In the first episode of our new "Environments for Health and Happiness" series, we sit down with Dr. Gaurab Basu, a leading expert in the intersection of climate change and health. As the Director of Education and Policy at Harvard Chan School's Center for Climate, Health and the Global Environment, Dr. Basu shares his insights into the profound effects of climate change on our well-being. This episode delves into the critical need for sustainable practices, the role of education in addressing climate issues, and innovative strategies for fostering resilient communities. Join us to explore how our environments shape health and happiness and discover how we can all play a part in creating a healthier future.
Ayla Fudala: Hello and welcome to Frontiers in Health and Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. My name is Ayla Fudala, Center Communications Coordinator, and I'll be asking experts how to live a healthy, happy life.
In the first series of Frontiers in Health and Happiness, we explored the topic of loneliness and well-being. This episode marks the start of our second series, Environments for Health and Happiness. Together, we'll explore the intricate relationships between aspects of the natural and built environments with our health, happiness, and well-being. As cities expand and climate change impacts intensify, the creation of resilient, equitable, and sustainable urban environments becomes crucial. Throughout this series will host a diverse array of experts, including environmental health scientists, architects, and urban public health leaders. Each episode will provide a platform for these diverse voices to share cutting edge research, practice informed insights and innovative solutions to promote physical, social and mental health and foster community resilience for all. Join us as we highlight the transformative power of natural and built environments to improve quality of life and create happier, healthier, and more resilient communities.
Today we're thrilled to welcome Dr. Gaurab Basu. Dr. Basu is a leading expert at the intersection of climate change and health, serving as Director of Education and Policy at the Harvard Chan School's Center for climate, health and the Global Environment, also known as C-Change. He is also a primary care physician and teaches both here at the Harvard Chan School and at the Harvard Medical School. His work focuses on the intersection of climate change, global health equity, human rights, medical education, and public policy.
So, Dr. Basu, you started off as a primary care physician and then you developed your work into the environmental field. What inspired you to take that path?
Dr. Gaurab Basu: I'm primary care doctor and working in Green Health Center and was working in a lot of global health work, teaching a lot of courses on health equity and social medicine. And then in 2018, I have this light bulb moment when I read the UN, IPCC report, understanding how climate change was impacting all those issues I cared about. And it feels like addressing climate change is the most potent lever, I believe, in improving all these things at once. So that's when I became really passionate about this, and I have seen a lot of victories and a lot of defeats and a lot of ups and downs, but I think we've got to keep going. And climate movement has never been as big as it has been now. We've got a lot of work to do through state policy, through our local communities, through international negotiations, and all of it's really needed. And we’ve got to keep fighting.
Ayla Fudala: Your work explores the profound impact of climate change on mental, social and physical health. Could you please discuss the ways in which environmental changes influence each of these factors?
Dr. Gaurab Basu: Climate change, ecological degradation, air pollution-- it basically impacts all parts of our health. It's really important for us to recognize that we're intertwined with nature. We're intertwined with our environment. And when I started as a primary care doc and through medical school and through my public health work, I kind of always understood that bigger social structures and how whether people have enough money, whether they feel safe in their communities and are valued and respected as people in their societies, all have major impacts on people's health. And it was really only later in my career, when I started working on climate change, that I came to really appreciate that the environment itself is really critical. So maybe a place to start with is eight mechanisms that climate change impact health, and that is through the impacts on food security, water scarcity, infectious diseases, extreme weather events, heat related disease, air pollution, mental health, forced migration, social instability. Each one of those mechanisms really have so many different implications.
Ayla Fudala: Great. Thank you. And what can be done to address the impacts of climate change on mental, social and physical health? What have you done and what are other scholars, government officials, community leaders and activists doing?
Dr. Gaurab Basu: Climate change is not easy. It's very complex. But in some ways, we have to start with the simple message that we have to stop burning fossil fuels, and we're having a challenging time talking about that right now. And I think there's a lot of misinformation and a lot of vested interests. We have made some progress for sure, but still are challenged to kind of really urgently, ambitiously make this transition to a clean energy economy. And so I think the first thing I want to say is that we have to identify the thing that's causing the problem and address it. We know the center of that crisis is the burning of fossil fuels to get electricity into our homes, to fuel our cars, to make concrete and cement, to warm our buildings, things like that. But we now have good alternatives to not burn fossil fuels for each one of those industries. Then, of course, other things like land conservation, stopping practices like deforestation and climate work. What we call it is mitigation. Working in mitigation means reducing the use of fossil fuels in society.
Ayla Fudala: Building on my first question, could you provide more specific examples or elaborate on how climate change affects our mental, social, and physical wellbeing? You previously mentioned the impact of heat on mental health.
Dr. Gaurab Basu: Yeah, sure. Let's talk about heat for a second. There was a study a few years ago by Amruta Nora Sarma, who's a colleague here at the Harvard T.H. Chan School of Public Health that showed that there's increased utilization of emergency room mental health services on very hot days. So increased mood issues, suicidality, schizophrenia, delusions, substance use disorder, violence, all of that increased. We know gun violence increases during hot days, and I think many of us can understand that, that when it's really hot, people don't do as well. If there's an underlying mental health issue, then it's going to exacerbate.
Also, I'm concerned about things like sleep, people being able to sleep well through the night. Heat impacts certain populations more than others, the elderly and children. We're getting these reports that schools are getting too hot and sometimes have to even be closed because it's too hot for kids to be in a classroom that's too hot for them to learn properly. Cognitive, you know, impacts learning impacts. So there's all of that.
And then there's the broader ways in which things like heat waves or other extreme weather events can displace people. Many people are living very vulnerable in society. And if there's a hurricane or if there's a flooding event that causes displacement, if you're barely holding on to your home or you're just trying to get into the health care system is impacted by extreme weather event, or your home is impacted by extreme weather events that could really have profound impacts on you.
Ayla Fudala: Okay. So that's heat and its impact on mental health. And I assume it also has negative effects on physical health.
Dr. Gaurab Basu: Yeah. What I would start by saying is heat impacts kind of every organ system in the body. So when the body is not habituated to a certain kind of heat, when you have erratic or prolonged heat waves that people are not accustomed to, it can have profound impacts. It's the changes in heat that's the real issue here. We know that 37% of heat related deaths can be attributed to climate change. Heat can increase the risk of heart attacks and strokes and respiratory disease obstetrical outcomes like premature labor. I have a patient who was a farmer in El Salvador and was outdoors farming day in and day out, and ultimately had end stage kidney disease. I can feel confident saying that chronic heat contributed to that, by dehydrating him so that the blood was not producing to his kidneys. Heat is complicated. There's a lot of factors like humidity, your social vulnerability, your underlying health status. There's a lot of factors. So I don't want to make it a very simple message, but we are really concerned about the impacts of severe heat on wide swaths of our population, and especially those who are most vulnerable.
Ayla Fudala: Speaking of heat, this introduces the topic of health equity. Would you agree that the ability to manage high temperatures using tools like air conditioning is a privilege not everyone can afford?
Dr. Gaurab Basu: Yeah, the experience of heat is different based on who you are, where you live, what power you have in society. One example of that is there was a study by Jeremy Hoffman that came out in like 2020 showing that red line communities. So redlining again was had explicitly racist language started in 1934. And these federal policies were in place for 34 years until 1968. The Fair Housing Act changed that. But those policies redlined communities, which meant that investments, bank mortgages, things like that were not put into these communities. There's incentives to pull those investments elsewhere. And what Hoffman's study showed was that those red line communities were 2.6°C hotter than other communities when controlled for other variables.
So, you know, if you break that down a little bit, the way I analyze that is that you need investments for places that are creating nice green spaces and tree canopies. What happens in these poor communities is they become full of concrete and cement, and don't have green spaces that can absorb the heat. So the red line communities have more heat, more air pollution, more fossil fuel infrastructure. If you have a lot of green space, it's able to absorb the heat on a very hot day. So in Cambridge, Massachusetts, where I live, 90 degrees could be 105 degrees in Chelsea, which is geographically pretty close, but is an 80% immigrant population. Every piece of this is intertwined with issues of health equity.
Ayla Fudala: To clarify, I was curious about your earlier point. Our extreme and sudden temperature increases the primary concern. There are regions consistently hotter throughout the year that don't necessarily experience heightened physical or mental health issues. Does that align with your findings?
Dr. Gaurab Basu: Yeah, maybe it's a way to describe it is that our internal body wants to keep a very firm core temperature. It doesn't want that core temperature change. When you experience heat that your body is not used to, that heat will get absorbed into your body when heat is really inside our body. It can be really dangerous to a variety of biophysical pathways. And so the key is whether your body is able to compensate for the heat. And so if you've habituated to the heat, if you're in a place where it's really hot all the time, your body is habituated and there's an equilibrium about it, but when your body's not ready for it and it's not able to process it properly, and it can work to get the heat off, that's compensated heat stress, okay. So if you compensate for it, you're able to release the heat. Your body's still working pretty hard and that doesn't feel good, but it can kind of get rid of the heat if you're healthy, if you're younger, but then if it's too hot or you have underlying health issues that prevent you from doing some of those things, if it's very humid or if there's really a prolonged exposure, your body may not be able to get rid of the heat. And that's when you start really having health issues.
Ayla Fudala: Just out of curiosity, do you think people will be able to adapt to these higher
temperatures?
Dr. Gaurab Basu: No. That's this increased area of conversation is habituation. There's not clear studies. There's examples of elite athletes training in hot places so that they're ready for hot temperatures. And they're actually the Olympics in Paris this last year were really impacted by heat. So now there's some new interest in having people train in hot places so that their body is kind of preparing for those kind of circumstances. There's habituation that can happen. The reason I, I'm concerned about that kind of thought process is because that suggests a steady, stable temperature patterns. People are saying, hey, you know, Boston is going to become like Maryland in terms of its heat. And so people in Maryland have habituated to the amount of heat that there is there. But I think it's a false framework, because what the challenge with climate change is, it's erratic nature. It's getting the planet out of equilibrium. The unstable heat wave unexpected scenario is one in which I don't think we can habituate well to.
Ayla Fudala: You have been instrumental in integrating climate change into medical education. What outcomes have you observed from these curricula in terms of students’ preparedness to address climate-related health issues?
Dr. Gaurab Basu: Climate change is impacting medicine, delivery of care and health in a variety of ways. And so we've been integrating it across the curriculum. And so when you're talking about vector borne illness and we know that a warming planet will change where mosquitoes are and the distribution of mosquito borne illness, that's important for people to understand when we're talking about cardiovascular health, what heat is doing that asthma, making sure we know the role of air pollution. So we've embedded it into the curriculum across the pre clerkship time before they go into the clinics. 94% of medical students in our class felt it was important to learn about this. And then we created a learning educational competency saying that by the end of med school, it's important for students to understand the pathophysiology, the way that it informs clinical counseling, the ways in which kind of their issues of equity, how the health care system itself contributes to climate change and is impacted by climate change. And then also how we can be part of a solution. How health voices can play a role.
We just finished a year and a half of studying the students, and what we did is we surveyed them before and after every time they had a piece of curriculum. So we haven't finished the analysis yet, so I won't say too much about it, but the initial findings suggest that people learned a lot and felt really confident about it. I think the reason I'm drawn to doing education work is that climate change is really confusing and daunting and intense. It can feel like I don't know what I should do about that. And if you're not engaged with the issue, you can feel a little paralyzed. But by doing good education, the hope is that people can understand what it means to their work. And that's why I felt it was important to do it in this integrated way, so that no matter what kind of doctor you're going to be, you can understand how it affects your practice. It's saying, hey, you know, there's real disruptions that occur from climate change on health. And I want to understand how it's disrupting the disease processes I treat and the way I counsel my patients and even how it's impacting the healthcare sector itself. The extreme weather events and things like that can really impact the delivery of care as well. And that's really important.
Ayla Fudala: I have a few follow up questions, if that's okay. First, starting in 2023, have all Harvard Medical School students been educated about climate change impacts. Will this initiative continue? And is there a possibility for expansion to other institutions, such as the Harvard T.H. Chan School of Public Health, where I work?
Dr. Gaurab Basu: Yeah, so we have some solid progress on all of that. We're adding content each year. For example, this year we got some additional inputs on mental health and climate change. And also it's food system food planetary health and human health can be connected. We did a simulation this year educating students about waste in the operating room, ways that we're using unnecessary supplies, or using anesthetics that have a higher emissions than others and have no clinical benefit. So we want to keep going and keep working on it. There's a lot of great schools doing this. Emory down in Atlanta has done great work on this for a long time. We've learned a lot from them. There was a report showing that within two years, the number of medical schools that had any content in climate change went up from like 27% to 55%.
And we have a new concentration in the Harvard School of Public Health as well. I leave that as well to Chris Goldin, and we started that this fall 2024. And so now we have an interdisciplinary climate change and planetary health concentration. We have monthly lecture series for that. There's been a lot of interest. And what's cool about the School of Public Health concentration is that any student in any department can take it. So it's just people have really diverse backgrounds and interests, and that's the way we wanted it. If you're in global health and if you're an epi, if you're in environmental health, if you're in social behavioral sciences, all of these are fundamentally issues that connect with climate change. So it's been a really interesting folks from the US, folks from around the world. A lot of different perspectives have been brought into the conversation.
Ayla Fudala: Wow, that's really amazing that at the School of Public Health and the medical school, you're educating the next generation of health care providers about the importance of climate change.
Dr. Gaurab Basu: Yeah, what students really want is opportunities to do something about it, too. And so education is critical to create pathways for this. But we’ve got to keep creating jobs where people can identify problems at the intersection of climate change and public health and really dig in and get people activated and inspired. So what we really want is that people find their voice in place and know how to contribute to the solutions.
Ayla Fudala: And what is the role of the health care sector in this? How can it both mitigate its own carbon footprint and become a proactive force in advocating for climate solutions?
Dr. Gaurab Basu: Yeah, I mean, it's a big piece of it. You know, 8.5% of US emissions are from the health care sector itself. Hospitals are energy intensive. There's a lot of waste also. And there's ways in which we need to be good stewards of the ways in which our hospital operates. One time I wheeled a patient out to the hospital. He would be in the hospital for a COPD exacerbation. And so give him all these medicines and steroids and all that so that his lungs would calm down. I walked him out to the lobby exit. And then there was this big shuttle putting all this exhaust right into the area there. And he was breathing that in. So could we have electric shuttles? Can we think about our food systems in the hospital?
And my friend Anna Goldman, who's the medical director of climate and sustainability and a primary care doctor at BMC, is doing big stuff there where they're putting solar panels on the top of BMC. They're putting Awesome food gardens on the roofs as well. So they use the infrastructure of BMC to, uh, put solar on it and get energy in. And they're using some of the credits they get by supplying the grid with clean energy to help pay the bills of patients. They're taken care of. So so it's a cool program because it's not only addressing the need for clean energy, but also that electricity bills are too high and it's impacting people's budgets. I think of hospitals as a civic space, you know, it's a public space, and it should be serving the public. And the ways that the hospital operates should be a good example of that.
A few other things is, you know, obviously there's a major plastics issue in the hospital. So waste of plastic and how much we're using that waste of just supplies overall. Um, so there's an efficiency issue there. And then also issues like I mentioned this before, but anaesthetic gases, a lot of the anesthesia that is used can have a really high greenhouse gas emission effect. And there's a lot of studies showing that you could be using other anesthetics and having the same kind of health outcomes.
Ayla Fudala: Thank you. I'm glad to hear that hospitals are becoming more sustainable. Changing tack a little eco anxiety is becoming increasingly widespread. What guidance can you offer to individuals and communities dealing with this climate-related stress? And how can health care providers best support their patients in managing these concerns?
Dr. Gaurab Basu: Yeah, it's a big deal. I think many of us, I would say, myself included, experience eco anxiety and real concern about the way it's changing the world and the way it's changing the way the planet will operate for generations to come. We've got a lot of work to do to get to where we need to be, and there's just so many profound breakthroughs that are happening now. No one could have expected that solar was going to be as explosive in its growth as it has been. I just want to mention here that I really do feel like we've got the tools we need to totally turn course. It's a heck of a lot of work, and I don't want to be naive about it. You know, there's, you know, transformative stuff that needs to happen. But in a lot of ways, a lot of these sectors, it is happening. You know, electric vehicles actually are growing a lot in a way that never has happened before. Um, there's record growth and solar and wind. It's in the United States. Contributes more energy than coal now. The issue really is the continued growth of gas and fossil gas and in supplying the grid. So there's a lot of good change happening.
It's not happening nearly fast enough. No, we're nowhere close enough. And we need to just keep passing really good bills to give people some sense of hope. And, you know, we're living in a time right now where there's some real aggressive assaults to the building out of a clean energy economy. And so that's only exacerbated this issue of eco anxiety. And I would say, especially among youth, the first things that feel critical to me is to get good information, to have trusted messengers supplying the information.
Number two, to have a sense of agency and be a part of groups, and to be a part of activities that are contributing to solutions that all can help a lot with eco anxiety. And also in my job as a primary care doctor is to treat symptoms also, you know, that's an important piece of it that I don't want to live out, and having therapy and costly medications and stuff like that is all part of the toolkit of how we respond to this. But I think having a real sense of community where you can be scared together, where you can understand things together, where you can find ways to take action together, is critical.
And I think social media and misinformation is really at the core. You've got a huge swath of online folks who are lying and saying misinformation that climate change is not concerning or fossil fuels aren't causing any harms. We need to do a much better job of stopping non-expert opinion to be presenting information that's not accurate. And I think that's a real central part of addressing the eco anxiety issue.
Ayla Fudala: Absolutely. Thank you. In your roles focused on health equity, have you seen communities successfully build resilience against climate-induced mental, social and physical health challenges?
Dr. Gaurab Basu: Communities that are impacted have a lot of really good solutions, and they understand the experience and what it means in their day-to-day lives. You know, in Chelsea, I was describing before the heat island effect, there's been a lot of studies and projects to get cooling units into people's homes there to address the heat island impact, to plant trees. There's a lot of great nonprofit groups that are doing this kind of work, like Green Roots and Chelsea. I think also about global work.
Some of the work I'm trying to do is in India, some of the communities I've worked with in the past are on the coastlines of the Bay of Bengal, and they've always been on the front lines of exposure to cyclone activity. But climate change is worsening the severity of these cyclones, and they've got to rebuild and still be on the front line. The cyclones keep coming right into their communities or right by it. And it's a pretty scary thing, right, to be on the front lines in that way. The project that we're talking about, we've proposed and we've submitted a grant for is to understand the ways in which these kind of rural coastline communities. How these major cyclone events are impacting them. This community also has this iconic mangrove forest in the ocean right on the coastline, and mangroves suck in much more carbon dioxide than other kinds of trees and plants, and it really mitigates a lot of the flooding. So when the water is coming off the ocean and into the inland, these mangroves that are sitting on the coastline can kind of play a buffer. But climate change itself is kind of harming the integrity of these, these mangroves. So we're trying to see can we get communities that are impacted by climate change into the work of ecological restoration?
So yeah, there's a lot of work to do. We need a lot of people's wisdoms and skills and just hard work on this. And that's part of where my mind goes to, is to create an activated group of people who are working towards climate solutions and really making sure many of them are from communities that are impacted by these harms.
Ayla Fudala: Do you see urban planning and development playing a major role?
Dr. Gaurab Basu: Yes, definitely. We've got to build our spaces with everything here in mind. First of all, the infrastructure itself can be really impacted by the heat and other kind of extreme weather events. And how we design our urban spaces is really important too. We need people to have good transportation options if we want them to take public transit, to have biking lanes and other active transportation opportunities. If we set it up so that everyone is very isolated and they're driving everywhere, and there's no way to move within your community without cars, that's what's leading us to these impacts of climate change. And so we've got to really rethink how we build things, where we build things, how people move around. Increase density of housing. We're having a housing crisis in Massachusetts. How expensive it is because we don't have enough housing. So if you have urban dense housing where more people are living closer to each other and are able to get places faster through public transit, there's a bunch of climate benefits that are in each piece of that. Not to mention health benefits.
Ayla Fudala: Where do you see the most critical needs for research and understanding the links between climate change and health? What would be your dream project to address one of these challenges?
Dr. Gaurab Basu: I want to emphasize the importance of continued research on everything. The connection to climate change and health reported out those eight mechanisms before. We need to keep learning because the planet is changing. And so we’ve got to keep active with all of it. I want to make sure I emphasize the importance of all of it. But in my mind also, the work here is to take action and to get people to contribute to climate solutions and make sure everyone understands how climate change impacts them in their lives.
I think part of the problem is community is not understanding the ways in which climate change is impacting their lives, their loved ones, the health of their loved ones, and the benefit of having green jobs. The benefits of having good infrastructure that's climate friendly and how it can make their lives better so they're not stuck in a commute. How their kids can stay out of the emergency room because there's not a highway next to them that's causing an asthma exacerbation.
So I think, honestly, what I feel is needed or what I would get really excited about is the translation work and the policy work. It's heartbreaking that we're recording this when there's real threats to the funding. The research I want to do is how do we create a culture and understanding a foundational respect for nature and the ways in which harming nature is against our well-being. If you look at countries like Ecuador and other countries around the world, there's a deep foundational anchoring that how we build society has to be in respect of nature. And I think, honestly, we've really done that wrong for a long time here, and we're really paying the consequences of it. So I'm interested in behavior change and attitude change and not just people sitting and worrying about it, but saying, hey, no, I need my elected officials to prioritize this and to work urgently on this. So I think that's the work we need to do. We have an active and up to date understanding of all the harms, but I don't want to just keep describing it. I want to fix the problem.
Ayla Fudala: I don't usually speak about myself on this podcast, but I wanted to say that what you just said really connected with me and where I'm coming from. I come from an environmental humanities background, and my dream has always been to try to convey to people the importance of environmental issues. I did my master's in environmental communication, and I studied incorporating art and creative writing into environmental education curriculum for students. And what I've always been most interested in is what you said, changing the culture around environment. Like convincing people, getting through to people that these things are so important.
Dr. Gaurab Basu: Health gives us the opportunity to communicate and humanize this issue. So I do think we have a responsibility as public health communicators and practitioners to say, let me explain why this matters to you. I was in Wyoming going to Yellowstone this summer. People take so much pride of nature in Wyoming, right? And they're burning a lot of fossil fuels. You know, and so we've got to just understand what people take pride in, what they love, who they love, and try to communicate the ways in which climate change impacts those things. There's benefits for everyone and for climate solutions. So many health benefits, so many economic benefits, so many national security benefits.
Ayla Fudala: Do you have any advice or suggestions for our listeners in particular? Anyone who cares about climate change but is feeling overwhelmed or disheartened by the issue and everything that's going on right now?
Dr. Gaurab Basu: Yeah, I mean, you’ve got to find community, I think is the answer. You know, you’ve just got to find your people and you've got to find your place, and everyone has something to contribute, and you’ve got to do it with a group of people. You got to talk about it. You got to do something, something small. We all have something to give and to reflect and think about what that could look like to you. Uh, but I think it's just critical we do that in community.
Ayla Fudala: Thanks so much for joining us on this episode with Dr. Gaurab Basu. It's been truly eye-opening to see just how deeply our environments, whether it's the neighborhoods we live in or the global climate we all share, shape our health and happiness. Dr. Basu's insights remind us that our surroundings aren't just a backdrop to our lives. They're an active force affecting our physical, mental, and social well-being. As the world around us continues to shift, it's essential for each of us to consider how we can help create environments that nurture resilience, equity, and sustainability. I hope that this episode inspires you to take action and adapt and improve your own communities, making them healthier and more supportive for everyone.
In the second episode of our Environments for Health and Happiness series, I'll be speaking with Dr. Joe Allen, director of Harvard's Healthy Buildings Program, Professor of Environmental Health at the Harvard Chan School and former detective. Stay tuned to learn about the surprising role indoor air quality can play in making us sick or keeping us well.
This has been another episode of Frontiers in Health and Happiness, the official podcast of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health. To learn more about upcoming events, visit our website. Sign up for our mailing list and follow us on LinkedIn, Instagram, YouTube, and Facebook.
New episodes will air every two weeks. Episodes can be found on the Lee Community Center for Health and Happiness website and YouTube channel, as well as on Spotify, Apple Podcasts, and wherever else podcasts are found. Thank you for listening.