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Dr. Patrice K. Nicholas completed a Bachelor of Science degree in Nursing at Fitchburg State University, and a Master of Science in Nursing degree and Doctor of Nursing Science degree at Boston University. From 1996-1999, she was a postdoctoral fellow at the Harvard T. H. Chan School of Public Health focusing her research on symptom management in HIV disease and global health and completing a Master of Public Health degree in International Health. In May 2010, Dr. Nicholas received a Doctor of Humane Letters degree Honoris Causa from her alma mater, Fitchburg State University. In 2007, she was selected as a Fulbright Senior Scholar at the University of KwaZulu-Natal focusing on adherence to HIV and TB medications. In 2008, she was inducted as a fellow of the American Academy of Nursing. Dr. Nicholas is Distinguished Teaching Professor in the School of Nursing, teaching in the Doctor of Nursing Practice Program, and was actively involved in curriculum redesign of the DNP program. From 2006- 2019, Dr. Nicholas served as Director of Global Health and Academic Partnerships at the Brigham and Women’s Hospital, where she also co-led the efforts in their successful American Nurses Credentialing Center Magnet journey. She has authored or co-authored over 100 peer-reviewed manuscripts, two texts, and many invited and peer-reviewed presentations including several manuscripts on climate change, climate justice and climate-related health consequences. Dr. Nicholas serves as director of the MGH Institute of Health Profession’s newly launched Center for Climate Change, Climate Justice, and Health.
Lindsay Gearheart: Tell me what led to the creation of the newly launched Center for Climate Change, Climate Justice, and Health.
Patrice Nicholas: My colleague Suellen Breakey and I co-authored a text called, “Global Health Nursing in the 21st Century” in 2015, and Chapter 2 in the text was about climate change. So we started thinking about it as the science was emerging about the big health impacts of climate change. Then in 2016, we submitted a manuscript to the Journal of Nursing Scholarship titled “Climate Change, Climate Justice, and Environmental Health: Implications for the Nursing Profession,” and the editor of that journal ended up launching a whole special edition on climate change. That launched the idea of us having what is the first school of nursing-led center for climate change, climate justice, and health right here in the Charlestown Navy Yard.
We have a vibrant steering committee and host an annual symposium. The inaugural symposium was last year, and Gina McCarthy, who was the head of the Environment Protection Agency during the Obama years, was our keynote speaker. She was at Harvard’s School of Public Health until recently, leading their climate center. Dr. Renee N. Salas, who is the lead author on the 2018 and 2019 Lancet Countdown on Health and Climate Change U.S. Brief, is actually our keynote speaker this year. We are really lucky that some of the leading experts on climate change and health are right within Massachusetts General Hospital and the Boston community.
After this interview took place, the MGH Institute of Health Professions, in accordance with Partners Healthcare System’s policy, made the decision to postpone this event.
LG: How long has this been an area of study for MGH?
PN: The idea emerged in late 2017 when a group of us decided to band together and consider launching the center. The president of the institute, who happens to be by background a doctorally prepared nurse, is very committed to the center. So is the provost office, and our Dean is a member of the steering committee, Dr. Elaine Tagliareni. We also have a lot of involvement with the local community. We offer Harvard Kent students an Earth Day presentation. We are going to teach more about heat stress with the elderly, which is a major concern with summer weather, and we hope to have 10 Charlestown High School students attend the climate symposium. So we are trying to build the arm of community engagement around climate and health.
LG: Who is most at risk of the negative health effects of climate change? You mentioned the eldery with heat. Are there any other particular populations you are focused on?
PN: Our pediatric population, definitely. For example, asthma exacerbations are very much influenced by greenhouse gas emissions, particularly by auto traffic. The Harvard Kent school is almost directly under the Tobin Bridge where it intersects with I-93, so those kinds of environmental circumstances make children more vulnerable for sure. Heat stress with elders is a major area of vulnerability. Occupational heat stress, so construction workers, farm workers, who at times may not have access to enough water and may not have enough heat breaks, are particularly vulnerable.
There is a new phenomenon called Mesoamerican nephropathy, which primarily affects migrant farm workers who don’t have heat breaks and don’t get access to enough water. Because of dehydration, they are experiencing kidney failure at a young age, and at times are requiring dialysis. Renal stones, renal calculi, are more prevalent because of heat and dehydration. Then there is the issue of vulnerable populations. Dr. Paul Farmer from Partners and Health had an editorial with two others, Jay Lemrey and Carmel Williams, and they called it the Great Procrastination. They have a particular quote in there that “those who least contribute to greenhouse gas emissions are the most vulnerable to the perilous health consequences and are increasingly vulnerable.”
We had a circumstance in 2018 with saltwater intrusion from the harbor when it overflowed onto First Avenue. School was closed, but it wasn’t attributed to a climate change event, it was inclement weather. But I remember slogging down First Avenue with water almost up to my knees during that event. So, people living in areas where salt water intrusion can occur are also particularly vulnerable.
LG: Are there similar centers at other hospitals around the country? Is Boston unique in taking this step?
PN: We have the Partners Healthcare sustainability group, which is a very committed, engaged group of physicians, nurses, and hospital leaders, who are engaged in the roles of hospitals in addressing climate change and also environment and sustainability. Between 10-13% of greenhouse gas emissions are attributed to healthcare institutions, which is an enormous amount of the contributions to climate change. What we know about hospitals is that often it’s difficult to recycle as there can be materials that are impossible to recycle. But we do have a committed group of people that are engaged within the Partners system.
I think we owe so much credit to organizations like yours, and also the lay media, that when we see the government pull back from the Paris Agreement, for example, that newspapers, magazines, and organizations are really stepping up to the plate to fill the void. Also, cities, towns, and state offices. Governor Baker, for example, is very engaged and committed to climate change and health, and Mayor Walsh has lots of resources built around climate change and health. There are reports that are specific to each neighborhood community around climate change and health. So we have a lot to be proud of, even with seeing drawbacks and lessening of funding at the national level, that local governments, states, and organizations have done a lot of work.
LG: What can people that are not in the healthcare industry do to get involved or support the efforts?
PN: I think climate advocacy is incredibly important. I think that people can write to their legislators to talk about the fact that they want climate change as one of the singular most important issues. To have climate change right at the top of the list that our legislators engage with.
There are also growing communities around climate change and health. We are hoping to really engage in community efforts with climate change. Educating elders how to avoid heat stress, our partnership with Harvard Kent school and Charlestown High School, really engaging the younger generations around climate change as a critical issue that is going to affect their future. We still do have time to draw down on greenhouse gas emissions, but it is important that we do it leading up to the year 2030 in order to have measurable and sustained positive outcomes.
LG: I think that Boston is in a unique position to educate young people as well, given that we are such a center of education.
PN: One other area that it’s important in terms of vulnerability is our children in schools. I read a report that used climate modeling across the U.S. to determine what the climate was in various cities, and they used PSAT scores because they are taken serially by students. They found for every one degree Fahrenheit of temperature increase in the range of the 90s, there was 1% less student learning. Not surprisingly, the schools that were not air conditioned were those where students performed less well on standardized tests. Often we worry that it is the students in poorer cities or poorer functioning schools, but they were even able to control for the socio-demographic status factor.
Through a friend of mine, I actually brought this to the attention of our terrific city of Boston Public Schools superintendent Brenda Cassellius. In Boston, I think only a quarter of schools are air conditioned. The first week of school, my granddaughter was going to pre-K in a wonderful City of Boston public school and I happened to go and pick her up. I believe that day we hit 95 degrees, and it’s an old brick school. The students and her teacher looked both exhilarated and exhausted from the heat. So that’s an issue that I like to bring to people’s attention around student performance going forward.
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