In September 2021, the New England Journal of Medicine and more than 200 other health journals worldwide published a joint editorial calling for urgent action to limit greenhouse gas emissions to protect human health,1 adding to growing demands from around the globe. Yet 9 months later, global greenhouse gas emissions — predominantly driven by fossil-fuel combustion — continue to rise as the responses required are debated or ignored. In the United States, the country that has the greatest cumulative emissions historically and is the largest producer of oil and gas, greenhouse gas emissions are rapidly returning to prepandemic levels and are growing faster than the U.S. economy.2 Meanwhile, recent U.S. pledges to promptly decarbonize are incompatible with current policies and practices, including issuing new lease permits for fossil-fuel drilling and allowing continued construction of new pipelines, which lock in future emissions and their associated health harms.
The average global temperature is now 1.1°C above preindustrial levels. The report from the United Nations Intergovernmental Panel on Climate Change published earlier this year warned that greenhouse gas emissions must start to decline by 2025 and fall by 43% from current levels by 2030 if we are to limit warming to 1.5°C, the preferred climate goal of the Paris Agreement.3 Humanity has the tools it needs to begin substantially reducing emissions over these next 3 years; technological advances have made solar and wind energy widely available and often cheaper than fossil fuels — especially if governments stop subsidizing fossil fuels.3 The primary barrier to an equitable transition away from coal, oil, and natural gas is a lack of political will, underpinned by the influence of the fossil-fuel industry.3
Why are fossil fuels an issue for medicine and, specifically, for medical journals? Their extraction and use are the root cause of air pollution and climate change. Each year, an estimated 8.7 million people die worldwide because of fossil-fuel–generated particulate air pollution,4 and the total number of deaths attributable to climate change is not even known. Air pollution and climate change also cause and exacerbate myriad health conditions, including heat-related illnesses, cardiovascular and respiratory disease, allergic conditions, vectorborne disease, pregnancy complications, and mental health disorders.5 Although nearly everyone is affected to some extent, health consequences are distributed inequitably. Owing to economic injustice and systemic racism, low-income communities and certain racial and ethnic groups often experience the greatest harms, despite their contributing the least to greenhouse gas emissions and pollution.6 As caregivers, we must be leaders in ameliorating these problems.
Climate change is also increasingly disrupting health sector infrastructure, power, and supply chains, especially during climate-intensified events such as wildfires, floods, and hurricanes. In a recent NEJM Catalyst Innovations in Care Delivery survey of nearly 800 global health care leaders, 70% of U.S. respondents reported that climate change is already affecting care delivery.7 Yet less than a quarter of respondents reported that their organizations had assessed their own climate-related hazards.
Although the NEJM Group publications have already been covering the health consequences of climate change and air pollution (see the Climate Change topic page, at https://www.nejm.org/climate-change), we are redoubling our commitment in response to the increasing urgency. We are launching a broader effort starting with articles in each of our journals — the New England Journal of Medicine, NEJM Evidence, and NEJM Catalyst Innovations in Care Delivery — addressing different aspects of this unprecedented challenge. In issues released today, Perera and Nadeau review consequences and responses for children’s health (New England Journal of Medicine),8 Keswani et al. address broad health harms of air pollution (NEJM Evidence),9 Heinzerling analyzes ramifications of a Supreme Court case against the Environmental Protection Agency (New England Journal of Medicine),10 and Patel et al. outline implications of extreme heat for the health care system (NEJM Catalyst Innovations in Care Delivery).11
Throughout 2022, we will publish at least one article in an NEJM Group journal each month related to fossil-fuel–driven health harms and will subsequently plan ongoing coverage of related content. To further engage trainees and educators, our Resident 360 website (https://resident360.nejm.org/) is launching, coincident with publication of the first articles in the series, a discussion about incorporating a climate lens into medical training. Meanwhile, our journals welcome submissions for this series, especially — but not limited to — high-quality original research.
This series is aligned with our core mission of equipping physicians and trainees with the knowledge and tools required to practice in the 21st century. Key goals include informing clinicians and health system administrators about the consequences of fossil-fuel extraction and use that are increasingly affecting our patients and care delivery systems and providing information about effective strategies for reducing the associated risks. We hope these articles will make clear the complementary roles of the medical and public health sectors in addressing this crisis and, by identifying knowledge gaps, stimulate research to guide development of equitable adaptation and mitigation policies.
As members of the medical and care delivery community, our readers are optimally positioned to reduce the devastating consequences of climate change and air pollution by instituting practices and advocating for policies that foster health and equity. The health of our patients, and our world, demands our engagement.
Funding and Disclosures
1. Atwoli L, Baqui AH, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. N Engl J Med 2021;385:1134-1137.
2. Rivera ALK, Larsen K, Pitt H, Movalia S. Preliminary US greenhouse gas emissions estimates for 2021. Rhodium Group, January 10, 2022 (https://rhg.com/research/preliminary-us-emissions-2021/).
3. Skea J, Shukla PR, Reisinger A, et al. Climate change 2022: mitigation of climate change. Intergovernmental Panel on Climate Change (https://report.ipcc.ch/ar6wg3/pdf/IPCC_AR6_WGIII_FinalDraft_FullReport.pdf).
4. Vohra K, Vodonos A, Schwartz J, Marais EA, Sulprizio MP, Mickley LJ. Global mortality from outdoor fine particle pollution generated by fossil fuel combustion: results from GEOS-Chem. Environ Res 2021;195:110754-110754.
5. Haines A, Ebi K. The imperative for climate action to protect health. N Engl J Med 2019;380:263-273.
6. Tessum CW, Apte JS, Goodkind AL, et al. Inequity in consumption of goods and services adds to racial-ethnic disparities in air pollution exposure. Proc Natl Acad Sci U S A 2019;116:6001-6006.
7. Salas RN. The growing link between climate change and health. NEJM Catal Innov Care Deliv 2022;3(3). DOI: 10.1056/CAT.22.0052.
8. Perera F, Nadeau K. Climate change, fossil-fuel pollution, and children’s health. N Engl J Med 2022;386:2303-2314.
9. Keswani A, Akselrod H, Anenberg SC. Health and clinical impacts of air pollution and linkages with climate change. NEJM Evid. DOI: 10.1056/EVIDra2200068.
10. Heinzerling L. Climate change in the Supreme Court. N Engl J Med 2022;386:2255-2257.
11. Patel L, Conlon KC, Sorensen C, et al. Climate change and extreme heat events: how health systems should prepare. NEJM Catal Innov Care Deliv 2022;3(7). DOI: 10.1056/CAT.21.0454.