As pediatricians and parents, Gabriel Cisneros, MD, and Maya Ragavan, MD, saw the negative impact of climate change on children’s health.
Believing the effects would get worse without policy changes, Drs. Cisneros and Ragavan helped to create Clinicians for Climate Action (C4CA). The group — made up of clinicians, faculty, and students from UPMC and the University of Pittsburgh — is striving to decarbonize health care.
Since its creation, C4CA has already made an impact.
In 2022, it sent a letter to UPMC leadership — signed by more than 300 medical professionals — calling on UPMC to commit to a decarbonization plan. Soon after, UPMC joined the White House Health Sector Climate Pledge and created the UPMC Center for Sustainability.
Their work to decarbonize health care continues. The United States health care system produces 8.5% of the country’s total greenhouse gas emissions.
“Climate change very much is something that needs to be solved at the structural level, at the policy level,” says Dr. Ragavan, pediatrician and researcher, UPMC Children’s Hospital of Pittsburgh. “It’s our responsibility as pediatricians to use whatever power we have to advocate for policy change.”
C4CA’s goal is a more sustainable future for children.
“When I think about this as it relates to children, children just need a sense of security, safety, and stability,” says Dr. Cisneros, medical director, UPMC Children’s Express Care. “More than anything, the climate crisis introduces this whole new way of living in a way that we can’t really fully understand and predict, and so we’re learning as we go along.
“And so, what we want to do is change the way that we operate in a way that can help mitigate some of those changes and maybe make for less severe outcomes in the future for them.”
A Professional and Personal Issue
According to the World Health Organization, climate change “presents a fundamental threat to human health.” Extreme weather events pose a major risk to physical and mental health.
“Climate relates to every other child health issue,” Dr. Ragavan says. “No matter what your passion is, what you’re dedicated to, climate probably relates in some way.”
Dr. Ragavan’s areas of research include health equity and intimate partner violence. Climate change affects both.
It has a disproportionate effect on marginalized communities. Studies have also shown a link between high temperatures and intimate partner violence.
Dr. Ragavan also had personal stakes in climate change as the mother of a young child. She wanted to do something to provide a better future.
“I spent some years just wrapped in my own angst about it and then really wanted to channel that anxiety into advocacy,” she says.
Dr. Cisneros saw similar climate change impacts in his own work with children. But the idea to create C4CA came from an experience in his personal life.
His daughter was staying with his mother when there was an unusual electrical storm. The storm caused a wildfire and forced them to evacuate.
“After that, it was like a wake-up call,” he says. “This was something that really hit close to home, literally and figuratively. And so, taking a step back, thinking, ‘What’s going on here? What do we need to do to take on this climate crisis?'”
Dr. Cisneros and two UPMC colleagues participated in a fellowship. They learned how to organize health care professionals to address climate change. That led to the creation of Clinicians for Climate Action in 2022.
Other professionals at UPMC and Pitt, including Dr. Ragavan, joined the cause.
Taking Action
One of C4CA’s first initiatives was to send a letter to UPMC leadership. The letter, signed by more than 300 health care professionals, called on UPMC to take several climate-related actions.
One was for UPMC to join the White House’s Health Sector Climate Pledge. The pledge commits health care organizations to cutting greenhouse gas emissions in half by 2030 and reaching net zero by 2050.
The letter also called on UPMC to join Practice Greenhealth. Practice Greenhealth is an organization that offers resources for sustainable health care. Finally, the letter asked UPMC to include sustainability in health care and the health curriculum.
“Within a day, we had a positive response from the CEO of UPMC [Leslie Davis] in support of what we were asking for,” Dr. Cisneros says. “And in addition to that, basically a list of interested health care professionals, doctors, nurses, students, allied health care professionals, all interested in pursuing this work.”
In October 2022, UPMC announced it was joining the White House Health Sector Climate Pledge. It became the first health system in Pennsylvania to do so.
Other initiatives include the creation of UPMC’s Center for Sustainability and the University of Pittsburgh School of Medicine’s Office of Sustainability Medicine.
UPMC also named Michael Boninger, MD, as its chief medical sustainability officer and John Krolicki as its chief administrative sustainability officer.
The mission of all these efforts is to reduce carbonization in medicine.
“U.S. health care systems have the second-highest carbon emissions out of all commercial businesses in the U.S.,” Dr. Ragavan says. “If the U.S. health care system was a country, it would be the 13th-highest carbon emitter in the world.
“As physicians, as health care clinicians, we have a lot of opportunity to work on decarbonizing our own health care systems and to make sure that we’re promoting sustainability within our health care systems.”
Aiming for a Brighter Future
Working toward a decarbonized future in health care isn’t easy. It’s also a goal that no one can achieve alone.
The members of C4CA are working together toward their mission. They have met with local and state leaders to discuss the impact of climate change on child health.
“As professionals, we have an important platform I think we should utilize and help,” Dr. Cisneros says. “Because people are thinking about this and asking questions, and we have an important role with our education to really clarify things.
“Sometimes, there’s a lot of confusion and misunderstanding, and we can be those voices that help explain and help lead toward positive outcomes.”
Pediatricians can play another role in supporting youth climate advocates, Dr. Ragavan says.
“They are the ones who are leading the charge,” she says. “I think that as pediatricians, as people who are supporting the voices of children, we can also support the incredible work that they’re doing in the climate change space and in the climate justice space.”
Clinicians can do their part by learning about sustainability. They can also ask questions and think of ways to increase it.
Even small sustainability actions can have a larger impact. Dr. Cisneros uses the example of a central Pennsylvania physician who created a community garden at her practice. Not only can that help with sustainability, but it also promotes healthy eating and spending time outdoors.
“When you do this work, there ends up being a lot of co-benefits,” Dr. Cisneros says. “One thing also can help improve in a lot of other ways. It’s what makes it so interesting and fun.”
Dr. Ragavan says she hopes to also bring in voices from the community to discuss ideas and actions for C4CA to pursue.
Drs. Cisneros and Ragavan encourage physicians interested in joining C4CA to visit the group’s website to learn more. They hope to see other health care organizations join the cause of bringing sustainability to medicine.
“It’s a movement, really,” Dr. Cisneros says. “Everyone can play a role in a positive way, so that’s really our hope.”