Editor’s Note: In Part 2 of our article examining the many ways the environment and our changing climate affect thoracic oncology, Dr. Nogueira explores strategies for managing disruptions in care and solutions for reducing healthcare’s contributions to climate change. For more, read Climate Change Increasingly Exposes Communities, Healthcare Systems to Unpredictable Circumstances.
Previously, we explored how climate change threatens cancer control activities by altering the frequency and behavior of extreme weather events. The inevitable question that follows is “what can we do about it?” Here we highlight some action items and potential solutions with climate and health co-benefits for the entire population.
What can be measured can be changed
As climate change continues to alter the frequency and behavior of extreme weather events, developing and implementing better disaster risk management strategies must become a research priority in order to improve the ability of healthcare systems to prepare and respond to the dynamic hazards posed by climate-driven disasters.5
Research aimed at better characterizing the vulnerability of people in different phases of cancer treatment and survivorship care is urgently needed. Further, lessons learned from tending to the needs of people diagnosed with cancer are relevant for other patient populations. The multiplicity of cancer types, treatment modalities, and related comorbidities and side effects provide cancer researchers and health professionals with a wealth of information that can be used to better protect the health and safety of several different vulnerable patient populations.6
Conversely, strategies developed to manage disruptions in cancer care caused by climate-driven disasters can inform our response to other disaster scenarios. For example, the modified radiation therapy schedules developed in the aftermath of Hurricane Maria resurfaced as a valuable solution during the early months of the COVID-19 pandemic, when radiation treatment was widely interrupted.5,7
The implications of this example highlight the fatal flaw in the prevalent narrative used to describe climate vulnerability. While it is important to recognize that climate change has the potential to exacerbate health disparities because communities who are already experiencing worse health outcomes are also the most vulnerable to climate hazards,8 this narrative reinforces problematic notions of privilege and disadvantage.9
First, this narrative creates the illusion that good health and access to resources can shield people from the threats of climate change. On the contrary, medical vulnerability is a dynamic state,3 we are all patients at some point in our lives.2 Moreover, patients are not the only ones suffering disproportionately from climate hazards. Healthcare professionals are exposed to compounding psychological challenges and professional demands during climate driven disasters, with higher prevalence of worse mental health outcomes.10 This dynamic vulnerability collides with the inescapability of climate hazards, which was recently exemplified by climate-driven heatwaves, wildfires, and floods impacting communities in the global north previously thought to be immune from climate hazards.11,12 Nobody is safe from the threats of climate change.
Second, this narrative reinforces the hierarchical categorization of people, places, and (especially relevant to cancer control) knowledge.13 Insular and parochial descriptions of how communities that have been targeted for marginalization—and therefore have fewer resources (i.e., lower adaptive capacity) and worse health (i.e., higher susceptibility)—have contributed the least to greenhouse gas emission but are exposed first and worse by climate hazards contributes to the “less than” portrayal of these communities.9 One of the most impactful consequences of this hierarchical framework is the dismissal of the knowledge and expertise coming from these communities.9,13
In contrast to the shortfalls of the prevalent narrative, the example of radiation therapy adjustments developed in Puerto Rico in the aftermath of Hurricane Maria becoming a crucial resource for alleviating the impact of the COVID-19 pandemic on cancer care exemplifies how essential expertise is coming from the places being impacted first and worse by climate hazards.14 This is not the first or only example, of course.
Communities targeted for marginalization, who struggle with the consequences of colonialism, imperialism, and other forms of oppression, such as Puerto Rico residents, have been the first to be exposed to environmental stressors and have been developing innovative solutions to thrive in changing environments throughout history.9,13 Herein lies the third and most important lesson lung cancer has to teach us about climate change and cancer.
Solutions at the intersection of climate change and cancer
The same human activities fueling the greenhouse effect also release toxic contaminants associated with worse cancer risk and outcomes.1 The causal relationship between exposure to air pollution and increased lung cancer risk is one of the most tangible examples of the immense potential of solutions at the intersection of climate change and cancer control.
Moreover, exposure to air pollution exemplifies how dismissing knowledge developed in communities targeted for marginalization enables proliferation of polluting activities that have detrimental health consequences for the entire population. Through discriminatory policies and practices, polluting human activities are frequently concentrated near communities that have been targeted for marginalization, resulting in disproportionate exposure to toxic compounds,15,16 and worse health outcomes.17 However, pollution cannot be confined to neighborhood boundaries and polluting activities have ripple effects that impact people of all demographic and socioeconomic backgrounds.
One of the most notorious examples of this is the region previously called “Plantation Country,” where enslaved people were forced to labor in the state of Louisiana. This region is now called “Cancer Alley” due to the increased cancer risk associated with the siting of more than 200 petrochemical facilities in the community.18,19 This strategy of hiding visible evidence of the most appalling environmental and public health consequences of polluting human activities in communities targeted for marginalization—out of daily view, public awareness, and outrage—enables our continuous reliance on fossil fuels.
Air pollution, in contrast, makes the invisible visible. No step in the fossil fuel cadre is clean. Eventually, the contamination reaches all of us. The detrimental health consequences of exposure to air pollution, including worse cancer risk and mortality among individuals of all sociodemographic backgrounds, illustrates how the toxic compounds released by these polluting activities cannot be confined to neighborhood borders and impact health outcomes in the entire population.9,13,17 Therefore, air pollution makes the connection between polluting human activities, climate change, and worse health outcomes visible and highlights the importance changing the “vulnerability” narrative and shifting towards recognizing and incorporating knowledge coming from communities targeted for marginalization.1
Given the current and substantial impact polluting human activities have on lung cancer risk and outcomes, championing environmentally responsible policies and practices is an inherent responsibility of anyone committed to reducing the cancer burden in the population. There are several actions and strategies readily available to individuals, institutions, and governments that have climate change and cancer control co-benefits.3,12,20 For example, minimizing plastic consumption,21 updating food procurement practices to reduce reliance on industrialized agriculture and reduce waste,20 improving electricity requirements and use in buildings and medical equipment,4 and streamlining transportation requirements (e.g., people, supplies).1
The substantial overlap between human activities fueling climate change and worsening cancer risk and outcomes combined with the threats climate change poses to lung cancer prevention, treatment, and survivorship are sending a clear message: the time is now for the lung cancer community to act. Later is too late.
References
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- 14. Ortiz AP, Hospedales CJ, Méndez-Lázaro PA, et al. (2024) Protecting Caribbean patients diagnosed with cancer from compounding disasters. The Lancet. Oncology. 25: e217-e24.
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- 18. Batiste J. (2022) Being Black Causes Cancer: Cancer Alley and Environmental Racism. Available at SSRN 4092077.
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- 20. Nogueira LM, Ross AJ, D’Angelo H, Neta G. (2024) Climate Change in Comprehensive Cancer Control Plans in the US. JAMA Oncol. 10: 977-9.
- 21. Nogueira LM, Sherman JD, Shultz JM. (2024) Derailing Carcinogens-Oncologists and the Ohio Train Derailment. JAMA Oncol. 10: 25-6.
