Publications
Selected papers, chapters, and articles by affiliated faculty and fellows.
Use of machine learning tools to predict health risks from climate-sensitive extreme weather events: A scoping review
Shakirah N. Ssebyala , Timothy M. Kintu, David J. Muganzi, Caleb Dresser, Michelle R. Demetres, Yuan Lai, Kobusingye Mercy, Chenyu Li, Fei Wang, Soko Setoguchi, Leo Anthony Celi, Arnab K. Ghosh
PLoS Climate. January 17, 2024
Use of ML algorithms to assess adverse health impacts from climate-sensitive extreme weather events is possible. However, to fully utilize these ML techniques, better quality data suitable for use is desirable. Development of data standards for climate change and health may help ensure model robustness and comparison across space and time.
Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement
Dresser C, Johns Z, Palardy A, McKINNON S, Breakey S, Ros AMV, Nicholas PK
Milbank Q. 2024 Jan 16.
The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system.
Portland’s response to the Western North American heatwave: A brief report
Burlotos A, Dresser C, Shandas V
Disaster Med Public Health Prep. 2023; e522(17):1-4
Heatwaves exhibit high predictability in the demographics of those most affected and have rising rates of recurrence. Given the effectiveness of residential cooling systems in preventing heat-related mortality, findings suggest that future public health and policy initiatives should put increased focus on the primary prevention of heat exposure.
Extramural US Federal Research Grants For Health Outcomes Associated With Climate Change Inadequate, Too Narrow In Focus
Sorensen C, Dresser C, Balakumar A, Wheat S, Yates E, Healy JP, Brown C, Butala N, Lehmann EY, Malina G, Redelmeier RJ, Hess JJ, Salas RN.
Health Aff (Millwood). 2023 09; 42(9):1289-1297. PMID: 37669497.
We identified and described extramural US federal research funding (that is, grants provided to organizations and institutions outside of federal agencies) that both addressed health outcomes associated with climate change and was awarded between 2010 and 2020. During this eleven-year period, 102 grants met our criteria, totaling approximately $58.7 million, or approximately $5.3 million per year (2020 adjusted US dollars). Federal investments in climate change and health research during this period failed to address the breadth of climate-sensitive exposures, health outcomes, and impacts on vulnerable populations.
Beyond Defibrillation During Immersion: Case Illustrates Value of Heatstroke Treatment Protocols
Dresser C, Rublee C, Giudice C, Sorenson C
Annals of Emergency Medicine, Volume 82, Issue 2, 2023, Pages 237-238. ePub July 19, 2023. ISSN 0196-0644
Rapid recognition and effective management of heatstroke is of increasing importance for emergency medicine. Ongoing climate change has led to a dramatic increase in the frequency and severity of heatwaves in US cities since the 1960s, and future warming is expected to result in escalating heatwave hazards… We urge emergency physicians and institutional decision makers to see this heatstroke case as more than an unusual example of defibrillator use and to take this opportunity to consider the value of evidence-based, protocolized approaches to diagnosing and treating this rapidly lethal condition.
Climate Change and Health: Addressing Gaps Through Patient Education in the Emergency Department
Giudice C, Rublee C.
Annals of Emergency Medicine. ePub July 18, 2023. ISSN 0196-0644.
it is no longer possible to focus only on preventing serious consequences of climate change, and it is therefore necessary to invest in adaptation efforts, with special attention to the needs of the most vulnerable people.
Building capacity of healthcare professionals and community members to address climate and health threats in The Bahamas: Analysis of a green climate fund pilot workshop
Hamilton W, Philippe C, Hospedales J, Dresser C, Colebrooke B, Hamacher N, Humphrey K, Sorensen C.
Dialogues in Health, Volume 3, 2023, 100141, ISSN 2772-6533, https://doi.org/10.1016/j.dialog.2023.100141
Following the training, participants demonstrated increased knowledge of the causes of climate change, health exposures, climate-sensitive diseases, and vulnerable populations relevant to The Bahamas. Further, participants reported high levels of willingness and readiness to tackle climate change and its health consequences.
Disaster Medicine in a changing climate
Dresser C, Balsari S.
Chapter 8 - Disaster Medicine in a Changing Climate, Editor(s): Gregory Ciottone, Ciottone's Disaster Medicine (Third Edition), Elsevier, 2024, Pages 51-57, ISBN 9780323809320, https://doi.org/10.1016/B978-0-323-80932-0.00008-2.
Climate change is exacerbating a variety of natural hazards and has substantial implications for disaster medicine. The practice of disaster medicine in a changing climate requires an approach guided by the best available scientific evidence and a willingness to adjust to changing risks and risk projections as they evolve.
Wildfire Threat to Inpatient Health Care Facilities in California, 2022
Bedi NS, Dresser C, Yadav A, Schroeder A, Balsari S.
Am J Public Health. 2023 Mar 2:e1-e4. doi: 10.2105/AJPH.2023.307236. Epub ahead of print. PMID: 36862972.
Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk
Bringing Together Climate-Conscious Health Professionals - creation of Climate and Health 2023
Humphrey, K., Rao, Sheetal., & Alexander, M.
Journal of Climate Change and Health. 2023. https://www.sciencedirect.com/science/article/pii/S2667278223000330
The climate crisis presents escalating threats to human health. To adequately address this challenge we will need a combination of widespread education, engagement and elevation of health professionals, and development of research to solve specific questions. Convenings of health professionals to discuss the intersection of health and climate change are an essential mechanism for building effective collaborative networks, sharing ideas, and empowering individuals and groups in this space.
Climate Change Effects on Vector-Borne Disease: The Case of Lyme
Tess Wiskel, Hawra Al-Lawati, Kimberly Humphrey
Contagion. February 2023 (Vol. 08, No. 1)
With evolving weather patterns, the natural habitat of ticks is expanding, and more people are becoming susceptible to them.
Natural disasters strike everywhere: Ways to help protect your health
Kimberly Humphrey and Caleb Dresser
Harvard Health Publishing. January 20, 2023.
Making basic preparations before climate emergencies can help you protect your health.
CrisisReady's novel framework for transdisciplinary translation: Case-studies in wildfire and hurricane response
Andrew Schroeder, Caleb Dresser, Akash Yadav, Jennifer Chan, Shenyue Jia, Caroline Buckee, Satchit Balsari
Journal of Climate Change and Health, Volume 9, 2023, 100193
The Data-Methods-Translational framework we have developed is scalable and relies on sharing science and co-creating products with policy makers and response agencies to ensure real-world applicability. These attributes make the framework particularly useful for formulating evidence-based approaches to protect human health through climate change adaptation.
Designing digital health applications for climate change mitigation and adaptation
Zerina Lokmic-Tomkins, Ann Borda, Kimberly Humphrey
The Medical Journal of Australia, 10 January 2023
Environmentally sustainable equitable digital transformation is central to delivering low carbon health care models."
Where are People Dying in Disasters, and Where is it Being Studied? A Mapping Review of Scientific Articles on Tropical Cyclone Mortality in English and Chinese
Dresser C, Hart A, Kwok-Keung Law A, Yen Yen Poon G, Ciottone G, Balsari S
Prehosp Disaster Med. 2022 Apr 5:1-8
Regions that have historically experienced high mortality from tropical cyclones have not been studied as extensively as some regions with lower mortality impacts. Long-term mortality and the implications of climate change have not been extensively studied nor discussed in most settings. Research in highly impacted settings should be prioritized.
Hurricanes and Health
Dresser C, Balsari S, Leaning J
Oxford Encyclopedia of Natural Hazards Research, 23 March 2022
Without concrete actions to address both hurricane hazards and population vulnerability, the 21st century may be marked by increasingly dangerous hurricanes affecting growing coastal populations that will be left with few viable options for seeking safety.
Who's at Risk in a Changing Climate? Mapping Electricity-Dependent Patient Populations in a Coastal City
Webb E, Balaji L, Nathanson LA, Balsari S, Dresser C
R I Med J, 2021
Healthcare systems can assess risk to climate-vulnerable patient populations using publicly available data in combination with hospital medical records. The approach described here could be applied to a variety of environmental hazards and can inform institutional and individual disaster preparedness efforts.
Climate Change and Health in New England: A Review of Training and Policy Initiatives at Health Education Institutions and Professional Societies
Dresser C, Gentile E, Lyons R, Sullivan K, Balsari S.
R I Med J, 2021
There is substantial activity related to climate change and health in New England, but it is concentrated in a small number of locations. Opportunities exist to improve access to education on this topic and increase involvement of health professional associations.
Information for Medical Professionals
Additional Materials for The 2021 Lancet Countdown on Health and Climate Change Policy Brief for the United States of America
Climate change is broadly harming the health of patients as individuals and communities across the United States (U.S.) increasingly experience the long-predicted consequences of climate change. There is no safe global temperature rise from a health perspective, and every fraction of a degree matters for patients and communities.
Climate change or COVID-19: Which is a greater threat to our health?
Dresser C
University of Auckland / The Big Q
The human impact of COVID-19 has been horrific, and the health impacts of climate change continue to mount. Rather than focus on comparing the scale of these catastrophes, we should heed the lessons of our experience with COVID-19 as we face a changing climate and future pandemics.
Chapter 27: Specific Impacts Upon Human Health
Dresser C and Balsari S
Global Climate Change and Human Health: From Science to Practice, 2nd Edition, Jay Lemery (Editor), Kim Knowlton (Editor), Cecilia Sorensen (Editor), 2021
The Second Edition of Global Climate Change and Human Health delivers an accessible and comprehensive exploration of the rapidly accelerating and increasingly ubiquitous effects of climate change and global warming on human health and disease. The distinguished and accomplished authors discuss the health impacts of the economic, climatological, and geopolitical effects of global warming.
Health Impacts of Climate Mobility in the United States
Parekh A, Dresser C, Kimball S
SGIM Forum, 2021
Movement of people in response to climate change, referred to as climate mobility, is increasingly expected to play an important role in reshaping American demographics in coming decades. Gradual alterations in temperature and sea level, combined with sudden natural disasters, such as hurricanes and wildfires, will push increasing numbers of people to migrate. This process may drastically shift population centers around the country and will likely worsen health outcomes.
Evidence-Based Heatstroke Management in the Emergency Department
Rublee C, Dresser C, Giudice C, Lemery J, Sorensen C
West J Emerg Med, 2021
Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling.
Climate Change and vibrio
Dresser C & Rublee C
Lancet Countdown on Health and Climate Change, Policy Brief for the United States of America, Appendix. December 2020.
To address the health harms from Vibrio, public health organizations and policymakers should prioritize aggressive climate change mitigation efforts. These efforts can reduce warming of water, sea level rise, and flooding, all of which increase suitability for Vibrio bacteria. To reduce the risk of Vibrio infections, public health protocols and public education should incorporate seasonality and updated location-specific hazards.
Training clinical and public health leaders in climate and health.
Lemery J, Balbus J, Sorensen C, Rublee C, Dresser C, Balsari S, Hynes EC.
Health Affairs, December 2020.
The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.
climate change, migration, and civil strife.
Balsari S, Dresser C, Leaning J.
Current Environmental Health Reports, October 2020.
In this article, we examine the intersection of human migration and climate change. Growing evidence that changing environmental and climate conditions are triggers for displacement, whether voluntary or forced, adds a powerful argument for profound anticipatory engagement. We find that the post-World War II regime designed to receive European migrants has failed to address population movement in the latter half of the twentieth century fueled by economic want, globalization, opening (and then closing) borders, civil strife, and war. Key stakeholders are in favor of using existing instruments to support a series of local, regional, and international arrangements to protect environmental migrants, most of whom will not cross international borders. The proposal for a dedicated UN agency and a new Convention has largely come from academia and NGOs. Migration is now recognized not only as a consequence of instability but as an adaptation strategy to the changing climate. Migration must be anticipated as a certainty, and thereby planned for and supported.
Mortality in Puerto Rico after Hurricane Maria.
Kishore N, Marqués D, Mahmud A, Kiang MV, Rodriguez I, Fuller A, Ebner P, Sorensen C, Racy F, Lemery J, Maas L, Leaning J, Irizarry RA, Balsari S, Buckee CO.
New England Journal of Medicine, July 2018.
In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64. Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016. From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial. This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate.
High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.
Dresser C, Allison J, Broach J, Smith ME, Milsten A.
Disaster Med Public Health Preparedness, December 2016.
Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries. Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations.
Perspective: Environment, biodiversity, and the education of the physician of the future.
Gómez A, Balsari S, Nusbaum J, Heerboth A, Lemery J.
Academic Medicine, February 2013.
To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.