What Otolaryngologists Can Do to Lessen Their Carbon Footprint

by Amanda E. Dilger, MD, Neelima Tummala, MD, and Natalie A. Krane, MD •

Climate change refers to an observed long-term change in global weather patterns. Due to a population- and economic-driven increase in anthropogenic greenhouse gas emissions, there has been an increase in average surface temperature of 1℃ since the late 19th century. This increase in global temperatures has led to rising sea levels and an increase in periodic severe weather conditions such as wildfires and floods. In addition, many sources of greenhouse gas (GHG) emissions, such as cars and trucks that rely on fossil fuels, also contribute to poor air quality by releasing airborne particulate matter.

The health effects of climate change are an increasingly urgent public health crisis that are infrequently recognized within the surgical community. The World Health Organization estimates that without reductions in current GHG emissions, climate change will account for 250,000 deaths per year from 2030 to 2050. 

As surgeons within a waste- and energy-intensive healthcare system, our contribution to the climate crisis is tangible. The healthcare sector in the United States was responsible for 8.5% of GHG emissions in 2018, which contributed to the loss of 388,000 disability-adjusted life years. While many other industries have adopted sustainability and carbon neutrality goals, the U.S. healthcare sector continues to have the highest per capita carbon emissions in the world, which increased by 6% from 2010 to 2018 (Health Aff. 2020;39;2071-2079).

The Health Connection

Otolaryngology isn’t immune to the effects of climate change. While it might be challenging to fully appreciate the health impacts of the climate crisis on a day-to-day basis, here are four ways your patients are being affected:

Allergic rhinitis: For many general otolaryngologists, the most commonly encountered climate-sensitive disease—and one of the most impactful in terms of both patient quality of life and economic effects—is allergic rhinitis (AR). The negative effects of AR on both pediatric and adult quality of life are well documented, and the economic burden attributable to AR has been found to be higher than that of asthma, diabetes, and cancer (Immunol Allergy Clin North Am. 2016;36:235-248). Global warming, increased carbon emissions, and air pollution have been associated with increased aeroallergen production, more geographically diverse pollen, and longer growing seasons (Allergy Asthma Immunol Res. 2020;12:771-782), all of which may contribute to an increased burden of allergic airway diseases and sinusitis (Ann Am Thorac Soc. 2015;12:274-278; Environ Health. 2012;11:25). As temperatures and aeropollutant concentrations continue to rise due to climate change, the economic and psychosocial burden of AR will likely continue to rise as well.

Cutaneous head and neck malignancy: The last 10 years have been the hottest decade on record. The incidence of skin cancer, which is strongly associated with heat and ultraviolet exposure and has a high predilection for sun-exposed areas such as the face, ears, and scalp (Br J Dermatol. 2011;165:35-43), is predicted to drastically increase by 2050 due to anthropogenic depletion of the ozone layer and higher temperatures (Phys Med Biol. 2004;49:R1-11).

Access and quality of care: Climate change affects our ability to provide safe, high-quality care to our patients. Access to surgical services is often disrupted during natural disasters (J Health Serv Res Policy. 2019;24:219-228), which are increasing in severity and frequency. This is exemplified in the U.S., where 2020 broke the record for the number of climate-related disasters, such as flooding, hurricanes, and wildfires. In addition, rates of surgical site infection have been found to be significantly higher during summer months than non-summer months (J Orthop Sci. August 12, 2020. doi:10.1016/j.jos.2020.05.015; Plast Reconstr Surg. 2018;142(3):653-660), which may be due to proclivity of bacteria for the hot, humid conditions that are becoming more prevalent with global warming.

Sleep-disordered breathing: Air pollution and climate change are inextricably linked. One of the main health consequences of air pollution is the inflammatory impact on the respiratory system. This is a concern for patients, as snoring in children and sleep-disordered breathing in adults have been shown to positively correlate with regional and seasonal variances in air quality (Eur Respir J. 2014;43:824-832; Am J Respir Crit Care Med. 2010;182:819-825). (To view more research on the impact of climate change on quality of sleep, see “Sleep and Climate Change.”)