Bruce Bekkar - Why The Climate Crisis Is a Health Crisis

[00:00:10] Adam: Hello. Welcome to Green Champions.

[00:00:12] Dominique: Thanks for joining us in a conversation with real people making real environmental change in the work that they do. I'm here with Adam, our social enterprise extraordinaire. 

[00:00:21] Adam: I'm so glad to be here alongside Dominique, our sustainability expert. We bring you guests who saw the potential for impact in their job or community and did something about it.

[00:00:31] Dominique: From entrepreneurs to artists, scientists to activists, this podcast is a platform for green champions to share their stories and plant new ideas.

[00:00:40] Adam: Today, Dominique and I are joined by Bruce Bekkar. Bruce is a former OB-GYN, who's now leading conversations around how the climate crisis is a health crisis. Through his work with ecoAmerica public speaking. And as a co-creator for the Green Docs podcast, Bruce helps health professionals become advocates for sustainability in climate smart care.

So last time we got to hear from Bruce about how he transitioned from taking care of mothers to taking care of Mother Nature and about the power of health professionals just showing up.

I also really like the analogy last time about how the climate crisis is more like a cancer than a chronic illness, not something that we can just bandaid and keep continuing, but something that we really need to take direct action on. So today we're excited to have Bruce with us again to dive into his work as an advocate. And he's gonna teach us why it's critical for healthcare workers to play a role in building a more sustainable future. So Bruce, welcome back.

[00:01:30] Bruce: It's great to be back with you both.

[00:01:32] Dominique: So, Bruce, do you wanna remind us just briefly for new listeners, how you went from being an OB-GYN to a climate activist?

[00:01:40] Bruce: Well, the actual moment that I had the light bulb come on was in late 2006 when I'd come home from a long day of seeing patients in my office and read an alumni newsletter from UC, San Diego, where I went to college. And there was an article called, "The End of the World as We Know It," and that caught my eye 'cause it was one of my favorite R.E.M. songs. But as I read through this article, it was from Scripps Institution of Oceanography about this thing called global warming, which I'd heard about but really didn't understand.

And by the time I finished reading that article, which was kind of long, I just felt the foundation of my life fall out beneath me because I was very, very bonded to the coast in San Diego. I'd moved back to where I lived in college because I loved it so much. And I realized that this thing called global warming, which we now called the climate crisis, was a direct threat to the coastline that I love so much, and to the ocean in general.

So that's when I had my realization. And very quickly after that I started going to city council meetings and doing all kinds of things differently in my life to lower my impact. And I found that it made me feel better to be involved. But that's where it all started for me and for the first several years that was my primary focus was working with our local municipalities within the county of San Diego, along with a bunch of other people that were also motivated to do this to help them take a real serious look at the risks that we were running with an out of control climate. And do something about it. And then in late 2013, I left my practice because I could, and I just felt like we needed to do more and it was up to people like me to help out. And the health message really grew as the literature grew in the scientific world around health impacts that were ongoing that we weren't really paying attention to due to exposures linked to climate change, like elevated temperatures, more and more heat waves, more intense heat waves, lack of nighttime cooling, increased humidity, which makes any temperature feel hotter of course, and more difficult for us to tolerate. But also air pollution and infectious diseases and other aspects of climate change that were already affecting people's health. And so how's that for my first long answer?

[00:03:50] Adam: Well, can you tell us just a, a little bit more about how those climate conditions affect people's health? Like what kind of conditions does that show up in?

[00:03:57] Bruce: Just

 taking one in particular, we know that children are physiologically quite different from adults. They're far more sensitive to things like air pollution. And we're learning that the pollutants that are created by the burning of fossil fuels and just by elevated temperatures, which raise ozone levels. And fires, which are certainly tied to droughts and tied to climate change, all produce air pollution that not only triggers asthma attacks in lots and lots of kids, but it also can cause asthma now. We are learning that chronic exposure to air pollutants can actually make a non asthmatic an asthmatic kid, which significantly affects the trajectory of their life and the things that they're able to do. But virtually everybody is at risk from not just one, but probably multiple exposures of climate change as they continue to worsen. And we would do well to stop that.

[00:04:49] Dominique: Well said. You've published findings on the impacts of climate change on pregnancy and public health. Since you're talking about children, can you share what you found in those publications?

[00:05:00] Bruce: Yeah, it was interesting because in late 2015 there was an article that came out from the American Academy of Pediatrics, and it was really the first big picture review of the expected harm to children around the world that would come from climate change. And there was a quote in there that really rattled me, and that was from the World Health Organization, and it said that 87% of the health impacts of climate change would fall on children under the age of five.

And you can't possibly imagine a population that's less responsible for this crisis than those little people. And I began to wonder, after reading that article, and I'm sure a lot of us were shook up by it, whether or not pregnancy was also being affected by the sorts of things that were in that article, by heat and air pollution in particular. And so I started looking for people that could help me answer that question because I just felt like if that was happening, we needed to know about it.

And so I was able to, through the contacts that I had created over several years within the climate space, find three researchers, actual people with academic training unlike me, that could help me answer that question by looking through the literature that was out there. And it took us about three or four years and frankly it was probably twice as long as it would've taken if I knew what I was doing. 

And as I was saying, we found a big, big link to heat and air pollution, a couple of types of air pollutants, which I can tell you if you're curious, but already strongly correlated with premature birth, low birth weight, and even still birth, which is of course just unspeakable tragedy. And that these exposures were linked to these bad birth outcomes all across the country. And even for those kids who survive as most preemies and low birth weight babies do, it still charts a very different course for them through their childhood. And we're now learning that babies that are born low birth weight or premature are affected well into adulthood with very significant risk for major illness. So these are not harmless outcomes. Even a baby just born a couple of weeks premature, still runs risks that we would certainly rather they did not.

[00:07:07] Dominique: So just to understand that study a little bit better, for three years, were you tracking air pollution, and heat patterns? And then also tracking pregnancy outcomes and maternal health? How are you reaching those findings? 

[00:07:23] Bruce: Our paper is listed with JAMA Network Open, which is an open source journal, and anybody can read the paper and I still reread it from time to time because I still can't believe that there's a paper in JAMA with my name on it.

[00:07:36] Dominique: Congrats, by the way. And, and genuinely thank you for your service. This hits my heart very closely, I mentioned this in our last episode as well, but my sister is pregnant right now and so I, I'm thinking a lot about her when you speak and her health and wondering like, what can we do and how this stuff shows up. So I'm extra curious for that reason. How did you come to these conclusions?

[00:07:56] Bruce: We did not do original research. We did a review paper, which basically was collecting the research that was in the medical literature, and it's from the time period of 2000, I believe it was 2009 to 2018 or 19, all the studies that were in the US domestic literature around heat and air pollution. And we picked those two because that's where the studies were showing up. That's where the exposures were being recorded and the adverse outcomes, like I was saying, premature birth, low birth weight, and even stillbirth were being noted. And we pulled those together and then did what you do as I learned slowly. And you do a quality control assessment of those papers and figure out which ones are legit and done right and have outcomes that were in line with what we were interested in.

So this is where I really leaned heavily on the other researchers because they're experts at determining which of the studies really met our criteria. And we came up with 68 papers, which isn't a whole lot, but it's certainly a significant number. And it also covered a span of over 32 million births in the US, which is a very significant number looking at these exposures and outcomes. And that's where we generated our conclusions from. 

 it reinforced our findings that the fact that many, many researchers from all over the country in these 68 studies used such different approaches, but basically came to the same conclusions more than 80% of the time. It was, I thought, really a ringing endorsement for the fact that these weren't just random connections, that heat and premature birth just happened to be, you know, living in the same location, but in fact we're related in a cause and effect way.

The wider the approaches and the more similar the conclusions, the more it felt like we were really on to something. And it was interesting too because JAMA, which is one of the top medical journals in the world and has been forever, had put out a call for papers on climate and health impacts about six months before we submitted ours. And they listed a bunch of vulnerable groups that they were particularly interested in. And notably pregnancy was not on that list. And so when we sent the paper to them, we didn't even know if they'd read it. But in fact, I think they jumped at it because they realized, "Hey, there's a lot of evidence here. We have to cover this." And of course the other big benefit to talking about pregnancy is it turns out that this is something that everybody cares about. Almost regardless of the ideological blinders people might wanna strap on, they still care fundamentally about their mother, sister, daughter that's having a baby and they want everybody to do well. So it worked for us on both levels.

[00:10:36] Dominique: What are those traditionally vulnerable groups that the medical community was putting a call out for, out of curiosity?

[00:10:43] Bruce: Children, elderly people, the poor and uninsured, people with chronic illnesses and people that are overweight we're already showing up in the medical literature as well.

[00:10:51] Dominique: Where you're sitting right now in 2025, are pregnant mothers now on that vulnerable list, or not quite, but your literature is still in there?

[00:10:59] Bruce: No, they're absolutely on it. I think, every time I've seen it for the past three or four years, we do see that pregnancy is listed as a vulnerable time, and both, that includes mother and baby. So, that has become clear. I think it was just, the point that this was still very new research being done early in 2010 and the first couple of years after that and now we've realized. One of my co-authors, Susan Pacheco, who's at the University of Texas, said this is so important to address because we can't afford to have generations born weakened from birth. This is something that is absolutely vital. As I was saying, premature birth and low birth weight carry significant harm, potential for harm, and we can't let that number inflate. And we shouldn't, and we don't need to.

[00:11:43] Adam: I would love to shift directions a little bit, and talk about EcoAmerica's climate for health program. So I know that's another major part of your work. Can you walk us through what that program does?

[00:11:53] Bruce: Well, EcoAmerica is a nonprofit based in Washington DC and I've been working with them and attending conferences with them for several years, and I've always been impressed at their approach to things. They're a relatively small organization, but they punch well above their weight. They're very smart in how they do things, and one of their three arms of their approach is to reach out to healthcare people. I think both things, first of all, because of how critical it is for people to realize that there's a connection to health and climate work that the climate crisis is harming people's health right now all around us. But also that healthcare people, once they're engaged with this, can have a real impact very quickly on work being done in things that are totally unrelated to patient care. For instance, if we swap out gas stove and gas heater in people's homes, the older people that have COPD or emphysema are gonna do better. The kids are less likely to have asthma and less likely to have their asthma triggered by breathing that home air. So there are definite health benefits to including the health message.

[00:12:56] Adam: Now, what's your role with EcoAmerica?

[00:12:58] Bruce: Well, the Climate for Health program specifically is designed to help health professionals get up to speed about the impacts of climate change on health, and also to learn how to be effective advocates both within their hospitals and clinics where they work and also within their communities. And so what they've done is to create a program which is CME. You get continuing education credits. But once you complete the program, you have an opportunity to become a climate ambassador, having gotten significant education about the connection between climate change and health. And also a lot of really good practical information about how to write an op-ed and how to find local climate groups to work with and other doctors to work with, and nurses that are doing these kinds of actions within your community and an ongoing list of resources which is constantly being updated for climate impacts in your state, if you're giving a talk at your grand rounds at your hospital or something like that where you can get really good information. So it really does empower people within healthcare to start to step into this fight and to utilize the significant impact that they can have.

[00:14:05] Dominique: And you've spoken to quite a few notable audiences. You've spoken at the US House Democratic Caucus, you have a podcast, and you've given a TED Talk. But across all your work, I'm really curious to hear kind of where you're seeing the impact. You alluded in the last episode a little bit to this idea of you've seen one particular impact. You have an impact story. Can you tell us about that?

[00:14:28] Bruce: Actually, I had a wonderful opportunity. I got flown to Perth, Australia to give the keynote address for the Royal Australia New Zealand College of Obstetrics and Gynecology, which is a lot of words.

[00:14:39] Dominique: Yeah. Wow. 

[00:14:40] Bruce: It's the National Organization for OB-GYNs in Australia and New Zealand. So it was really a, an incredible opportunity to go there and to give a presentation. And one of the people that I follow who's a very, very smart and strategic speaker told me a little trick that he uses on his last slide as he puts up a QR code on the last slide of his presentation that people in the audience can link to a website that takes 'em directly to actions that they can do right away. And there's a group in Australia, a climate active group of healthcare professionals, and it was their QR code that I put on my last slide. And I just said to the audience when I was done with my attempt at being inspiring, I said, "Okay. So before you get up outta your chairs, I'd like you to point your cell phone camera at this QR code and sign up on this website." And I had never spoken to those people. It was an organization that somebody else knew about, but we got an email from them a few hours later saying, "Whatever it was you guys did today, something happened. We got a whole flood of people signed up to join our group." So that was the first and I think maybe the only time I've known specifically what kind of an impact these presentations have, but I think they probably do have an impact quite a bit more than we realize.

[00:15:55] Dominique: I would agree as someone who's already shared your TED Talk with all the health professionals I know in my personal life. I think that it resonated a lot and I wanted to share it, which I feel like is the best thing to do in that situation. But I also like that you, your successful point there was passing along a message to take action with a local organization and not the fact that they flew you out to Australia, but that's really, really awesome and you deserve that recognition.

Well, I felt it was a really great privilege to be able to go to a meeting like that and to go to a place in the world I'd always wanted to visit. I think I mentioned in the last episode several times that I'm a mediocre surfer so there are a bunch of places in Australia that I've always wanted to see. And I got to go spend a week there after I did my work. But yeah, I was extremely grateful that they reached out to me and invited me to come to Australia.

[00:16:43] Bruce: And they were charming and very friendly and down to earth and their beaches are gorgeous. 

[00:16:48] Adam: Not to mention good surfing.

[00:16:49] Bruce: Yeah, when I was there it wasn't, but it was still wonderful to be in some of those places.

[00:16:53] Dominique: You've also worked with organizations like the American Lung Association, Surfrider Foundation, Climate Reality Project. You're really across the board with your action, not only going to Australia, but you have a lot of diverse connections with the foundations and organizations. How does collaboration across sectors, such as like environment, health policy, how do you view those intersections and like what does working at the intersection of things like that amplify the impact talking about climate advocacy?

[00:17:22] Bruce: It's a really good question because it's all about impact. At the end of the day, what everybody wants when they are concerned about the climate crisis is to see things happen. And what you get with the intersections of groups, even within the same space, even people doing local work on legislation, the more groups that are involved and the more they cooperate, the more likely we're gonna get things done. And it's been one of the encouraging signs I've seen in the last five years as we've gotten a lot more cooperative. I've seen a lot of people get out of their silos and really start to work together and plan things together. So it's a sign of maturation within the climate space and I really like seeing it.

[00:17:58] Adam: Let's

 talk about solutions. From your experience, what does climate smart healthcare actually look like in practice?

[00:18:05] Bruce: Well, this is along the lines of lowering the carbon footprint of You know, it was a big joke when I trained at LA County Hospital that if people came to the hospital without heart disease, after they'd been in the hospital for several days and eaten the food from the cafeteria, they would have heart disease. So it does feel like healthcare had a few things to learn in terms of its own operations. And there are organizations, national nonprofits like Healthcare Without Harm and Practice Green Health, that are coordinating these efforts nationwide and they're doing great work.

[00:18:35] Adam: It'sAnd one of your primary goals is helping those healthcare professionals become climate advocates. What do you say if somebody you're talking to in healthcare says they don't see themselves as an activist?

[00:18:45] Bruce: I tell them that I completely understand and it was certainly nothing I'd ever thought of with myself. But I think it's really important to remind people in healthcare that they don't have to take on the role of activist in any way that doesn't feel right to them. That there are lots of ways of being an advocate or an activist that don't involve things that we're not trained in, and you don't have to be a climate scientist nor even a competent public speaker.the fact that you're a health professional makes whatever it is you do significant and impactful. I totally understand this, but it's something that is a, it's really a non-issue once they realize the potential they have with what they know already.

[00:19:26] Dominique: Yeah, I was just thinking about that, about like how somebody might feel like, "oh, I'm educated as a healthcare provider, but I'm not educated to talk about climate" and they might feel like they're busy and don't have time to learn about climate.

What were some resources that you found that people could go turn to now as accessible alternatives to maybe learning in like a accessible fashion?

[00:19:52] Bruce: We talked a bit about EcoAmerica and the Climate for Health program, which is something that anybody in healthcare can look up online and find out about and take that three or four hour online free course and get CME credits. And get not only information about the links between climate change and health, but also get some training and connections along the lines of advocacy.

There's another organization called the Medical Society Consortium on Climate and Health, which is again, a lot of words, but people can Google that organization and they have a number of really good resources for healthcare professionals.

We had a, a national convening of people from EcoAmerica and the Medical Society Consortium and also Physicians for Social Responsibility. We had a big group meeting in Washington, DC in early February, where hundreds us met for a couple of days and talked about and actually heard from a number of organizations that are outside of health altogether, just to learn from them. But then we also spent a day up on Capitol Hill going to legislator's offices and meeting with our Congress people, which is a really inspiring and fun thing to do even if you live in red districts.

It's actually culturally just kind of fascinating to watch how different they are and to learn how to get your message across even when things are not necessarily gonna go your way. But there are lots of ways for people to participate that don't include having a lot of advanced training.

[00:21:13] Adam: And there are plenty of resources through, again, those two organizationsThat sounds fun, just going to Capitol Hill and, and talking with our Congress people.

[00:21:22] Bruce: It really is fun. It makes them real. We see them in these political ads, but these are actually human beings and they wear shoes and it's just fun to meet their staff and, and you can generally find common groundas soon as people find any kind of a sense that they are engaging in a way that is useful, it's pretty thrilling. So I don't mind asking people to do this at all, and I always anticipate they're gonna tell me they're way too busy and I never disagree with them. I'm just gonna find them a new source of energy.

[00:21:50] Adam: So looking ahead, what's next for you in your work? Are there any new directions or partnerships or goals on the horizon for the climate health advocacy that you're doing? 

[00:21:59] Bruce: I am involved with a couple of folks that I have met over the years, one's at EcoAmerica, and, and the other person is used to be the head of environmental stewardship for Kaiser Permanente, where I worked for 24 years. And we're putting together a speakers bureau. And what we've done is we've realized that over the course of the last 10 years, we have a pretty significant number of people that are really good communicators around climate and health and advocacy. And we also have a number of organizations and industries that are interested in having speakers come out. And so what we're going to do is to facilitate connections between those organizations and the best speakers that we know. So we're putting together what is going to be called Climate and Health Voices to share speakers with these organizations and media as well.

I'm sure it's no surprise to your listeners that when it gets hot, we get a lot of requests from the media to talk about the dangers of heat. So, the Speaker's Bureau is something that we're ramping up and about to launch. You heard about it first.

[00:23:01] Dominique: That's awesome. And whenever you wanna send any of those climate and health voices to the Green Champions Podcast to share their story, we would love to have them.To leave us off, for our listeners, whether they're doctors, nurses, medical students, future parents, what is one concrete thing that you wanna leave behind that they can do today to join the movement of building a, a healthier, more sustainable future?

[00:23:24] Bruce: The action that you might take turns out to be not all that important. What's important about it is that you take it. The price of inaction when it comes to understanding even a little bit about this climate crisis, the price of that is it takes energy and joy away from you to have to keep hoping and ignoring this problem. But as soon as you switch to some kind of engagement, whether it's talking to neighbors and friends, whether it's learning some more, whether it's going to a city council meeting or Googling climate change orgs near me and showing up to a meeting.

Whatever step you take, I have confidence based on years of my own experience, but also many, many health professionals around the country and people that are not in health professions who do this work, who have found their voice to some way, in some way that as soon as they switch from being passive and trying to ignore this to taking some kind of an active role in planting a community garden, there's so many ways that people can participate. I am absolutely a hundred percent convinced that they will appreciate how that feels and being part of the solution. We all have a role in the climate crisis and we all have a role in fixing the climate crisis.

 We're so glad that we could have you on today. It feels like we covered so much in this episode, really going in deep to the work that you're doing. And one, we talked a bit about the health impacts, specifically around pregnancy and how the climate crisis is, is affecting health.

[00:24:57] Adam: We talked about your work with EcoAmerica, and then the advocacy work that you're doing of really getting out and talking, connecting different organizations, and really leading down to this idea that, "hey, you gotta take an action. Doesn't matter so much what action as long as you take something."

So thank you so much for being on today and sharing that message.

[00:25:15] Bruce: Thank you both for what you're doing. I think it's extremely important and I really appreciate the opportunity to share my little corner of the world with you.

[00:25:22] Adam: What's the best place for people to support the work that you're doing?

[00:25:25] Bruce: I would say go to EcoAmerica and look up the Climate for Health program. Or they can follow me on @greendocsd for San Diego, on Instagram. We'll probably leave some other contact information in the show notes.

[00:25:37] Dominique: And I think we'll make an effort to link a lot of the organizations you referenced and direct people towards in the show notes as well as some of your publications and your speaking engagements. So if anybody wants more of Bruce or any of the recommendations that Bruce threw out there, that will all be in the show notes.

Thank you so much, Bruce. This was awesome.

[00:25:57] Bruce: It was great to talk to you both. Thank you.

[00:25:59] Dominique: As always, our guests have found a unique way to champion sustainability. We're here to put real names and stories like Bruce's, behind the idea that a matter your background, career, or interests, you really can contribute in the fight against climate change.

[00:26:11] Adam: You can find our episodes at thegreenchampions.com. If you wanna stay in the loop, give us a review and follow us on your favorite podcast platform. If you have questions about climate change or sustainability, you can reach us on our website at thegreenchampions.com. Our music is by Zayn Dweik. Thank you for listening to Green Champions. We'll dig into another sustainability success story in our next episode.