Pioneering the Future

Reducing Health Care’s Carbon Footprint

Global climate change has real consequences for human health. Rising temperatures and changing patterns of precipitation increase food and water insecurity and spur the spread of many infectious disease, while extreme weather events put people at further risk. Health care systems are responding to this challenge not just by delivering quality care but also by reevaluating their own impact on climate. More than 4% of the greenhouse gases that drive climate change come from health care systems, and in the United States, health care’s contribution to carbon emissions is even greater.

One way that hospitals and clinics can reduce their carbon footprint is through telemedicine, which uses videoconferencing or other technology to increase access to care and eliminate the need for patients to travel to meet with their provider. Mollie R. Cummins, PhD, RN, professor at the University of Utah College of Nursing, analyzed more than 79,000 telemedicine visits that took place during 2021 and 2022, when remote visits surged due to the COVID-19 pandemic, to figure out just much of a difference this approach can make.

She and her colleagues found that the median round-trip driving distance between the patients and providers involved in these interactions was 49 miles. Based on these data, they estimated that telemedicine reduced U.S. carbon emissions by 1.44 million metric tons annually—the amount that would be generated by using 165 million gallons of gasoline. Their findings have influenced policy discussions and clinical practice. Although telemedicine use fluctuates varies depending on public health needs and other factors, the positive environmental impact is clear. “Telemedicine isn't just about convenience, it's a step toward a greener future for health care,” Cummins says.

Brain and Body Impacts of TBI

Traumatic brain injuries (TBIs) are injuries that affect the function of the brain—and millions of people worldwide have experienced at least one. Bumps and blows from falls and collisions, as well as gunshots and explosive blasts, can cause TBIs. When a TBI is mild, the initial headaches, confusion, and memory loss may resolve within days or weeks. But even mild TBIs—also known as concussions—may impact a person’s physical and mental health in the future, sometimes in surprising ways. These effects are unexpectedly complex, and doctors and researchers need to understand them holistically to provide patients with optimal care.

Epidemiology professor Mary Jo Pugh, PhD, RN, is a retired Air Force nurse who now studies the long-term impacts of hazards encountered during military service. She estimates that about 20% of post 9/11-veterans have experienced TBI. By exploring heath data from millions of veterans, she has discovered that people who experience TBI are more likely than others to develop dementia, substance use disorders, cardiovascular disease, brain cancer, and neurological issues. They are also at greater risk of dying by suicide.

Her team’s findings expose the complex aftermath of brain injury while also highlighting opportunities to manage these risks. “Documenting these patterns of risk is a crucial step toward implementing preemptive interventions to help veterans stay healthy,” Pugh says. She adds that the findings should also inform care for athletes and other patients after TBI.

A High-Altitude Cancer Clue

For people with the rare blood cancers polycythemia vera and essential thrombocythemia, inflammation is common, widespread, and problematic. The chronic inflammation increases the risk of developing blood clots, putting people at risk for heart attacks, stroke, or pulmonary embolism. It also drives the progression of the cancer itself.

Biologists Jihyun Song, PhD, and Josef Prchal, MD, at Huntsman Cancer Institute and the Department of Internal Medicine at the Spencer Fox Eccles School of Medicine, have found inspiration for combatting this dangerous inflammation by studying the Aymara, an indigenous group in South America whose people live high in the Andes Mountains.

Investigating the adaptations that help the Aymara thrive in this high-altitude environment, where the level of oxygen in the air is low, led them to an immune regulator that works in our body’s cells called NFKB1. Low oxygen levels can promote inflammation, but the researchers found that most Aymara make a version of NFKB1 that helps keep inflammation in check. Then they discovered that about a third of people of European, Asian, and Hispanic ancestry make this inflammation-limiting form of NFKB1, too.

That prompted Prchal and Song to investigate how this version of NFKB1 might impact patients with polycythemia vera and essential thrombocythemia. They found that it helps dial down the activity of genes that promote both inflammation and blood clots. Patients with these cancers who had the variant responded better to treatment than patients whose cells made a more common form of NFKB1.

“They are all more likely to get complete remission with treatment and may have a better course,” Song says. The researchers hope to use what they’ve learned to develop therapies that will improve treatment response for patients who haven’t inherited the advantageous protein.