On Saturday afternoon, Aug. 10, 2013, a small fire was reported on the middle fork of the American River, deep in Tahoe National Forest near Foresthill, Calif. By Monday it had grown to 800 acres. A brilliant plume of white smoke billowed like a giant thunderhead against the limpid blue sky to the northeast of our farmhouse, 30 miles away. On Tuesday, my wife and I awoke to the throat-rasping pungency that is a familiar reminder of summer jeopardy to those of us living on the W side of the WUI — the "wildland-urban interface." The early morning light had an ominous orange cast; the hills to our west were invisible, cloaked in a low-hanging haze so thick you could almost feel the ash collecting in your lungs.

In the weeks that followed, the growing American Fire, as it was called, consumed more than 27,000 acres — 43 square miles — of mixed conifers. At its peak, 1,500 firefighters aided by helicopters and aerial tankers battled to create containment lines. Pockets are still smoldering as I write in October. Meanwhile, sparked only a week later by a carelessly tended campfire, the giant Rim Fire burst out of control at the edge of Yosemite National Park, 100 miles to our south. It raged across 400 square miles of ridges and canyons, and for most of a month — depending on which way the wind blew — we inhaled the charred residue of one or the other of two blazing national forests.

Only a couple of summers earlier, the choking pall over California from a widespread complex of lightning-struck wildland fires had become so oppressive that my wife and I — tired of stinging eyes and raw craws — suddenly packed up and fled, on the excuse of visiting our son in Flagstaff, Ariz. Driving along the eastern slope of the Sierra, we could barely make out Mono Lake through the eerie, acrid haze that lingered far into Nevada. We were approaching Las Vegas before we could see a sharp horizon.

Up in Smoke

Fire has always been an essential element in the ecology of the West. But in the mid-1980s, a tipping point was crossed, and wildland fires have mushroomed in frequency, intensity and duration.

Between 1986 and 2003, according to a research paper by scientists at the Scripps Institution of Oceanography in San Diego; the University of California, Merced; the U.S Geological Survey; and the Laboratory of Tree-Ring Research at the University of Arizona, Tucson, a climate cycle of reduced winter precipitation, hotter springs and summers, earlier snow melt and drier (increasingly diseased) vegetation has been directly responsible for adding 78 days to the historic Western wildfire season. By the end of that 17-year period, four times as many major conflagrations were breaking out every year, and the total area blackened each season was six and a half times larger.

The forestland of the American West is an enormous carbon sponge; it sops up as much as 40 percent of the nation's output of the principal greenhouse gas-trapping terrestrial heat, carbon dioxide. But if wildfire trends continue, the scientists warned, "the forests of the western United States may become a source of increased atmospheric carbon dioxide rather than a sink, even under a relatively modest temperature-increase scenario."

Which, in fact, looks like about the best scenario we can hope for.

"Warming of the climate system is unequivocal," the Intergovernmental Panel on Climate Change declared in its recently released 2013 report, "and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased … .

"Global surface temperature change for the end of the 21st century is likely to exceed 1.5° C [almost 3° F] relative to 1850 to 1900," the IPCC concluded. "Warming will continue beyond 2100 [and] it is virtually certain that there will be more frequent hot and fewer cold temperature extremes over most land areas on daily and seasonal timescales as global mean temperatures increase. It is very likely that heat waves will occur with a higher frequency and duration. Occasional cold winter extremes will continue to occur."

Implications for Human Health

Fires are deadly. Four of my former neighbors were among 25 people killed and 150 injured as they fled a wildland-urban firestorm in the Berkeley hills in 1991. It wiped out 4,000 dwellings, including the one I'd lived in and helped save from a previous fire as a volunteer on a hose line. Nineteen elite young firefighters died in a massive Arizona blaze earlier this year. Air tankers crash, engines and bulldozers tumble over smoke-shrouded precipices, chainsaws gouge human as well as arboreal limbs. And then there's the civilian toll. Smoke inhalation, burns, evacuation, fear, stress, loss, homelessness — these are adverse side effects of natural disasters with obvious negative implications for a community's well-being.

Fires denude hillsides. When the rains come — increasingly in deluges predictable in association with climate change — runoff water sluices into creeks and riverbeds along with soil that would have been retained by the lost vegetation. Almost 12,000 people were evacuated from flood- and mudslide-ravaged communities along a 200-mile swath of Colorado's Front Range in September, when almost half a year's normal rainfall descended in just 15 hours.

Smoke from wildland fires, dust blowing off parched ground, ozone accumulations in simmering cities, and pollen from weeds and grasses exacerbate asthma and respiratory diseases. The very young and the very old are most at risk when air quality is degraded, but athletes, too, are considered highly vulnerable and warned to stop jogging outside and practice lightly inside on days when smoke from California forest fires hangs thickly over the Central Valley.

Fifty million Americans suffer from allergic symptoms that can be triggered by air pollution: conjunctivitis, hives, eczema, dermatitis … . Smoke from wildland fires may be laced with urushiol, the toxic ingredient in poison oak. That's another scourge, along with its eastern cousins ivy and sumac, proliferating and becoming more potent as the climate warms. Some 350,000 cases of toxicodendrondermatitis are reported to doctors nationwide each year, and plant scientists expect the toll to rise.

Oh, and critters that bite and sting: They, too, are flourishing and moving into new habitats as the world simmers. Reptile and spider venom can kill. Nips from insects can transmit diseases like flea-borne pulmonary hantavirus and tick-borne Lyme disease, or trigger anaphylactic shock in sensitive individuals. Mosquitoes once unknown in temperate climates have found comfortable niches in the United States, bringing diseases that used to be confined to the tropics — West Nile viral encephalitis, yellow fever, dengue fever, for example — to North Americans.

Gloom and Doom

A wildland fire is just one type of natural disaster whose occurrence fits into a pattern consistent with planetary warming. (Note the huge fires that have scorched rural France, Greece, Russia and Australia in the past few years.) Natural cataclysms have always been with us; none can be said to have been "caused" by climate change — it takes a spark, whether from a match or lightning, to ignite a forest, after all. But the environment is primed for such events by climatic conditions.

Hurricanes, tornadoes, floods and earthquakes threaten far more widespread devastation as the world's thermometer climbs. Rising sea levels give storm-driven ocean surges and tsunamis ever-greater destructive power. When floodwaters recede, survivors may be injured by debris or sickened by mold, contaminated drinking water supplies or food crops tainted by overflowing sewage systems.

Heat waves will get hotter and longer, especially in cities. Dehydration and heat stroke, the most common causes of weather-related morbidity and mortality, are forecast to take up to seven times as many lives in Los Angeles at the end of the century as they do today. Meanwhile, physicians along the northern tier can anticipate more heart attacks, injuries from falls, and frozen extremities as cold snaps worsen snow and ice storms.

In the U.S. heartland, aquifers are being drained. Drought is reducing food production. Demographics are changing as young people move to urban areas — the population of 80 percent of the counties in the Great Plains is older than the national average.

So, yes, climate change poses a host of tangible threats to human health — leaving aside the likelihood of mass migrations and wars as islands are engulfed, coasts erode, deserts spread and nations vie for possession of natural resources.

Not a comforting picture. What are we going to do about it?

The Precautionary Principle

Unfortunately, politically, the answer would appear to be, "Not much." Our elected representatives worldwide cavil, deny, procrastinate and plead the economic hardship of accommodation … while mining, drilling, refining and burning of hydrocarbons continue apace — even though, the IPCC warns, "most aspects of [today's] climate change will persist for many centuries."

Health care providers answer to a higher call.

"Given that healthcare is underpinned by an ethical imperative to ‘first, do no harm,'" write Gary Cohen and Jeffrey Thompson in a recent Skoll World Forum/Forbes editorial (they are, respectively, the founder and president of the international organization Health Care Without Harm, and the CEO of Wisconsin's Gundersen Health System), "it has a responsibility to reduce all of its pollution and lead our society toward renewable energy, energy-efficient products, local and sustainable food systems, safer chemicals and other mitigation efforts that support healthier people in healthier communities."

The health care industry is remarkably energy-intensive. University of Chicago researchers determined in 2009 that the constellation of hospitals and clinics, medical research labs and drug/device manufacturers and distributors nationwide accounts for some 8 percent of U.S. carbon dioxide emissions. That makes health care equivalent in climate-change impact to agriculture.

Thus, argue Cohen and Thompson, health care organizations have an ethical duty to reduce their damaging carbon footprint. And the beauty is that energy conservation is massively cost-effective: You get a clear conscience and a better bottom line.

Cogeneration, for example, can shave 35 percent off the huge heating, ventilation and air conditioning, lighting and hot water bills that make a hospital almost three times as expensive to operate as an office building of the same dimensions, they note. Gundersen Health System is saving $1.3 million annually through energy conservation at its six hospitals, 27 regional medical clinics, four nursing homes and other facilities in three states. Maine's York Hospital reports $100,000 in savings each year for the past decade through reliance on renewable sources for 90 percent of its energy needs.

Kaiser Permanente is installing solar panels at many of its 648 hospitals and medical clinics throughout the country and purchasing wind energy with a goal of reducing emissions 30 percent by 2020. Kaiser even has appointed an environmental stewardship officer to oversee organizational adaptations to climate change.


Littler things can mean a lot, too. For instance, planting a healing garden on a hospital roof not only reduces the facility's heat-island effect, it soaks up atmospheric carbon dioxide — while helping patients to recover faster. Hospitals are often the biggest employer in a community; they can set an example and contribute to cleaner air by offering incentives to staff to walk, bicycle or ride public transportation to and from work.

Even more basic than helping to slow climate change through responsible energy stewardship is assuring that hospitals survive to succor the sick and wounded when disasters spawned by planetary warming recur. The vulnerability of poorly designed, older facilities was manifest when Hurricane Katrina took out all but one of New Orleans' 11 hospitals in 2005. Hurricane Sandy ousted patients and wrecked three key New York hospitals seven years later. A deadly tornado gutted a nine-story regional medical center in Joplin, Mo., in 2011, killing a visitor and five critically ill patients whose ventilators failed because of a faulty emergency generator.

"Hospitals should be the last buildings standing," maintain Cohen and Thompson, "rather than some of the first to go down." Spaulding Rehabilitation Hospital, they note — a new 132-bed teaching institution in Boston — was designed with such "future-proofing" features as rooftop electrical equipment, a raised ground floor and a landscaped protective "reef" in case of flooding. Windows are triple-glazed and can be opened manually in case of an air conditioning breakdown. These "climate-proofing" measures added all of one-half of 1 percent to the total building costs, Spaulding reports.

What's more, say Cohen and Thompson, health care organizations and the 5 million doctors, nurses, technicians, researchers and administrative support staff they employ ought to become a forceful chorus in support of "a global campaign to kick people's addictions to fossil fuels and toxic chemicals. They can become climate champions … and critical spokespeople at the local, state, national and global levels for actions, laws and treaties to rein in climate change."

Smokey Bear, the U.S. Forest Service cartoon mascot, will turn 70 next year. Both the terminology in his famous admonition — "Only you can prevent forest fires" (it's now "wildfires") — and the message (periodic fires are now acknowledged to be necessary to the health of a forest) have been muted. He's in semiretirement. Maybe this is the time for his grown cubs — the one who became a doctor, the one who became a nurse — to step forward, point a finger and growl, "What are you doing to prevent climate catastrophe?"

David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.