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ATS: Moving the Needle on Climate Change

 EOPH Assembly Program Chair,Mary Rice, MD, ATSF, contributed to this month's President's Message.

The COVID-19 pandemic was a health crisis that resulted in an unprecedented mobilization of the health care sector and the development of highly effective prevention and mitigation strategies in record time.  As we recover from the tragedy of the pandemic, we must also learn from the success stories of how the medical community responded and apply those lessons to how we address climate change, the most pressing health crisis of our time. 

The continued emissions of heat-trapping greenhouse gases are warming the atmosphere, which harms respiratory health and causes critical illness in multiple ways. Heat waves trigger respiratory hospitalization and ICU admission for numerous health conditions, especially for the elderly. Summer heat increases the formation of ground-level ozone pollution, a powerful respiratory irritant linked to asthma attacks in children and adults.  Warmer weather is lengthening the pollen season and increasing the quantity of pollen formation, with implications for allergic respiratory disease.  Warmer weather also lengthens the wildland fire season and promotes wildfire events.  Wildfire smoke is a major source of air pollution in many parts of the U.S. and around the world that consists of a mixture of particles, gases and toxic chemicals.  The increase in large, devastating wildfires has caused tremendous human suffering and is a serious respiratory health hazard for all age groups. 

Warmer weather increases the incidence of extreme weather events such as hurricanes, that displace people, damage infrastructure and promote mold formation.  The health consequences of climate change are expected to worsen as emissions continue.  Just how imminent is the danger? Consider this new simulation technology developed by NASA to help illustrate the progression of a warming planet.  NASA will be showcasing a Hyperwall at ATS 2023 where attendees can learn more about climate simulations.

Addressing the health crisis of climate change is imperative and aligns with the core mission of the ATS: to advance respiratory health through multidisciplinary collaboration, education, and advocacy.  In fact, one of the things that sets ATS apart from other respiratory-related specialty medical societies is that we also view advocacy as a core mission. 

ATS has been active in the public discussion of climate and health for decades, including:

  • Convening ATS workshops on climate change and wildland fires
  • Surveying S. and international ATS members about the impact of climate on their patients
  • Supporting the original EPA climate change endangerment finding
  • Filing an Amicus brief in the West Virginia v EPA 2022 case to support the EPAs authority to regulate greenhouse gas emissions from power plants
  • Supporting the EPA methane emissions reduction rule
  • Proposing a resolution to the AMA House of Delegates calling for federal action on climate change


While all of these activities help to drive the discussion I want to focus on one in particular, the ATS Workshop that led to the Social Cost of Carbon Report. Social cost of carbon is a term used to describe the estimate of the total economic costs or external social damages for each additional ton of carbon dioxide released into the atmosphere.  The social cost of carbon is a policy yard stick (or meter stick for our non-U.S. colleagues) that helps U.S. and international policy makers compare the implementation cost of policy options to reduce greenhouse gas emissions to the “social cost” of allowing those emissions to continue.

The ATS has taken the view that prevailing social cost of carbon estimates do not fully capture the health costs associated with climate change. The ATS is not alone in this view.  In a 2017 report, the National Academies of Science called for more research and refinements in the damage function of the social costs of carbon estimates.  Because previous social cost of carbon estimates did not capture the full health costs of carbon emissions, policymakers were making ill-informed policy decisions by underappreciating the costs of carbon pollution to public health.

In an effort to improve the current heat-health damage functions, in 2021 the ATS held a workshop with experts from respiratory, cardiology, vector-borne infectious diseases, and economics to review the available research on heat-health damage functions.  In preparation for the workshop, the ATS commissioned a systematic review and the meta-analyses of available research on the impact of temperature change on an array of relevant health outcomes that could potentially inform the development of relevant damage functions for changes in temperature due to greenhouse gas emissions. Workshop participants used the meta-analyses data to develop pooled effect estimates for increased temperature (1C) on increased all-cause mortality risk by global region – effectively more accurately capturing the costs of climate change on health. The workshop data can be used by health economists to improve their work in developing refined social costs of carbon estimates.

Gratifyingly, health economists are already using the ATS data.  Leading health economists used the ATS workshop data in a recent Nature publication to provide revised social cost of carbon estimates.  Kevin Rennert, David Anthoff and colleagues published a new model estimate that relies on the ATS workshop pooled estimates to significantly increase the social cost of carbon estimate from $51 dollars per CO2 ton that the U.S. governments previously used to a new estimate of $185 per CO2 ton.  This new higher social cost of carbon estimate will likely be used by the U.S. government and other governments around the globe to evaluate climate change policy and hopefully will tip the scales toward policy action to reduce future GHG emissions.

This is a clear example of ATS not just participating in the public debate on climate change solutions, but actually moving the needle on it. As members of the ATS, we can be very proud of this! Of course, work such as this and our other areas of public health focus could not be performed without the exhaustive work of our member/volunteers who serve on a number of ATS committees, including Environmental Health Policy, Health Policy, Research Advocacy, and Tobacco Action. If you want to get a broader sense of just how active ATS is on the advocacy front, skim through recent editions of the Washington Letter, published on a regular basis by our Washington office.

I hope this short case study is an inspiring example of the impact that your Society has achieved through multidisciplinary collaboration, education and advocacy on climate change.  At this year’s conference in Washington DC, you will find scientific sessions on climate change, the carbon footprint of the healthcare sector and environmental justice.  Climate change is the great health crisis of our time, and as scientists and clinicians dedicated to respiratory health, we must address it with the same level of persistence and urgency that we brought to our fight against the COVID-19 pandemic.