In 2017, the late American physician Paul Auerbach and Jay Lemery, an ER specialist and a professor of emergency medicine at the University of Colorado School of Medicine, wrote Enviromedics. The book recognized the field of climate medicine and the possible role that doctors can play in this raging debate. Excerpts from an interview with Jay Lemery at Jaipur Literature Festival 2025:

As an emergency doctor, what made you correlate climate change and medicine when many were generally denying that climate change was happening?

In 2007, I was disheartened by how we were not just debating policy but now questioning the science behind climate change. As an emergency physician working in wilderness and environmental medicine, which is the craft of taking care of people in remote places, I realised that, as physicians, we had a responsibility to advocate for those fragile and unique ecosystems and how that fed into human health. My colleagues at the Centers for Disease Control and Prevention and my mentor, Paul Auerbach, who became my co-author, wrote a very elegant treatise in the Journal of the American Medical Association that impacted my perspective. I began to look around and said, ‘We’re the physicians, a very powerful scientific community, and we should own this issue.’

As a clinician, my interest was piqued, and I read the research that substantiated what I was experiencing. I was also comfortable doing this because emergency medicine is all about acting with incomplete information.

What were the kind of patients that compelled you to approach health care differently?

At the time, you don’t know that is the case. You had to put two and two together. For instance, when people from Denver and Colorado, places with high summer wildfires, would come in with reactive airway disease, you could see this wasn’t asthma. There was wheezing, or bronchospasm, precipitated by something other than the asthma disease. Often, young and healthy patients would come and say, I never knew I had asthma, and I guess I need an inhaler. And I’d respond, ‘You don’t need it; you don’t have asthma, but you’re responding to the poor air quality because, say, you are a triathlete who was out biking all day long, breathing hard on the road and inhaling all this stuff, right? They have several hours of robust exercise inhalation.’

And we don’t always have that attribution science sorted out. When a doctor writes a prescription, he doesn’t have medical codes for the hottest day of the year. Public health research showed that on days of extreme heat, we’d see an increase in these chronic disease exacerbations.

What do you mean by the term, “Enviromedics”?

“Enviromedics” is when we talk about how climate change is affecting heat, water, food insecurity, aeroallergens, vector-borne disease, and mental health, factors that affect human health. When we coined the term, “Enviromedics” felt creative; in a way, we wanted to define a body of knowledge that had yet to be defined.

Now, it is climate medicine. It questions the role of physicians, nurses, pharmacists, and other healthcare providers in understanding climate change and health. How does that change their practice? How does that shift healthcare systems? And you know what we do from that, and how does that inform policy?

We already know how to take care of heat; we know how to take care of diarrheal disease. But we’re putting two and two together and saying this is a new, novel thread coming from a very particular thing that’s hard to explain. Climate change is slow, it’s faceless, it’s insidious. And so, how do we address that and define it, and where does it begin and end? That was the idea.

How can recognizing climate medicine help doctors and health care workers with the issue?

Doctors are not trained to deal with climate change. There is no agreed-upon curriculum. Medical schools teach based on professors’ or deans’ decisions. Again, we know that practising physicians have very little exposure to this.

We all have to learn about the root causes of climate change, what it does to you and how it should be part of any clinician’s screening exams, etc. We have to have situational awareness around it. And we are not just there yet. That’s the deficit.

Best practices are emerging at different organizations, like the American Associated Medical Colleges or the World Health Organization, which has the ATACH network that discusses best practices around healthcare system decarbonization.

Certain groups deem this a secondary concern. There’s even pushback to say clinicians shouldn’t be talking about this. Treating climate medicine as if it were a scam is horrible. You’re just trying to take people’s freedom away because this is a health threat grounded in solid science, and it’s directly a result of the carbon economy.

You also speak of climate medicine affecting countries like India, which are located near the equator.

In a big city, we can eat from many places. Most of the world isn’t like that. In the equatorial and temperate areas of the world, agricultural productivity is going to drop as the region gets warmer and warmer and becomes more prone to food disruption, droughts or floods. This will lead to undernutrition, malnutrition and, at worst, starvation, which, to me, is going to affect most people most profoundly over the longest period of time.

Heat, too, will rear its ugly head in the near term. Events of high heat and humidity combined with power insecurity would lead to brownouts or blackouts. Many vulnerable people have no external means to cool their bodies, which may lead to many deaths.

You talk a lot about air pollution in the US in the book. How is it affecting the health of Americans?

I needed an inhaler for this whole trip. I was in Jaipur, Trivandrum and now, particularly, in Delhi. I couldn’t finish a sentence without coughing. This is also a problem in the US. Air quality is worsened by extreme heat because the chemical changes in the air are exacerbated by it. In the book, I say volatile organic compounds, nitrox, and sulfur dioxide make your air quality way worse.

In America, wildfires degrade air quality over swathes of a continent. I’ll talk about the South Bronx in New York City. Historically, it has horrible air, and it’s a marginalized, poorer community. So, it has the highest number of asthma cases in the nation.

It’s because it’s intensely industrialized with roads, highways, and people living near lots of traffic. Climate change is a disease of vulnerability, which is socioeconomic vulnerability, perhaps a little bit of geographic vulnerability. In one of the examples in the book, we narrate what it is like to intubate a breathing tube down a young girl’s throat who is no longer able to breathe through inhalers, and the hot climate didn’t help her. It was the perfect storm of an asthma exacerbation.

Your work has also focused on spotlighting the health care industry’s carbon footprint (8.5 percent in the US and 5 percent worldwide). What steps can be taken to build climate-smart health care?

Health care has a mandate to do no harm, and so we have the opportunity to reimagine our carbon footprint, decarbonize the process, and actually improve health care delivery.

When you think about three things that a health care system, like a chief financial officer or chief executive officer, has to consider, they have to think about finances, carbon footprint, and patient outcomes. Right now, we know there are best-practice playbooks out there. Health Care Without Harm (an international NGO) is big. There’s the ATACH network with the WHO. And so, these best practices exist.

Again, artificial intelligence and large language models promise to decarbonize healthcare without making it a capital-intensive exercise. We’ve learned by training these models that there’s a significant link between virtual care visits and these outcomes. Let’s say we make all of our Tuesday afternoon outpatient visits virtual; we realize we maintain revenue and decrease carbon by X percent. We can give the hospital management such specific data and convince them that this can save money. This is one thing where I think AI could force multiple or potentiate these changes.

Kanika Sharma is an independent journalist.