AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: 420

(A-22)

Introduced by: California, American College of Physicians, Maine, Massachusetts, Oregon,

Washington, Minnesota

Subject: Declaring Climate Change a Public Health Crisis

Referred to: Reference Committee D

Whereas, Ahead of the November 2021 United Nations Climate Summit known as t

he 1

Conference of the Parties (COP26), over 200 international health journal editors made an 2

unprecedented joint statement that “the greatest threat to global public health is the continued 3

failure of world leaders to keep the global temperature rise below 1.5°C” to prevent catastrophic 4

and irreversible harms to public and global health

; and 5

hereas, The Lancet Countdown on Health and Climate Change has warned that the “rapidly 7

changing climate has dire implications for every aspect of human life, exposing vulnerable 8

populations to extremes of weather, altering patterns of infectious disease, and compromising 9

food security, safe drinking water, and clean air” earning it the title of the “greatest public health 10

challenge of the 21st century”

2-4

; and 11

Whereas, The U.S. health sector is responsible for an estimated 8.5% of national carbon 13

emissions– stemming directly from the operations of healthcare facilities (scope 1) and indirectly 14

from both purchased sources of energy, heating, and cooling (scope 2) and the supply chain of 15

healthcare services and goods (scope 3)

, and 16

Whereas, Our AMA is a member of the Steering Committee of the Action Collaborative on 18

Decarbonizing the Health Sector, which is part of the National Academy of Medicine Grand 19

Challenge on Climate Change, Human Health, & Equity; whose four strategic objectives are to: 20

(1) communicate the climate crisis as a public health and equity crisis, (2) develop a roadmap 21

for systems transformation, (3) catalyze the health sector to reduce its climate footprint and 22

ensure its resilience, and (4) accelerate research and innovation at the intersection of climate, 23

health and equity

; and 24

Whereas, In August 2021, the U.S. Department of Health & Human Services announced the 26

creation of the new Office of Climate Change and Health Equity (OCCHE), tasked with taking on 27

the health impacts of climate change and its effects such as extreme weather; and 28

Whereas, Our AMA does not currently have a strategic plan to respond to the climate health 30

crisis and most physician practices are not prepared to decarbonize our practices in alignment 31

with emerging national goals and regulations; and 32

Whereas, the longer-term health benefits of addressing climate change have been well 34

documented: preventing roughly 4.5 million deaths, 3.5 million hospitalizations and emergency 35

room visits and approximately 300 million lost workdays in the U.S. over the next 50 years, and 36

a rapid shift to a 2ºC pathway could reduce the toll of air pollution, which leads to nearly 37

250,000 premature deaths per year in the US, by 40% in just a decade

7,8,9

; and38

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Resolution: 420 (A-22)

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Whereas, The World Health Organization estimates that direct damage to health (not including 1

costs of damage mediated by effects on agriculture, water, and sanitation) will reach $2-4billion 2

per year by 2030

10,

and 3

Whereas, Across all climate-related risks, children, older adults, low-income communities, 5

outdoor workers, minoritized communities, and communities burdened by poor environmental 6

quality are disproportionately affected

11-14

; and 7

Whereas, ‘Climate justice’ is a term used for framing global warming as an ethical and political 9

issue, rather than one that is purely environmental or physical in nature by relating the effects of 10

climate change to concepts of justice, particularly environmental justice and social justice and 11

by examining issues such as equality, human rights; collective rights, and the historical 12

responsibilities for climate change

, and 13

Whereas, To avoid the worst consequences of climate change by keeping global warming from 15

pre-industrial levels to 1.5 degrees Celsius (2.7 degrees Fahrenheit), as outlined by the 16

Intergovernmental Panel on Climate Change (IPCC) will require global greenhouse gas (GHG) 17

emissions to have peaked by 2020 and net zero carbon emissions by 2050 at the latest, 18

highlighting that we are in a “vanishing window of opportunity for meaningful action”

16,17,18

; and 19

Whereas, Physicians are uniquely trusted messengers with a responsibility to advocate for 21

science-based policies to safeguard health in the face of any public health crisis

; and 22

Whereas, Our AMA House of Delegates has adopted multiple policies addressing climate 24

change (H-135.919, H-135.938, H-135.977, H-135.923, D-135.968,D-135.969, H-135.973), but 25

these policies fall short of actively coordinating strategic physician advocacy and leadership on 26

the scale necessary for such a health crisis; and 27

Whereas, In the face of the existential threat that the climate crisis poses, these policies have 29

not been leveraged to fulfill our AMA’s Declaration of Professional Responsibility which commit 30

our profession to “[earning] society’s trust in the healing profession” by “[educating] the public 31

and polity about present and future threats to the health of humanity” and “[advocating] for 32

social, economic, educational, and political changes that ameliorate suffering and contribute to 33

human well-being” (H-140.900); therefore, be it 34

RESOLVED, That our American Medical Association declare climate change a public health 36

crisis that threatens the health and well-being of all individuals (Directive to Take Action); and be 37

it further 38

RESOLVED, That our AMA protect patients by advocating for policies that: (1) limit global 40

warming to no more than 1.5 degrees Celsius, (2) reduce US greenhouse gas emissions, and 41

(3) achieve a reduced-emissions economy (Directive to Take Action); and be it further 42

RESOLVED, That our AMA develop a strategic plan for how we will enact our climate change 44

policies including advocacy priorities and strategies to decarbonize physician practices and the 45

health sector with report back to the House of Delegates at the 2023 Annual Meeting. (Directive 46

to Take Action) 47

scal Note: Not yet determined

Received: 05/06/22

The topic of this resolution is currently under study by the Council on Science and Public Health

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Resolution: 420 (A-22)

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References:

1. Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity and Protect Health. N Engl J Med.

September 16, 2021; 385:1134-1137. https://www.nejm.org/doi/full/10.1056/NEJMe2113200?query=featured_home DOI:

10.1056/NEJMe2113200

2. Intergovernmental Panel on Climate Change. Summary for policymakers. In: Global warming of 1.5°C. 2018

(https://www.ipcc.ch/sr15/ )

3. Watts N, Amann M, Arnell N, et al. The 2018 report of the Lancet countdown on health and climate change: Shaping the health

of nations for centuries to come. The Lancet. 2018;392(10163):2479-2514. doi:10.1016/s0140-6736(18)32594-7

4. Watts N, Amann M, Arnell N, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the

health of a child born today is not defined by a changing climate. The Lancet. 2019;394(10211):1836-1878. doi:10.1016/s0140-

6736(19)32596-6

5. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in the

United States: an update. Health Aff (Millwood) 2020;39:2071-2079.

6. N

ational Academy of Medicine description of the Climate Collaborative: https://nam.edu/wp-content/uploads/2021/09/Climate-

Collaborative-one-pager-9.27.21.pdf

7. Health and Economic Benefits of a 2°C Climate Policy https://docs.house.gov/meetings/GO/ GO00/20200805/110965/HHRG-

116-GO00-WstateShindellD-20200805.pdf

8. Haines A. Health co-benefits of climate action. The Lancet Planetary Health. 2017;1(1). doi:10.1016/s2542-5196(17)30003-7

9. Haines A, Ebi K. The Imperative for Climate Action to Protect Health. New England Journal of Medicine. 2019;380(3):263-273.

doi:10.1056/nejmra1807873

10. World Health Organization. Climate change and health. February 1, 2018 www.who.int/mediacentre/factsheets/fs266/en/

11. Kiefer M, Rodríguez-Guzmán J, Watson J, van Wendel de Joode B, Mergler D, da Silva AS. Worker health and safety and

climate change in the Americas: issues and research needs. Rev Panam Salud Publica. 2016;40(3):192-197.

12. Vickery J, Hunter LM. Native Americans: Where in Environmental Justice Research?. Soc Nat Resour. 2016;29(1):36-52.

doi:10.1080/08941920.2015.1045644

13. Gutierrez KS, LePrevost CE. Climate Justice in Rural Southeastern United States: A Review of Climate Change Impacts and

Effects on Human Health. Int J Environ Res Public Health. 2016;13(2):189. Published 2016 Feb 3. doi:10.3390/ijerph13020189

14. Roth M. A resilient community is one that includes and protects everyone. Bulletin of the Atomic Scientists. 2018;74(2):91-94.

doi:10.1080/00963402.2018.1436808

15. UN Environment Programme https://leap.unep.org/knowledge/glossary/climate-justice

16. IPCC, 2021: Summary for Policymakers. In: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I

to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Masson-Delmotte, V., P. Zhai, A. Pirani, S.

L. Connors, C. Péan, S. Berger, N. Caud, Y. Chen, L. Goldfarb, M. I. Gomis, M. Huang, K. Leitzell, E. Lonnoy, J.B.R. Matthews,

T. K. Maycock, T. Waterfield, O. Yelekçi, R. Yu and B. Zhou (eds.)]. Cambridge University Press. In Press.

17. The Paris Agreement. United Nations Climate Change. https://unfccc.int/process-and-meetings/the-paris-agreement/the-paris-

agreement. Accessed May 5, 2021.

18. Special Report-Global Warming of 1.5°C. (n.d.). IPCC. https://www.ipcc.ch/sr15/

19. Saad L. U.S. Ethics Ratings Rise for Medical Workers and Teachers. Gallup.com. https://news.gallup.com/poll/328136/ethics-

ratings-rise-medical-workers-teachers.aspx. Published March 23, 2021. Accessed May 5, 2021.

RELEVANT AMA POLICY

H-135.919 Climate Change Education Across the Medical Education Continuum

Our AMA: (1) supports teaching on climate change in undergraduate, graduate, and continuing

edical education such that trainees and practicing physicians acquire a basic knowledge of the

science of climate change, can describe the risks that climate change poses to human health,

and counsel patients on how to protect themselves from the health risks posed by climate

change; (2) will make available a prototype presentation and lecture notes on the intersection of

climate change and health for use in undergraduate, graduate, and continuing medical

education; and (3) will communicate this policy to the appropriate accrediting organizations such

as the Commission on Osteopathic College Accreditation and the Liaison Committee on Medical

Education. [Res. 302, A-19]

H-135.938 Global Climate Change and Human Health

Our AMA: 1. Supports the findings of the Intergovernmental Panel on Climate Change's fourth

assessment report and concurs with the scientific consensus that the Earth is undergoing

adverse global climate change and that anthropogenic contributions are significant. These

climate changes will create conditions that affect public health, with disproportionate impacts on

vulnerable populations, including children, the elderly, and the poor. 2. Supports educating the

medical community on the potential adverse public health effects of global climate change and

incorporating the health implications of climate change into the spectrum of medical education,

including topics such as population displacement, heat waves and drought, flooding, infectious

and vector-borne diseases, and potable water supplies.3. (a) Recognizes the importance of

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physician involvement in policymaking at the state, national, and global level and supports

efforts to search for novel, comprehensive, and economically sensitive approaches to mitigating

climate change to protect the health of the public; and (b) recognizes that whatever the etiology

of global climate change, policymakers should work to reduce human contributions to such

changes. 4. Encourages physicians to assist in educating patients and the public on

environmentally sustainable practices, and to serve as role models for promoting environmental

sustainability. 5. Encourages physicians to work with local and state health departments to

strengthen the public health infrastructure to ensure that the global health effects of climate

change can be anticipated and responded to more efficiently, and that the AMA's Center for

Public Health Preparedness and Disaster Response assist in this effort. 6. Supports

epidemiological, translational, clinical and basic science research necessary for evidence-based

global climate change policy decisions related to health care and treatment. [CSAPH Rep. 3, I-

08; Reaffirmation A-14; Reaffirmed: CSAPH Rep. 04, A-19; Reaffirmation: I-19]

H-135.977 Global Climate Change - The "Greenhouse Effect"

Our AMA: (1) endorses the need for additional research on atmospheric monitoring and climate

imulation models as a means of reducing some of the present uncertainties in climate

forecasting; (2) urges Congress to adopt a comprehensive, integrated natural resource and

energy utilization policy that will promote more efficient fuel use and energy production; (3)

endorses increased recognition of the importance of nuclear energy's role in the production of

electricity; (4) encourages research and development programs for improving the utilization

efficiency and reducing the pollution of fossil fuels; and (5) encourages humanitarian measures

to limit the burgeoning increase in world population. [CSA Rep. E, A-89Reaffirmed: Sunset

Report, A-00; Reaffirmed: CSAPH Rep. 1, A-10 Reaffirmation A-12; Reaffirmed in lieu of Res.

408, A-14]

H-135.923 AMA Advocacy for Environmental Sustainability and Climate

Our AMA (1) supports initiatives to promote environmental sustainability and other efforts to halt

obal climate change; (2) will incorporate principles of environmental sustainability within its

business operations; and (3) supports physicians in adopting programs for environmental

sustainability in their practices and help physicians to share these concepts with their patients

and with their communities. [Res. 924, I-16 Reaffirmation: I-19]

D-135.968 Implementing AMA Climate Change Principles Through JAMA Paper

Consumption Reduction and Green Health Care Leadership

Our AMA will continue to explore environmentally sustainable practices for JAMA

distribution. [BOT Rep. 8, I-19]

D-135.969 AMA to Protect Human Health from the Effects of Climate Change by Ending

its Investments in Fossil Fuel Companies

Our AMA, AMA Foundation, and any affiliated corporations will work in a timely, incremental,

and

fiscally responsible manner, to the extent allowed by their legal and fiduciary duties, to end

all financial investments or relationships (divestment) with companies that generate the majority

of their income from the exploration for, production of, transportation of, or sale of fossil fuels.

[BOT Rep. 34, A-18]

H-135.973 Stewardship of the Environment

The AMA: (1) encourages physicians to be spokespersons for environmental stewardship,

ncluding the discussion of these issues when appropriate with patients; (2) encourages the

medical community to cooperate in reducing or recycling waste; (3) encourages physicians and

the rest of the medical community to dispose of its medical waste in a safe and properly

prescribed manner; (4) supports enhancing the role of physicians and other scientists in

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Resolution: 420 (A-22)

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environmental education; (5) endorses legislation such as the National Environmental Education

Act to increase public understanding of environmental degradation and its prevention; (6)

encourages research efforts at ascertaining the physiological and psychological effects of

abrupt as well as chronic environmental changes; (7) encourages international exchange of

information relating to environmental degradation and the adverse human health effects

resulting from environmental degradation; (8) encourages and helps support physicians who

participate actively in international planning and development conventions associated with

improving the environment; (9) encourages educational programs for worldwide family planning

and control of population growth; (10) encourages research and development programs for

safer, more effective, and less expensive means of preventing unwanted pregnancy; (11)

encourages programs to prevent or reduce the human and environmental health impact from

global climate change and environmental degradation.(12) encourages economic development

programs for all nations that will be sustainable and yet nondestructive to the environment; (13)

encourages physicians and environmental scientists in the United States to continue to

incorporate concerns for human health into current environmental research and public policy

initiatives; (14) encourages physician educators in medical schools, residency programs, and

continuing medical education sessions to devote more attention to environmental health issues;

(15) will strengthen its liaison with appropriate environmental health agencies, including the

National Institute of Environmental Health Sciences (NIEHS); (16) encourages expanded

funding for environmental research by the federal government; and (17) encourages family

planning through national and international support. [CSA Rep. G, I-89; Amended: CLRPD Rep.

D, I-92; Amended: CSA Rep. 8, A-03; Reaffirmed in lieu of Res. 417, A-04; Reaffirmed in lieu of

Res. 402, A-10; Reaffirmation I-16]

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