An annual doctor’s visit often entails some degree of fibbing about how much you’ve been exercising, drinking, smoking, et cetera. But now there’s a health risk you don’t have to lie about, because you have almost no control over it: air quality.

In a new article in the New England Journal of Medicine, doctors from Boston College and Case Western Reserve University reviewed the evidence that ties airborne pollutants to cardiovascular disease, which is the leading cause of death in the United States. What they found was compelling enough to entreat their colleagues to add exposure to air pollutants to the list of health risks they discuss with their patients.

“What has been missing from this whole conversation about cardiovascular disease is the impact of environmental factors outside of an individual’s control,” said [Philip J.] Landrigan, a pediatrician and epidemiologist whose pioneering work led to the removal of lead from gasoline. “It is time to bring these issues into the conversation.”

Of course, there’s only so much you can do to change the air you breathe. Unlike many of the other factors that you’re supposed to tend to for the care and well-being of your corporeal form — what you eat and drink, what kinds of substances you put in and on your body, how much you get up and run around — access to fresh, unpolluted air isn’t something you have much power to moderate. 

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Not many people have the ability or opportunity to move away from major sources of air pollution. ProPublica, for example, recently did an unprecedented analysis of Environmental Protection Agency data showing which micro-regions in the United States have consistently hazardous levels of contamination in the air, and the worst areas are almost always in the immediate vicinity of industrial facilities that consistently subvert regulation. 

To that end, the authors of the New England Journal of Medicine article primarily call on government officials to meaningfully legislate air pollution and transition to cleaner, renewable sources of energy for the sake of their constituents’ health.

Despite the increasingly clear connection between climate change and many public health woes, many doctors have not necessarily been inclined to get into larger advocacy efforts to influence legislation and regulation, as Claire Fieseler reported for Grist this summer. But as environmental factors such as air and water become increasingly severe threats to our wellbeing, that kind of action may fall more and more within their purview. Just this week in British Columbia, a doctor diagnosed his 70-year-old patient as “suffering from climate change.”

The New England Journal of Medicine article suggests that the medical community may be ready to become more politically hands-on with the issue of climate change. And consider that this latest article asks American doctors to talk to American patients about an issue heavily influenced by inequity. There are considerable international imbalances when it comes to the hazards of particulate pollution, as a study in the journal Nature Communications recently explored, where industrializing countries like China and India bear the health impacts of producing what wealthier Western countries consume. 

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We’re still embarrassingly far from recognizing the risks of climate change in the chambers of Congress, but the halls of hospitals seem like some progress.

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