Six practical public health interventions in ‘climate cardiology’ could help prevent the climate crisis from undermining cardiovascular health, according to a Commentary in BMJ Global Health.

They include transitioning from high red meat to plant-based diets, from vehicular to active transportation, and from fossil fuels to clean energy.

As well, expanding green spaces, supplying clean cooking stoves and improving resource efficiency in healthcare were key opportunities to both improve cardiovascular health and mitigate the impact of climate change.

The US authors said a change to sustainable plant-based diets had the co-benefits of reducing saturated fat intake while also reducing greenhouse gases from livestock. However such a change required more than individual action.

“Food subsidies and taxation should be restructured to make red meat more expensive and locally sourced, and plant-based foods more available and affordable,” they said.

Similarly, policies to encourage walking and cycling over vehicle use could increase levels of physical activity and reduce greenhouse gases from fossil fuel consumption.

The Commentary said reductions in fossil fuel emissions necessary to meet the Paris Agreement would dramatically reduce air pollution exposures and avert over 20 million attributable deaths over the next 30 years.

“Transitioning away from coal, oil and gas and towards solar, wind, geothermal and hydroelectricity therefore provides the greatest opportunity to protect both the planet and cardiovascular health.”

The authors’ position supports a 2021 joint opinion by the World Heart Federation, American College of Cardiology, American Heart Association, and the European Society of Cardiology which said nearly 20% of CVD deaths worldwide were attributable to air pollution.

Sustainable healthcare

The BMJ Global Health Commentary said healthcare delivery was “extraordinarily energy-intensive” compared with other commercial and service activities.

“Globally, the healthcare sector is responsible for 4.4% of all GHG emissions, as well as 2.8% of fine particulate matter air pollution (PM2.5).”

Yet there were several interventions which could promote cardiovascular health and reduce the carbon footprint of healthcare. They included:

• Expand CVD prevention, self management, telehealth and local ambulatory care to reduce hospital stays and resource intensive interventions
• Reduce wasteful practices including over treatment and over prescribing
• Invest in disaster planning and early warning systems to prepare for waves of illness associated with extreme weather events, wildfire smoke or climate refugees.

“A new field of climate cardiology can study and implement such opportunities to protect patients and planet,” they said.

Canberra cardiologist Dr Arnagretta Hunter, who is also the Human Futures Fellow at ANU, told the limbic that clinicians focussed on the biology of disease but also increasingly understood the social determinants of health.

“I think the impact of the environment on our health, we probably underappreciated that because things have been fairly stable. Winter, summer, air pollution …[it] has all been fairly stable over the last 100 or 200 years.”

“What’s happening now is that it’s not as stable. And we’re beginning to really appreciate in a much more meaningful way that the climate impacts on our health and wellbeing in a way that will matter tremendously.”

Dr Hunter, who recently spoke on reducing low value care for environmental sustainability at a Choosing Wisely National Meeting, said the BMJ Global Health Commentary highlighted the flow-on benefits for health by taking action on our carbon footprint individually, as a community and more broadly.

She said there was good research evidence that an improvement in cardiovascular risk was one of the easy wins from a low carbon lifestyle.

“I’m sure all healthcare professionals have a growing interest in this relationship between environment and health and that the things we can do to reduce our carbon footprint and to do our bit for climate change, can have huge health benefits.”