Speaker 00: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare, and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 01: 0:19

Hey everybody, welcome to episode 15. It's Dr. David Hilden, your host. You know, as the seasons change, many of us experience changes to our health. But something that has no season is climate change, and that too has an effect on your health. So today, we're going to talk to Dr. Bess Stegora. She is a climate health ambassador, and we're going to talk about the effects of climate change on your physical health and your mental health. And in part two, we'll offer you tips for staying healthy and what you can do to make a positive impact on climate change for a healthy future. There's a lot to unpack here, so let's get right into it. Beth, thanks for being here. Welcome back to the podcast.

Speaker 03: 0:57

Thanks for having me.

Speaker 01: 0:57

So first of all, tell us what a climate ambassador is. What do you do?

Speaker 03: 1:01

Yeah, so I'm a healthcare provider by day, and I've been seeing the impacts of climate change on our patient population, and it caused me to take extra training in how climate health impacts our patients and the specific phenomenon. So I've done some training nationally, globally, to learn about It's

Speaker 01: 1:20

just fascinating to me, your two roles, because listeners, previously we did a show on pelvic health and Dr. Stegora talked to us about that topic. Today, climate change. So we hear that word a lot. What really does that mean? What is climate change all about?

Speaker 03: 1:35

Yeah, so climate change is a term we hear all the time. And what it really means is when we burn fossil fuels such as oil, gas in our homes, our factories, or how we transport around, that releases greenhouse gases, mostly carbon dioxide. That carbon dioxide acts like a blanket trapping in heat close to our Earth's surface. That trapping of heat causes increases in our planet's temperatures.

Speaker 01: 2:01

So we used to use the word global warming. Is that what you're talking about?

Speaker 03: 2:04

So overall, we've seen temperatures increasing, especially since the 1940s, but even more so in the last decade. Our temperatures are exceedingly higher compared to previous decades.

Speaker 01: 2:16

How is climate not weather? We had a cold winter. It was 20 below zero there, Beth.

Speaker 03: 2:21

Yeah, it was. And we've also had one of the warmer winters that we've ever had as well. So we are not I would love

Speaker 01: 2:34

to talk about all of that. It's such a fascinating topic. Listeners, today we're going to focus on the effects on your health. We're not going to talk about policies or all the other issues around climate change, although I'd love to do that. We're going to talk about the effects on personal health. What is the connection, Beth?

Speaker 03: 2:50

When we look at climate change, it's helpful to think about the phenomenon that happened with climate change. So those increases in temperature cause specific weather events or phenomenon that directly impact our health. Phenomenon might include excessive heat, poor air quality, more floods or droughts, and changes in our ecosystems, which would cause more widespread influences of vector-borne illnesses.

Speaker 01: 3:14

What's a vector?

Speaker 03: 3:15

Vector-borne illness, as we're warming up, we'll start to see changes in pests or insects that carry disease. So, for instance, in the northern hemisphere, we're starting to see increases in Lyme's disease, or we're starting to see dengue fever start to spread north these pests can survive warmer temperatures.

Speaker 01: 3:35

Or Zika virus, a mosquito-borne thing that is in the southern part of the U.S., the way southern part of the U.S. Maybe someday it's going to move its way north, too, because of climate change. Is this a future problem? Or are we talking about a problem right now? Or is this something that our listeners can rightfully say, yeah, got it. It's going to be a problem in 150 years. It's going to be a problem in 300 years. Can't worry about it.

Speaker 03: 3:58

Yeah, I think we can all say that we... have maybe seen some of these phenomenon happening globally. So it is a now problem. I think the phenomenon that we're seeing most or most people can relate to are excessive heat waves and poor air quality. And those things directly impact our health. For example, when we have increased temperatures and heat waves, that causes directly negative impacts to our body's ability to tolerate heat and prolonged exposures to heat. The overall warming to our planet's temperatures also causes changes in our ecosystems, creating longer allergy seasons and changes in our vector-borne illnesses like we talked about with Lyme's disease or dengue fever. And when we have warmer temperatures, that directly impacts our air quality. So with climate change, those increases in temperature cause higher levels of evaporation and more drought conditions. When we're in drought conditions, there are more air particles in the air, we inhale those air particles. When there's drier conditions, we have more increases for wildfires. And then poor air quality is directly caused by increases in temperature. When we have our regular air pollution, which is more fine particle air pollution, when that heats up, it causes ozone pollution. Both of those types of pollution we inhale into our lungs. So poor air quality impacts our respiratory systems, our cardiovascular systems, and our mental health.

Speaker 01: 5:26

You talked about different kinds of air pollution. I would like to delve into that just a teeny bit more. Actually, yeah.

Speaker 03: 5:52

That's a great point. In Minnesota, we didn't typically have those types of air quality alerts. For example, in the last decade, we had one red air quality alert, which is one of the highest ones per decade. However, in 2023 alone, the Minnesota Pollution Control Agency issued almost 14 red alerts just in one

Speaker 01: 6:13

year. I don't ever remember them, to be honest. Well, maybe I was just naive or not aware when I was growing up in Minnesota. But now that seems like they're quite common.

Speaker 03: 6:22

Just to put it into reference as well. In 2023, we had 20 air quality alerts in Minnesota covering 52 days of our entire year compared to 2021 where we had about 42 days. So that we are seeing an increase. It's not just you noticing, but there is an increase.

Speaker 01: 6:39

Okay. So let's break it down into some of these physical conditions. A little bit later, we're going to talk about some mental health and some kind of climate anxiety issues because that's a thing too. But let's talk about some physical issues. You've talked about respiratory issues. Let's break that down even more. What is happening with climate change air quality, and people's breathing.

Speaker 03: 6:59

So there are multiple causes of poor air quality that we mentioned. Wildfires, the air pollution, allergens that are going to be here longer, and they're all dangerous to our bodies. More specifically, we know that those larger air pollution particles, such as the ozone, gets into our lungs. So that can cause increases in our respiratory symptoms or exacerbations of already existing respiratory conditions like asthma or COPD. And then those smaller air particles actually can cross into our bloodstream. So folks that have cardiovascular disease are at increased risk with air pollution. And on a larger scale, what we notice with poor air quality is that it impacts a lot of things. So when we have poor air quality or wildfires, our emergency responders have to go to that area to respond and give resources. So that takes resources away from other communities that might need those resources. And we even see that poor visibility or poor air quality impacts planes or transport to bring in medical supplies or diabetic medications or things like that. So we see large interruptions to the medical supply chain too.

Speaker 01: 8:07

I see it in my own clinic. People with respiratory illnesses, mostly asthma, COPD, two of them that you mentioned. Kids, although I don't see kids, they tell me about their kids, are struggling when we have these air quality days and even some of the days when it isn't an official air quality day. It's rough on people's airways that are already high Mm-hmm. You mentioned that heat-related illnesses are a big deal, and that's something that I've been thinking about too.

Speaker 03: 8:53

So heat is one of the more dangerous phenomenon that we do see, and there are multiple ways that excessive heat can impact our body. We have what we call heat-related illnesses, and so those are things like heat stroke, heat exhaustion, heat syncope, heat cramps, or heat rash from prolonged exposure or even short-term exposure to heat. Cardiovascular disease as a pre-existing condition is the primary cause of death during heat waves. So if you have cardiovascular disease, you are at increased risk of death when it's warmer. And then we know that respiratory diseases, especially COPD as a pre-existing condition, is actually a secondary cause of death during heat waves. So having those medical issues And being exposed to heat can be deadly.

Speaker 01: 9:40

So we're in the clear here in the great state of Minnesota in the frozen tundra. Everybody thinks we're half frozen up here anyway. You know, I have friends from around the country. They go, how do you like even survive? Actually, cold related injuries are not as prevalent as heat related injuries relative to climate change. But we are up here in the northern tier of the country. What about our winters and summers and climate change related things to people living in in the bold north, as we like to say.

Speaker 03: 10:07

That's a really good point because we think that we might be safe here. So there is research that shows that the most dangerous times for exposure to heat are when we go from cold to hot. And we notice that a lot now in the northern hemispheres where we have really short springs. So the times for heat-related illnesses aren't actually August or times that you might think like that. It's actually May. When we look at emergency room encounters, it's early in the season that our bodies haven't gotten ready for that excessive heat. So slowly exposing your body to heat over time, they say it takes almost up to two weeks to expose your body to hot weather. And that would apply to especially our outdoor workers. If you've had any time off of work or going back into the season.

Speaker 01: 10:55

Your body's half, you're used to the cold and then you go out and it's 95 degrees and muggy outside or something and you're not used to it.

Speaker 03: 11:01

Yeah. And I think another important population too that we have specific data about in the Minneapolis Twin Cities area are people who are pregnant. And so there's been research showing that people who are pregnant and exposed to heat in the northern hemisphere here in the Twin Cities area, they were shown to have pregnancy complications, adverse fetal and neonatal complications, preterm birth, stillbirth, low birth weight, congenital anomalies, preeclampsia, gestational diabetes, and emergency hospital admissions during pregnancy. The data also showed that women of color who were pregnant had even increased higher risks of all of those health risks, especially preterm birth.

Speaker 01: 11:44

That's fascinating. Is there a hypothesis about why especially pregnant women of color, birth outcomes are well-known, well-established to be not as positive in women of color? It's one of the actually the things that we ought to do something about. It's such a massive problem in our country that women of color have worse birth outcomes. But is there a thought about why some of these things might affect women of color more?

Speaker 03: 12:09

So in some of the research, they controlled for variables like education, access to health care, things like that. And even when you compared people who had same educational levels, the women of color were still at higher risk for preterm birth compared to white women. And so you would hypothesize that the impacts of systemic racism are impacting those women in a more despairing way.

Speaker 01: 12:37

Yeah, you're exactly right. Even if you control for education level or if you control for income, where you live and race do have higher predictors of outcomes. We need to do something about that in our society. And I think the first step is to say it. Yes. So thank you for bringing that up.

Speaker 03: 12:56

And that's what really got me into this work is with pelvic health. I'm working mostly with people who are pregnant or postpartum. I could see those impacts to those people and wanted to do something bigger. And that pushed me into more education and exploring this realm.

Speaker 01: 13:10

You have a fascinating career path. I actually know Beth's career path a little bit because we've worked together a little bit in the past. It's absolutely fascinating. I just love what you do. Before we move on to some of the mental health things, I want to talk a little bit about food and water access. What are some of the issues around that?

Speaker 03: 13:25

So with excessive heat and drought or flooding, so we do see these more extreme weather patterns of downpours where we don't actually absorb the water. Those changes in our pet ecosystems, all of those can change our food production and access to food. And the other way that it impacts food is when we have these severe weather alerts, our ability to access that food supply chain will change too. When there's a hurricane down south, we can't get resources here or food that we might normally get. We also can't get medical supplies that we may get, like IV fluids.

Speaker 01: 14:01

Fluids. We ran out of salt water in medical systems because of that hurricane.

Speaker 03: 14:07

Yeah. So hurricanes and extreme weather really impact our ability to function globally as a medical system.

Speaker 01: 14:15

I've heard the term climate anxiety. Is that a thing?

Speaker 03: 14:18

It is a thing. So climate anxiety is a more well-known topic now. And it can include feelings of helplessness, grief. And then we noticed the mental health impacts after extreme weather events. There's well-documented numbers of PTSD, depression, sleep disruption after weather events or around wildfires, any of those weather phenomena. cause significant changes to mental health.

Speaker 01: 15:00

These strike me as kind of normal reactions or at least something easy to understand why people might be a little bit nervous about that. I can also see why younger people might be. Their whole lives are ahead of them.

Speaker 03: 15:11

Right. It should cause some alarm, right? When we see things that are impacting our health, it should raise some awareness. So those feelings are very common to have and people are not alone in those feelings. There are a lot of people out there who are feeling climate anxiety and feeling climate grief. And when we surveyed our county, the number one impact that people, residents actually replied of how they're impacted by climate change is their mental health. Over 75% said that their mental health was extremely impacted by climate change.

Speaker 01: 15:43

And it feels like, what do I do about it? It doesn't feel, it feels somewhat out of an individual's control. It does. Especially when our worldwide discourse is what it is now. Things are polarizing and things are or what to do about it isn't really clear. But what is happening is relatively clear. It's what we've been talking about so far. We've been talking with Dr. Bestagora. She is a climate health ambassador, and she's an expert on the impacts that climate change has on your health. So we've been talking about the problem in this first half. And after the break, I'd like to talk about some specific interventions for your own life. Stay with us.

Speaker 02: 16:24

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at hennepinhealthcare.org. Hennepin Healthcare is here for you, and here for life.

Speaker 01: 16:54

And we're back talking to Beth Stegora about climate change and your health. So Beth, What we did in the first half was talk about all the causes and all the problems. Now I want to leave people with some things they can do. So physical health for air quality. Start with that.

Speaker 03: 17:16

Yeah. So there is a lot that we can do to respond to the changes that have already happened. And then there's also a lot that we can do to help mitigate and change some of the things that have happened. So we'll first talk about how we can adapt to what's already been happening. So what poor air quality, it's really important to know your air quality sensitivity. So that could be thinking about your medical conditions, medications that you're on, and having a discussion with your provider about what your air quality sensitivity is. And then using the weather apps that are out there and finding a good one that works for you that can tell you about the air quality that's present. There are really great apps that exist now that can tell you when is a good time to go for a walk? When is it a good time to play pickleball? When is it a good time to walk your dog, all of those things. So use those tools to help you be out at times where there isn't a lot of risk.

Speaker 01: 18:14

So it'll tell you like hour by hour when's a good time of day? Or are you talking like this whole week I have to hibernate?

Speaker 03: 18:20

So it'll actually tell you hour by hour. So it will look at what the temperature is. It'll look at the particle levels. It'll look at the allergy and pollen that's in the air. And then it'll give you calculations. One of the best times to actually be outside for poor Poor air quality is right after it rains. So all of those air particles are out of the air. But checking your weather app is really, really important. And then if we do have a poor air quality alert, trying to limit yourself from being outside as much as possible. And I know that that's not possible for those who work outside. So when you are outside and you have to exercise or work or transport, making sure that you maybe use a mask. There are specific masks that can help to filter those particles. Masks that are designed to, that will say that they filter ozone or PM 2.5 are great masks.

Speaker 01: 19:14

Particulate matter, I'm going to guess is what PM is.

Speaker 03: 19:16

It is. Yep. So you'll look for PM 2.5. Any of the masks that are rated N95, KN95 or N99 are highly recommended for outdoor activity.

Speaker 01: 19:26

And you can buy these over the counter.

Speaker 03: 19:28

Yeah. And I think it's important to note too that athletes are at high risk for air quality and excessive heat waves because of their increased demand that they're taking into their body of air.

Speaker 01: 19:40

And we're not just talking about professional athletes. We're talking about you runners and you people who are outdoors exercise.

Speaker 03: 19:46

Those eight-year-old soccer players that I know and all those little ones.

Speaker 01: 19:51

More on air quality, but I want to move us into our houses. I had a really good friend of mine sort of chastise me for having a gas stove. Okay, so I want to talk about indoor air quality.

Speaker 03: 20:05

So when you have to be outside and sometimes we do, right? And we're exposed to poor air quality. The big thing you want to think about is giving yourself some break indoors. So having clean air inside is really important. You can do that by using air purifiers, having plants. There are certain plants that can help pull air pollution out of your home. And you want to limit the indoor sources of air pollution. Like

Speaker 01: 20:30

my gas stove. I love that gas stove. But I've been told they have these convection ones or conduction ones that are good.

Speaker 03: 20:38

Induction. Induction. Okay, thank you. Yes, those are a lot better for you. And decreasing things like burning candles, things like that when you need to have your windows closed in our indoors.

Speaker 01: 20:49

I have a wood-burning fireplace in my house. I'm going to take a wild stab that that isn't great for indoor air quality either.

Speaker 03: 20:55

Correct. It's not.

Speaker 01: 20:56

All right. All right. So maybe open some windows. But there are things you could do. There are things you could do. All joking aside, indoor air quality really does matter.

Speaker 03: 21:06

It does. Yeah. Your body needs a break to have some clean air. And then on a big scale level, if we're thinking about how can you contribute when there's poor

Speaker 01: 21:15

air quality. Yeah, I'd love you to tell us some tips on that.

Speaker 03: 21:18

So think about limiting your carbon output. So maybe you don't drive to work that day. but maybe we don't want you to bike because there's poor air quality, but take public transportation or work from home, things like that. So trying to limit your output on those days is really important to the overall air quality for everybody.

Speaker 01: 21:36

People say what you individually do doesn't matter, but it really does matter if a million of you are all doing that.

Speaker 03: 21:42

Exactly.

Speaker 01: 21:42

Let's move to excessive heat.

Speaker 03: 21:44

Yeah, so excessive heat, again, is another phenomenon that people, there are a lot of things that you can control with excessive heat and your body's ability to tolerate it. Again, similar to poor air quality, it's knowing your heat risk. What are the factors such as your medications, your conditions that would limit your body's ability to adapt to heat? So even just being a kid or being a senior or being pregnant or a person of color, all of those things are going to be increased risk factors for increased health risks during heat waves. And then when we start to see increases in heat, again, slowly increasing your exposure to heat to let your body get used to that, roughly taking about two weeks to let your body get adjusted.

Speaker 01: 22:33

What if you can't? You know, I know that's a hard question, but what if you're... I see people, I don't know why I thought of roofers at this moment, but just one example of someone who can't stay out of the heat. They're on top of a sunny roof working hard and sweating and out in the heat.

Speaker 03: 22:53

That's a good point. It's not... just our physical or physiological conditions that increase our heat risk there's also things like financial reasons that people might be more exposed to heat so if it is hot out and you need that money as a roofer you may put your body at risk to to work because you need that money so there are legal implications for people to be exposed to more heat there are financial all kinds of different reasons why people might be at increased risk for heat.

Speaker 01: 23:25

So if I have to be outside for whatever reason, whatever my reason is, and it's hot, are there things I can do to stay safer?

Speaker 03: 23:32

Yeah, so trying to get into shade and giving yourself breaks is really, really important. So that might be getting back into your work truck or under trees, things like that. Any source of shade, it's typically 15 degrees cooler in a shady space. Wow, I didn't know that. Yeah, so plant some trees. Get under a tree. Get under a tree, create shade. Wearing light-colored clothing is really helpful too. It will help to not absorb the heat. keeping hats on, use artificial shade if you need to with an umbrella, things like that. And then making sure to hydrate is really, really important to prevent some of those heat-related illnesses. You can carry a towel with you and keep that wet. That will help to keep you cool. And then knowing where some of your cooling centers are. So if you live in a home or an apartment or are unhoused and you don't have access to a cooling center or air conditioning, finding those places in your community where you can get a break from the is really important that your body, even though it has had that exposure, it needs to have that break to really help to limit your risk.

Speaker 01: 24:39

And looking out for your neighbors, I would think might be something we should all do a little bit more of.

Speaker 03: 24:44

Yeah, I think as we think about climate change, it's really going to take all of our communities to become more resilient. And so make sure you take care of yourself and you're safe, but then call that neighbor who may be is on a limited budget because they're a senior and might be more apprehensive to use their air conditioning or doesn't have air conditioning. So check on your neighbors. People who have pets are less likely to seek cooling centers. So there's just lots of different factors that might limit your neighbors or loved ones from seeking Okay,

Speaker 01: 25:18

so before I let you go, talk about that mental health piece, that climate anxiety. What are some tips for people who might be experiencing that?

Speaker 03: 25:25

Yeah, so luckily there's a lot more support and research about climate anxiety. The big solutions that they talk about or most impactful solutions are acknowledging that you're having those feelings, that that is a response to what's going on in our environment. noticing how impactful they are to your body and mind. So if you're having anxiety that's really impacting your function, please seek out professional help. There are lots of great mental health professionals out there who are trained in eco-anxiety and can help to give you guidance. The other activities or things that are highly suggested is to find other people who are passionate about those topics. For instance, I am passionate about trees and kids' health, so I tend to do a lot of work with those types of groups that are planting trees or working on environmental health. Find groups that have that same passion and get active. Use that anxiety and turn it into action. That can be one of our best strengths.

Speaker 01: 26:29

That is a great tip. I just absolutely love that because do you know what? There are things we can do. So today we learned that climate change isn't just an environmental issue, which it is, but it's a health issue for you and your communities. We're all affected by that. So a huge thank you to you, Beth, for joining us. But are there any final thoughts you'd like to leave our listeners with?

Speaker 03: 26:50

Yeah, I would love to say that there's some really great work that's going on out there. The more active that I get in this work, the more passionate people I meet doing this work. And so knowing that there is really good momentum moving forward is very hopeful. So I think we're hopefully moving in a really good trajectory from people's passion and people on the ground doing the hard work. And climate resilience really starts with our own personal resilience. So it's important to take care of your own body, your own mind, and then each other. And there are ways that you can make a really big difference. So being aware of your own carbon footprint in what you buy, how you transport. All of those things will help to reduce the carbon released into our atmosphere and help to make our planet and ourselves healthier.

Speaker 01: 27:43

There are things that we can't control, starting with how we take care of ourselves. And I'm struck by that there is hope for change in the future. Beth, could you tell us how you got into this?

Speaker 03: 27:54

Yeah, I would say I've always been a person very in touch with nature, and I love being out in nature. And Over the last decade or so is when I started to really notice these impacts of climate change, and it caused my own anxiety about climate change and sadness about it. I have young children, and I didn't want to feel paralyzed by that anxiety or fear, and I wanted to be able to tell my kids that I've done everything that I can to try to help make this planet a healthier planet so that they can take their kids camping and swimming and do all those things without having to wear masks

Speaker 01: 28:34

outside. Wonderful. Dr. Bestigora, thank you for being here.

Speaker 03: 28:38

Thank you for having me.

Speaker 01: 28:39

Listeners, I hope you've picked up some information here. And just remember that action is the antidote. I hope you'll join us in two weeks' time when we drop another episode. And in the meantime, be healthy and be well.

Speaker 00: 28:52

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.