January 07, 2019
Area(s) of Interest: Environmental Health Physician Leadership Public Health 

By Elizabeth Schwyzer

(This article was originally published in the Winter 2018 Central Coast Physicians magazine.)

Passion. Dedication. An unwavering moral compass. Sensitivity to social justice. For more than four decades as a physician, San Luis Obispo's Stephen Hansen, M.D., brought these traits to his practice. In his retirement, he has turned his focus to a new patient: planet Earth. The disease he battles is climate change.

For Dr. Hansen, politics and health education have always been central to his medical practice, and indeed, to his life. Longtime San Luis Obispo residents may remember Dr. Hansen as the doctor who campaigned hard against smoking in the late 1980s - and won.

“I was seeing patients in their 40s die of heart attacks and lung cancer,” he remembered. “I'd see their widows and children grieve. The youngest patient I remember was an 18-year-old chain smoker who came in complaining of left shoulder pain: he had suffered a major heart attack."

Around the same time, Dr. Hansen attended a conference of the American Medical Association (AMA) where he learned of studies that showed carcinogens in second-hand smoke and discovered that the AMA was preparing to classify the substance as a Class A carcinogen.

His determination set, Dr. Hansen returned to the Central Coast with a mission to eradicate second-hand smoke wherever possible.

Thanks in part to Dr. Hansen's efforts, San Luis Obispo was the first city in the entire world to ban smoking in all public buildings, including bars and restaurants. The law went into effect in 1990, the same years that lung cancer death rates in American men peaked and began their decline. Hundreds of cities and the majority of U.S. states followed.

"I got death threats at work,” Dr. Hansen remembered of the era. "Executives at tobacco companies were calling me. People thought it would kill business."

Instead, SLO discovered that eateries and even bars could flourish without the ubiquitous presence of tobacco smoke.

Hansen had established his passion for championing public health over corporate profit and helped his small Central Coast town lead the way to smoke-free businesses.

These years of anti-tobacco advocacy influenced Hansen's medical practice and his research and connected him with professionals in settings such as the World Health Organization's World Conference on Tobacco or Health held every three years. It was at this conference in 2009 that professor Richard Jackson, then of the U.C, Berkeley School of Public Health, impressed upon him the gravity of another public health risk: climate change.

Jackson explained to me that the pandemics associated with climate change would far exceed those of tobacco," Hansen said. "We estimate 1 billion lives lost in the past century due to tobacco; it will likely be far more from climate change. Our food water, and security are all in peril.

For Dr. Hansen, who officially retired from his medical practice in 2012, climate change is the new smoking: an urgent health threat that demands his commitment and energy. Instead of spending his golden years in leisure, Dr. Hansen is hard at work advocating for changes in policy that will help slow the effects of anthropogenic global warming

When he talks about climate change, Hansen's tone is serious and insistent "You have to imagine a globe with shellac painted on it, he said. That's our atmosphere. When you pollute it with heat-trapping gases, that's a direct threat to every living thing on the planet. That heating effect is accelerating rapidly now, and it's an urgent threat to all of us, yet it's distant from most people's consciousness.

“Humans evolved because we responded well to immediate threats" Hansen went on, "but we don't respond so well seems remote. We need to understand that all thes fires, this period of political instability, disease, and they’re all related."

Put simply, climate change is the phenomenon of average atmospheric temperatures rising over a long period of time. The term has come to be associated with the extreme rise in temperature Earth has undergone in the past century, and particularly in the past 20 years. The vast majority of climate scientists agree that this rise in temperature is due primarily increased levels of carbon dioxide in the atmosphere produced by the use of fossil fuels.

According to data from NASA and the National Oceanic and Atmospheric Administration (NOAA), the planet has warmed roughly 1.7 degrees Fahrenheit since 1880, and the rate of heating is accelerating alarmingly. Climate scientists including James Hansen (no relation) warn that if we don't heavily reduce emissions of heat-trapping greenhouse gasses like carbon dioxide, global temperatures could rise as much as 9 more degrees by the end of the century, with catastrophic results. For perspective, average global temperatures were approximately 5 to 9 degrees cooler than today at the end of the last ice age. Climatologists estimate a temperature increase of even 3.6 degrees would tip climate change into irreversible and apocalyptic territory.

Dr. Hansen, too, sees the situation as one of grave peril for a humanity: "It's like we are trapped in a hot car with the windows up and no way out.”

Also concerning to Dr. Hansen is the fact that most of us accept anthropogenic climate change as a serious problem yet remain ignorant to the true implications for our communities and fail to grasp the very real ways global warming is already threatening our health.

In recent years, the medical community has become more active in monitoring the health effects of climate change and sounding the alarm. An October 2017 report titled "Countdown on Health and Climate Change published in the British medical journal The Lancet and authored by an international team of more than 60 doctors, public health officials, and scientists suggested that "the human symptoms of climate change are unequivocal and potentially irreversible."Likened to a physical check-up, the report offers an alarming prognosis left unchecked, climate change threatens to render planet earth uninhabitable.

Meanwhile, physicians across the United States are organizing to study the public health impacts of climate change inform the public of their findings, and advocate for public policy to address the crisis.

Among the groups Dr. Hansen works with is the Medical Society Consortium on Climate and Health or MSCCH: An organization of more than 500,000 individual physicians and medical groups whose joint mission is to inform the public and policymakers about the health effects of climate change. The MSCCH points out that wellbeing of citizens across the United States and beyond is already impacted by climate change. Fr ought, wildfires, hurricanes, and flooding to mass migrations poor air quality, and infections caused by contaminated food

and water, our health is suffering. Other health effects of climate change include heat stress caused by extreme temperatures, mosquito and tick-borne diseases, and mental illness.

These health threats are often interrelated: extreme weather events like the recent spate of hurricanes that ravaged the Caribbean, Puerto Rico, and the southern U.S. states in August and September of 2017 can lead to contaminated water mosquito-borne disease, and mental health issues. While major wildfires, such as the devastating Northern California fire October 2017 and the Thomas Fire that scorched Ventura and Santa Barbara counties in December 2017, create dangerous air quality conditions. And too often, extreme weather events such as these lead to the gravest health impact of all: the loss human lives.

One might imagine Dr. Hansen as a gloomy character - so long has he placed his focus on dire threats to human health. In fact, he's something of the opposite. Energetic and engaging he radiates curiosity and determination. At the same time, he doesn't sugarcoat his message. He's also utterly unapologetic about laying the blame where he believes it belongs, and the current political administration doesn't get off lightly.

"When I give talks, I usually start by saying, I've got Prozac for everybody; this isn't going to be easy," he joked. "The truth is, we are all complicit. We're all hypocritical. Yet we mustn't be focused on that. We must be focused on a world where all of our politicians defend the public interest or are held accountable.”

A registered Republican, Hansen repeatedly expressed his disgust with the policies of the Trump administration. “I call them ‘fossil fools,'” he said. "Every country with a scientific academy has endorsed the Paris Agreement. Right now, we're using far more of the world's resources than can be justified. More war and strife will come of this.”

As for what actions can and should be taken, and by whom Dr. Hansen was unequivocal. "Anyone who doesn't think about it every day isn't living in the real world," he said. "Everyone needs to take responsibility. Don't stay quiet when you hear someone talking as if climate change isn't real or isn't a present threat."

Physicians, Dr. Hansen said, should be talking to their patients about climate change and putting pressure on national organizations like the AMA, which left the MSCCH shortly after Trump took office, and the CDC, which canceled its conference on climate change and health shortly before it was to take place in January 2017.

Other actions Hansen recommends to local physicians include writing op-eds and letters to the editor regarding the health impacts of climate change, lobbying hospitals, reaching out to legislators, and joining the Citizens Climate Lobby or CCL: an international grassroots nonprofit focused on building the political will for climate solutions. Much of CCL's current work is focused on encouraging a carbon fee and dividend that would create an economic incentive for carbon pollution reduction.

Although his bedside manner is to deliver the bad news straight, Hansen is optimistic about the possibility of recovery or at least slowing the rate of global warming by changing laws governing carbon emissions. All those years of working to limit the presence of tobacco smoke in his community taught him lessons that apply in this case, too.

"Just as restaurants weren't ultimately hurt by removing tobacco, nobody will be hurt by mandating solar power and this kind of thing except for fossil fuel companies," he said/

Among those who give Dr. Hansen hope is Florida Congressman Matt Gaetz, a Republican and the newest member of the congressional Climate Solutions Caucus.

“I think history will judge very harshly those who are climate deniers," Gaetz stated recently. "I want to work... on bipartisan solutions to climate change.”

As Hansen sees it, one of the greatest challenges we face is to heighten public awareness of the urgency of climate change for all residents of planet Earth. Physicians, he believes, play a crucial role in informing patients about the massive health threat climate change represents.

(This article was originally published in the Winter 2018 Central Coast Physicians magazine, a publication of the Central Coast Medical Association.)