, climate change is already having an effect on human health.
In a recent paper, Katherine Burke and Michele Barry from the Stanford Center for Innovation in Global Health, along with former Wellesley College President Diana Walsh, described climate change as “the ultimate global health crisis.” They offered recommendations to the new United States president to address the urgently arising health risks associated with climate change.
Bangladeshi children make their way through flood waters.
The authors, along with Stanford researchers Marshall Burke, Eran Bendavid and Amy Pickering who also study climate change, are concerned by how little has been done to mitigate its effects on health.
There is still time to ease — though not eliminate — the worst effects on health, but as the average global temperature continues to creep upward, time appears to be running short.
“I think we are at a critical point right now in terms of mitigating the effects of climate change on health,” said Amy Pickering, a research engineer at the Woods Institute for the Environment. “And I don’t think that’s a priority of the new administration at all.”
Health effects of climate change
Even in countries like the United States that are well-equipped to adapt to climate change, health impacts will be significant.
“Extremes of temperature have a very observable direct effect,” said Eran Bendavid, an assistant professor of medicine and Stanford Health Policy core faculty member.
“We see mortality rates increase when temperatures are very low, and especially when they are very high.”
Bendavid also has seen air pollutants cause respiratory problems in people from Beijing to Los Angeles to villages in Sub-Saharan Africa.
“Hotter temperatures make it such that particulate matter and dust and pollutants stick around longer,” he said.
In addition to respiratory issues, air pollution can have long-term cognitive effects. A study in Chile found that children who are exposed to high amounts of air pollution in utero score lower on math tests by the fourth grade.
“I think we’re only starting to understand the true costs of dirty air,” said Marshall Burke. “Even short-term exposure to low levels can have life-long effects.”
Low-income countries like Bangladesh already suffer widespread, direct health effects from rising sea levels. Salt water flooding has crept through homes and crops, threatening food sources and drinking water for millions of people.
“I think that flooding is one of the most pressing issues in low-income and densely populated countries,” said Pickering. “There’s no infrastructure there to handle it.”
Standing water left over from flooding is also a breeding ground for diseases like cholera, diarrhea and mosquito-borne illnesses, all of which are likely to become more prevalent as the planet warms.
On the flip side, many regions of Sub-Saharan Africa — where clean water is already hard to access — are likely to experience severe droughts. The United Nations warned last year that more than 36 million people across southern and eastern Africa face hunger due to drought and record-high temperatures.
Residents may have to walk farther to find water, and local sources could become contaminated more easily. Pickering fears that losing access to nearby, clean water will make maintaining proper hygiene and growing nutritious foods a challenge.
Climate change will affect health in all sectors of society.
All of these effects and more can also damage mental health, said Katherine Burke and her colleagues in their paper. The aftermath of extreme weather events and the hardships of living in long-term drought or flood can cause anxiety, depression, grief and trauma.
Climate change will affect health in every sector of society, but as Katherine Burke and her colleagues said, “….climate disruption is inflicting the greatest suffering on those least responsible for causing it, least equipped to adapt, least able to resist the powerful forces of the status quo.
“If we fail to act now,” they said, “the survival of our species may hang in the balance.”
What can the new administration do to ease health effects?
If the Paris Agreement’s emissions standards are met, scientists predict that the world’s temperature will increase about 2.7 degrees Celsius – still significant but less hazardous than the 4-degree increase projected from current emissions.
The United States plays a critical role in the Paris Agreement. Apart from the significance of cutting its own emissions, failing to live up to its end of the bargain — as the Trump administration has suggested — could have a significant impact on the morale of the other countries involved.
“The reason that Paris is going to work is because we’re in this together,” said Marshall Burke. “If you don’t meet your target, you’re going to be publicly shamed.”
The Trump administration has also discussed repealing the Clean Power Plan, Obama-era legislation to decrease the use of coal, which has been shown to contribute to respiratory disease.
“Withdrawing from either of those will likely have negative short- and long-run health impacts, both in the U.S. and abroad,” said Marshall Burke.
Scott Pruitt, who was confirmed today as the head of the Environmental Protection Agency (EPA), is expected to carry out Trump’s promise to dismantle environment regulations.
Despite the Trump administration’s apparent doubts about climate change, a few prominent Republicans do support addressing its effects.
Secretary of State Rex Tillerson, the former chairman and CEO of Exxon Mobile, supports a carbon tax, which would create a financial incentive to turn to renewable energy sources. He also has expressed support for the Paris Agreement. It is possible that as secretary of state, Tillerson could help maintain U.S. obligations from the Paris Agreement, though it is far from certain whether he would choose to do so or how Trump would react.
More promising is a recent proposal from the Climate Leadership Council. Authored by eight leading Republicans — including two former secretaries of state, two former secretaries of the treasury and Rob Walton, Walmart’s former chairman of the board — the plan seeks to reduce emissions considerably through a carbon dividends plan.
Already an issue, malnutrition will increase with droughts in Sub-Saharan Africa.
Their proposal would gradually increase taxes on carbon emissions but would return the proceeds directly to the American people. Americans would receive a regular check with their portion of the proceeds, similar to receiving a social security check. According to the authors, 70 percent of Americans would come out ahead financially, keeping the tax from being a burden on low- and middle-income Americans while still incentivizing lower emissions.
“A tax on carbon is exactly what we need to provide the right incentives and induce the sort of technological and infrastructure change needed to reduce long-term emissions,” said Marshall Burke.
Pickering added, “This policy is a ray of hope for meaningful action on climate.”
It remains to be seen whether the new administration and congress would consider such a program.
What can academics do to help?
Meanwhile, academics can promote health by researching the effects of climate change and finding ways to adapt to them.
“I think it’s fascinating that there’s just so little data right now on how climate change is going to impact health,” said Pickering.
Studying the effects of warming on the world challenges traditional methods of research.
“You can’t create any sort of experiment,” said Bendavid. “There’s only one climate and one planet.”
The scholars agree that interdisciplinary study is a critical part of adapting to climate change and that more research is needed.
“If ever there was an issue worthy of a leader’s best effort, this is the moment, this is the issue,” said Katherine Burke and her colleagues. “Time is short, but it may not be too late to make all the difference.”
As India's middle class has expanded, the nation's public health concerns have shifted. Obesity rates have risen, coinciding with a surge in diabetes. The number of Indians with type 2 diabetes is expected to double by 2030 to nearly 80 million. Meanwhile, 43 percent of children in India are underweight.
Concern about patient safety has promoted efforts to improve safety climate. A better understanding of how patient safety climate differs among distinct work areas and disciplines in hospitals would facilitate the design and implementation of interventions.
OBJECTIVES:
To understand workers' perceptions of safety climate and ways in which climate varies among hospitals and by work area and discipline.
RESEARCH DESIGN:
We administered the Patient Safety Climate in Healthcare Organizations survey in 2004-2005 to personnel in a stratified random sample of 92 US hospitals.
SUBJECTS:
We sampled 100% of senior managers and physicians and 10% of all other workers. We received 18,361 completed surveys (52% response).
MEASURES:
The survey measured safety climate perceptions and worker and job characteristics of hospital personnel. We calculated and compared the percent of responses inconsistent with a climate of safety among hospitals, work areas, and disciplines.
RESULTS:
Overall, 17% of responses were inconsistent with a safety climate. Patient safety climate differed by hospital and among and within work areas and disciplines. Emergency department personnel perceived worse safety climate and personnel in nonclinical areas perceived better safety climate than workers in other areas. Nurses were more negative than physicians regarding their work unit's support and recognition of safety efforts, and physicians showed marginally more fear of shame than nurses. For other dimensions of safety climate, physician-nurse differences depended on their work area.
CONCLUSIONS:
Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.
To examine the relationship between measures of hospital safety climate and hospital performance on selected Patient Safety Indicators (PSIs).
DATA SOURCES:
Primary data from a 2004 survey of hospital personnel. Secondary data from the 2005 Medicare Provider Analysis and Review File and 2004 American Hospital Association's Annual Survey of Hospitals.
STUDY DESIGN:
A cross-sectional study of 91 hospitals.
DATA COLLECTION:
Negative binomial regressions used an unweighted, risk-adjusted PSI composite as dependent variable and safety climate scores and controls as independent variables. Some specifications included interpersonal, work unit, and organizational safety climate dimensions. Others included separate measures for senior managers and frontline personnel's safety climate perceptions.
PRINCIPAL FINDINGS:
Hospitals with better safety climate overall had lower relative incidence of PSIs, as did hospitals with better scores on safety climate dimensions measuring interpersonal beliefs regarding shame and blame. Frontline personnel's perceptions of better safety climate predicted lower risk of experiencing PSIs, but senior manager perceptions did not.
CONCLUSIONS:
The results link hospital safety climate to indicators of potential safety events. Some aspects of safety climate are more closely related to safety events than others. Perceptions about safety climate among some groups, such as frontline staff, are more closely related than perceptions in other groups.
BACKGROUND: Safety climate refers to shared perceptions of what an organization is like with regard to safety, whereas safety culture refers to employees' fundamental ideology and orientation and explains why safety is pursued in the manner exhibited within a particular organization. Although research has sought to identify opportunities for improving safety outcomes by studying patterns of variation in safety climate, few empirical studies have examined the impact of organizational characteristics such as culture on hospital safety climate.
PURPOSE: This study explored how aspects of general organizational culture relate to hospital patient safety climate.
METHODOLOGY: In a stratified sample of 92 U.S. hospitals, we sampled 100% of senior managers and physicians and 10% of other hospital workers. The Patient Safety Climate in Healthcare Organizations and the Zammuto and Krakower organizational culture surveys measured safety climate and group, entrepreneurial, hierarchical, and production orientation of hospitals' culture, respectively. We administered safety climate surveys to 18,361 personnel and organizational culture surveys to a 5,894 random subsample between March 2004 and May 2005. Secondary data came from the 2004 American Hospital Association Annual Hospital Survey and Dun & Bradstreet. Hierarchical linear regressions assessed relationships between organizational culture and safety climate measures.
FINDINGS: Aspects of general organizational culture were strongly related to safety climate. A higher level of group culture correlated with a higher level of safety climate, but more hierarchical culture was associated with lower safety climate. Aspects of organizational culture accounted for more than threefold improvement in measures of model fit compared with models with controls alone. A mix of culture types, emphasizing group culture, seemed optimal for safety climate.
PRACTICE IMPLICATIONS: Safety climate and organizational culture are positively related. Results support strategies that promote group orientation and reduced hierarchy, including use of multidisciplinary team training, continuous quality improvement tools, and human resource practices and policies.
Objective. To compare
safety climate between diverse U.S. hospitals and Veterans Health
Administration (VA) hospitals, and to explore the factors influencing
climate in each setting.
Data Sources. Primary
data from surveys of hospital personnel; secondary data from the
American Hospital Association's 2004 Annual Survey of Hospitals.
Study Design. Cross-sectional study of 69 U.S. and 30 VA hospitals.
Data Collection. For
each sample, hierarchical linear models used safety-climate scores as
the dependent variable and respondent and facility characteristics as
independent variables. Regression-based Oaxaca–Blinder decomposition
examined differences in effects of model characteristics on safety
climate between the U.S. and VA samples.
Principal Findings. The
range in safety climate among U.S. and VA hospitals overlapped
substantially. Characteristics of individuals influenced safety climate
consistently across settings. Working in southern and urban facilities
corresponded with worse safety climate among VA employees and better
safety climate in the U.S. sample. Decomposition results predicted 1.4
percentage points better safety climate in U.S. than in VA hospitals:
−0.77 attributable to sample-characteristic differences and 2.2 due to
differential effects of sample characteristics.
Conclusions. Results
suggest that safety climate is linked more to efforts of individual
hospitals than to participation in a nationally integrated system or
measured characteristics of workers and facilities.
BACKGROUND: Concern about patient safety has promoted efforts to
improve safety climate. A better understanding of how patient safety
climate differs among distinct work areas and disciplines in hospitals
would facilitate the design and implementation of interventions.
OBJECTIVES: To understand workers' perceptions of safety climate and
ways in which climate varies among hospitals and by work area and
discipline. RESEARCH DESIGN: We administered the Patient Safety Climate
in Healthcare Organizations survey in 2004-2005 to personnel in a
stratified random sample of 92 US hospitals. SUBJECTS: We sampled 100%
of senior managers and physicians and 10% of all other workers. We
received 18,361 completed surveys (52% response). MEASURES: The survey
measured safety climate perceptions and worker and job characteristics
of hospital personnel. We calculated and compared the percent of
responses inconsistent with a climate of safety among hospitals, work
areas, and disciplines. RESULTS: Overall, 17% of responses were
inconsistent with a safety climate. Patient safety climate differed by
hospital and among and within work areas and disciplines. Emergency
department personnel perceived worse safety climate and personnel in
nonclinical areas perceived better safety climate than workers in other
areas. Nurses were more negative than physicians regarding their work
unit's support and recognition of safety efforts, and physicians showed
marginally more fear of shame than nurses. For other dimensions of
safety climate, physician-nurse differences depended on their work
area. CONCLUSIONS: Differences among and within hospitals suggest that
strategies for improving safety climate and patient safety should be
tailored for work areas and disciplines.
BACKGROUND: Strengthening hospital safety culture offers promise for
reducing adverse events, but efforts to improve culture may not succeed
if hospital managers perceive safety differently from frontline
workers.
OBJECTIVES: To determine whether frontline workers and
supervisors perceive a more negative patient safety climate (ie,
surface features, reflective of the underlying safety culture) than
senior managers in their institutions. To ascertain patterns of
variation within management levels by professional discipline.
RESEARCH
DESIGN: A safety climate survey was administered from March 2004 to May
2005 in 92 US hospitals. Individual-level cross sectional comparisons
related safety climate to management level. Hierarchical and
hospital-fixed effects modeling tested differences in perceptions.
SUBJECTS: Random sample of hospital personnel (18,361 respondents).
MEASURES: Frequency of responses indicating absence of safety climate
(percent problematic response) overall and for 8 survey dimensions.
RESULTS: Frontline workers' safety climate perceptions were 4.8
percentage points (1.4 times) more problematic than were senior
managers', and supervisors' perceptions were 3.1 percentage points
(1.25 times) more problematic than were senior managers'. Differences
were consistent among 7 safety climate dimensions. Differences by
management level depended on discipline: senior manager versus
frontline worker discrepancies were less pronounced for physicians and
more pronounced for nurses, than they were for other disciplines.
CONCLUSIONS: Senior managers perceived patient safety climate more
positively than nonsenior managers overall and across 7 discrete safety
climate domains. Patterns of variation by management level differed by
professional discipline. Continuing efforts to improve patient safety
should address perceptual differences, both among and within groups by
management level.
Objective: To assess variation in safety climate across VA hospitals nationally.
Study Setting: Data were collected from employees at 30 VA hospitals over a 6-month period using the Patient Safety Climate in Healthcare Organizations survey.
Study Design: We sampled 100 percent of senior managers and physicians and a random 10 percent of other employees. At 10 randomly selected hospitals, we sampled an additional 100 percent of employees working in units with intrinsically higher hazards (high-hazard units [HHUs]).
Data Collection: Data were collected using an anonymous survey design.
Principal Findings: We received 4,547 responses (49 percent response rate). The percent problematic response-lower percent reflecting higher levels of patient safety climate-ranged from 12.0-23.7 percent across hospitals (mean=17.5 percent). Differences in safety climate emerged by management level, clinician status, and workgroup. Supervisors and front-line staff reported lower levels of safety climate than senior managers; clinician responses reflected lower levels of safety climate than those of nonclinicians; and responses of employees in HHUs reflected lower levels of safety climate than those of workers in other areas.
Conclusions: This is the first systematic study of patient safety climate in VA hospitals. Findings indicate an overall positive safety climate across the VA, but there is room for improvement.
Objective: To describe the development of an instrument for assessing workforce perceptions of hospital safety culture and to assess its reliability and validity.
Data Sources/Study Setting: Primary data collected between March 2004 and May 2005. Personnel from 105 U.S. hospitals completed a 38-item paper and pencil survey. We received 21,496 completed questionnaires, representing a 51 percent response rate.
Study Design: Based on review of existing safety climate surveys, we developed a list of key topics pertinent to maintaining a culture of safety in high-reliability organizations. We developed a draft questionnaire to address these topics and pilot tested it in four preliminary studies of hospital personnel. We modified the questionnaire based on experience and respondent feedback, and distributed the revised version to 42,249 hospital workers.
Data Collection: We randomly divided respondents into derivation and validation samples. We applied exploratory factor analysis to responses in the derivation sample. We used those results to create scales in the validation sample, which we subjected to multitrait analysis (MTA).
Principal Findings: We identified nine constructs, three organizational factors, two unit factors, three individual factors, and one additional factor. Constructs demonstrated substantial convergent and discriminant validity in the MTA. Cronbach's coefficients ranged from 0.50 to 0.89.
Conclusions: It is possible to measure key salient features of hospital safety climate using a valid and reliable 38-item survey and appropriate hospital sample sizes. This instrument may be used in further studies to better understand the impact of safety climate on patient safety outcomes.
Bangladeshi children make their way through flood waters.
Climate change will affect health in all sectors of society.
Already an issue, malnutrition will increase with droughts in Sub-Saharan Africa.