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If not us, then who? nursing and climate change

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        Kenneth White, PhD, AGACNP, ACHPN, FACHE, FAAN
        Nursing has a critical role in addressing the looming public health challenge of climate change and its associated—and inequitable—adverse health consequences. The nursing profession is essential in communicating with patients, families, communities, and societies, as well as legislators and policymakers, to recognize and respond to climate change. The Academy's policy role positions us to take on the important work from the unique perspective of nurses as scientists, educators, caregivers, managers, and leaders as we identify and implement collective solutions.
        The Lancet Commission first began publishing their annual Countdown Reports on Health and Climate Change in 2015, sharing the urgent message that climate change must be front and center on the landscape of the most pressing problems facing our global community in the 21st century (
        • Watts N.
        • et al.
        The 2015 report of The Lancet Countdown on health and climate change: Policy responses to protect public health.
        and after;
        • Romanello M.
        • et al.
        The 2021 report of The Lancet Countdown on health and climate change: Code red for a healthy future.
        ). Each report stresses the adverse health consequences that are emerging from climate change. In 2015, the Lancet Countdown Report was subtitled: “How can we transform climate change from a threat to an opportunity to improve global health” (
        • Watts N.
        • et al.
        The 2015 report of The Lancet Countdown on health and climate change: Policy responses to protect public health.
        , p. 581). Later reports moved towards tracking progress on health and climate change with a lens on limiting greenhouse gas emissions; the critical roles of health professions in tackling climate change; the opportunity to shape the health of nations for the future through tracking key health dimensions; climate change-related impacts on children; and the converging crises of COVID-19 and climate change-related health consequences. The 2021 Report sought to track the connections between public health and climate change and suggested a “code red for a healthy future” (
        • Romanello M.
        • et al.
        The 2021 report of The Lancet Countdown on health and climate change: Code red for a healthy future.
        ).
        In early May 2022, the Biden Administration announced the launch of a new public information series called Climate and Health Outlook. Operating under the Office of Climate Change and Health Equity within the U.S. Department of Health and Human Services (HHS); this resource houses timely data and evidence linking climate-related risks to health risks, and serves to inform communities most at-risk for adverse health outcomes related to climate and weather-related changes (). As this article is being published during some of the hottest months for many across the country, how appropriate that the first installment of this new series is titled, Climate and Health Outlook: Extreme Heat. notes that warmer temperatures increase the risk for conditions including: hospitalization for heart disease; heat exhaustion; heat stroke; asthma and chronic obstructive pulmonary disease; kidney injury; and violence, crime, and suicide (). Individuals living in areas known as “urban heat islands” are on the whole at a greater risk for these complications, which can be compounded by other socioeconomic and demographic factors ().
        The Academy has elevated the complex issues of climate change in publications in Nursing Outlook, including reference to the influence of Florence Nightingale on environmental health—and advocacy for environmental health and justice (
        • McCauley L.
        • Hayes R.
        From Florence to fossil fuels: Nursing has always been about environmental health.
        ).
        • Lilienfeld E.
        • Nicholas P.K.
        • Breakey S.
        • Corless I.B.
        Addressing climate change through a nursing lens within the framework of the United Nations Sustainable Development Goals.
        incorporated the United Nations Sustainable Development Goals (

        United Nations (2015). Sustainable Development Goals. https://sdgs.un.org/goals.

        ) and Nightingale's prescient understanding of the intersection of the environment and health. In their policy brief,
        • Liu J.
        • Potter T.
        • Zahner S.
        Policy brief on climate change and mental health/well-being.
        urge that “nurses advocate for research, education, and policies that support disaster-resilient infrastructure and human services that allow communities across the globe to effectively mitigate the impact of climate change on human health” (p. 517).
        • Leffers J.
        • Butterfield P.
        Nurses play essential roles in reducing health problems due to climate change.
        noted that “nurses play essential roles in reducing health problems due to climate change” (p. 210). Nicholas, et al. emphasized the engagement of nursing in policy and advocacy regarding looming health challenges that are emerging in our warming global community (
        • Nicholas P.K.
        • Breakey S.
        • Tagliareni M.E.
        • Simmonds K.
        • Sabo K.K.
        Climate change and population health: Incorporating stages of nursing's political development.
        ). Clearly, the Academy will need to continue to analyze the current state of play, develop thoughtful policy recommendations, and disseminate these recommendations to policymakers, our membership, and the public.

        Vulnerable Populations and Climate Change: Policy Implications

        Vulnerable populations are disproportionately affected by climate change and differentially harmed by the associated health consequences. From severe natural events (hurricanes, flooding, and wildfires) to poor air quality (and associated respiratory illness) and heat stress with its mental health sequelae, climate change has become one of the most pressing public health problems in the 21st century. Children, older adults, pregnant women, communities of color, low-income communities, and those with disabilities experience greater impacts. The Academy's mission and lens on equity, diversity, and inclusion has critical relevance for policy efforts to mitigate the health consequences of climate change: the Academy aims to “improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science” (, para 1). There is no more urgent challenge than climate change, which so deeply affects health equity and so clearly intersects with the Academy's commitment to equity, diversity, and inclusion.

        The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity—A Call to Action for the Academy in Addressing Climate Change and Health

        The National Academy of Medicine (NAM) and the Robert Wood Johnson Foundation launched The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity to elevate the importance of a culture of health and to fully engage in the dialogue regarding the effects of systemic, structural, and institutional racism—and to work to achieve an equitable, just, and fair society (
        National Academies of Sciences, Engineering, and Medicine
        The Future of Nursing 2020-2030: Charting a path to achieve health equity.
        , p. x). Amidst the backdrop of the COVID-19 pandemic, the NAM courageously highlighted the health consequences of climate change and the disproportionate impact on vulnerable populations—particularly Black, Indigenous, people of color (BIPOC). Recommendation 8 of the report includes:To enable nurses to address inequities within communities, federal agencies and other key stakeholders within and outside the nursing profession should strengthen and protect the nursing workforce during the response to such public health emergencies as the COVID-19 pandemic and natural disasters, including those related to climate change (
        National Academies of Sciences, Engineering, and Medicine
        The Future of Nursing 2020-2030: Charting a path to achieve health equity.
        , p. 14).
        This recommendation explicitly calls out climate change, COVID-19, and natural disasters– but the adverse health consequences of climate change are broader, more complex, and more challenging than those of natural disasters; nurses have important roles in responding to the wide array of deleterious health consequences, including ecoanxiety and solastalgia—distress related to environmental degradation. At no other time in history has the need for Nursing Out Loud been so urgently needed as it is now in our current climate-changing world—and the code red for a healthy future (
        • Romanello M.
        • et al.
        The 2021 report of The Lancet Countdown on health and climate change: Code red for a healthy future.
        ) that we encounter in the 21st century.

        References

          • Watts N.
          • et al.
          The 2015 report of The Lancet Countdown on health and climate change: Policy responses to protect public health.
          The Lancet. 2015; 386: 1861-1914https://doi.org/10.1016/S0140-6736(15)60854-6
          • Romanello M.
          • et al.
          The 2021 report of The Lancet Countdown on health and climate change: Code red for a healthy future.
          The Lancet. 2021; 398: 1619-1662
        1. U.S. Department of Health and Human Services. (2022). Climate Change and Health Equity. What's New. https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/news/index.html.

          • McCauley L.
          • Hayes R.
          From Florence to fossil fuels: Nursing has always been about environmental health.
          Nursing Outlook. 2021; 69: 720-731https://doi.org/10.1016/j.outlook.2021.06.007
          • Lilienfeld E.
          • Nicholas P.K.
          • Breakey S.
          • Corless I.B.
          Addressing climate change through a nursing lens within the framework of the United Nations Sustainable Development Goals.
          Nursing Outlook. 2018; 66: 482-494https://doi.org/10.1016/j.outlook.2018.06.010
        2. United Nations (2015). Sustainable Development Goals. https://sdgs.un.org/goals.

          • Liu J.
          • Potter T.
          • Zahner S.
          Policy brief on climate change and mental health/well-being.
          Nursing Outlook. 2021; 68: 517-522https://doi.org/10.1016/j.outlook.2020.06.003
          • Leffers J.
          • Butterfield P.
          Nurses play essential roles in reducing health problems due to climate change.
          Nursing Outlook. 2018; 66: 210-213https://doi.org/10.1016/j.outlook.2018.02.008
          • Nicholas P.K.
          • Breakey S.
          • Tagliareni M.E.
          • Simmonds K.
          • Sabo K.K.
          Climate change and population health: Incorporating stages of nursing's political development.
          Nursing Outlook. 2021; 69: 65-73https://doi.org/10.1016/j.outlook.2020.08.001
        3. American Academy of Nursing (2022). Equity, diversity, and inclusion statement. https://www.aannet.org/about/about-the-academy/edi#:∼:text=In%20furthering%20equity%2C%20diversity%2C%20and,Published%20October%202021.

          • National Academies of Sciences, Engineering, and Medicine
          The Future of Nursing 2020-2030: Charting a path to achieve health equity.
          The National Academies Press, Washington, DC2021https://doi.org/10.17226/25982