Women in global health need to take lead in climate crisis: Dr. Michele Barry

Dr. Michele Barry has been a lifelong advocate.

As an advocate for women's rights in the medical profession, she created the Women Leaders in Global Health Conference and founded WomenLift Health, an international nonprofit which aims to elevate women leaders in global health.

As an advocate for global health education, she helped launch both the Stanford-Yale Global Health Scholars program and NIH-Fogarty Global Health Equity Scholars Fellowship, which trains physician-scientists. She also founded the Stanford Global Health Media Fellowship in partnership with CNN and Stanford Journalism.

More recently, Dr. Barry has become one of the leading advocates for health equity and efforts to address climate change as "the ultimate global health crisis."

To mark this year's Earth Day, we spoke with Dr. Barry, who is currently the director of the Stanford Center for Innovation in Global Health and senior associate dean for global health at Stanford University, about how global health policymakers and practitioners can better communicate how climate change will impact their communities and the need for more women global health leaders to take the lead in addressing the threat.

Climate change and increased exposure to pollutants are already both directly and indirectly affecting human health and well-being. How can we expect climate change to impact global health over the next several decades?

Dr. Barry: Sadly, there are almost too many ways to name. The Lancet and WHO have declared climate change to be the greatest threat to human health in the 21st century. As the senior dean for global health at Stanford, I see this as the number one issue facing our field. Even though I started my life as a tropical disease doctor interested in how infectious diseases impacted global health, it's clear that the changing climate will worsen health far more dramatically.

Climate change clearly increases heat-related illness and death from rising temperatures. This is particularly so for the most vulnerable — elderly, pregnant women, newborns, as well as laborers and those with fewer resources. With heat, you also see increases in gender-based violence and violence in general, cardiovascular disease, and asthma, to name but a few.

More frequent and intense natural disasters, such as tsunamis, hurricanes, and cyclones will cause numerous negative health impacts: Coupled with rising seas, they will increase the number of climate refugees who, by the way, are 80% women. Increased natural disasters will also increase disease outbreaks, disrupt preventive health campaigns, such as childhood vaccine schedules, and cause direct physical trauma.

We've already seen these impacts in my home state of California, where wildfires have caused severe respiratory problems. In Pakistan, we see illnesses that were caused by the contaminated waters from recent floods. Droughts will also cause climate refugees, exacerbate food insecurity, and shorten crop growth cycles, particularly for maize, rice, and wheat.

You’ve been at the forefront of efforts to address climate change as 'the ultimate global health crisis.' What needs to be done to accelerate global understanding that these issues are related? And how could global health policymakers and practitioners better communicate the threat posed by climate change?

Dr. Barry: It's very hard to put your arms around climate. One of the really impactful ways one could do that is by using health as a pillar to examine how climate changes can impact humans. I think when you bring health into the equation, all of a sudden people can focus on the very real impact on their lives – whether it's pollution causing premature deaths, or more locally for me, wildfires which bring respiratory diseases and potentially contribute to cancer.

I testified in front of Congress about how climate impacts health and I think the more we get this in front of our legislators the easier it will be to actually raise money and attack the problem of climate change.

Physicians are also very trusted providers of information and well positioned to frame this existential problem in more immediate and relatable terms, such as how smoke affects asthma in a child or how extreme heat stresses elderly family members. I'm working with a group that is putting information sheets in doctors' offices on climate and health. It's important to get that information out – also to counter misinformation that's out there about climate.

At the same time, it's really important to leave room for hope by empowering communities and individuals with information and resources to take action on climate change, build resilience to extreme weather, and protect their own health. I think we can help people engage in a more meaningful way.

You began your career focusing on tropical diseases – how concerned are you that climate change will increase the emergence of new pathogens and vector-borne diseases?

Dr. Barry: I'm very worried. We know that climate change can impact disease emergence, zoonotic spillover, and transmission of diseases. When heat increases, disease vectors like mosquitoes can breed in different areas. My Stanford colleagues Erin Mordecai and Desiree LaBeaud predict that climate change, coupled with urbanization, could shift disease burden and transmission patterns for malaria and vector-borne illnesses like dengue, with significant consequences for disease control and public health.

Warming coastal waters provide a better reservoir for Vibrio cholerae, which causes cholera. COVID-19 has underscored that the risk of zoonotic disease is exacerbated by ecologic disruptions. Additionally, industrial agricultural practices – including the keeping of stressed, confined animals, and an over-reliance on antibiotics – really create a ticking time bomb for spillover disease that's resistant to treatment.

We're also seeing new pathogens emerge in remote corners of the world, including those trapped in rapidly melting ice and permafrost. To give you an example, there have been 33 viruses, including 28 totally novel ones, found in Tibetan Sea ice estimated to be almost 15,000 years old. This is an example of how emergence of new pathogens can occur.

I am concerned that climate change will increase human and non-human host exposure to vectors such as these.

You’ve said that ‘when we talk about climate and health, we also have to talk about environmental justice.’ Could you elaborate?

Dr. Barry: I think it's well known that historically marginalized communities tend to be most impacted by the climate crisis and other environmental challenges, particularly communities of color and indigenous communities and those in lower-income settings. These groups have contributed the least to the climate crisis, yet are bearing the brunt of its consequences through threats to their homes, their livelihoods, and their health. For example, in 'Cancer Alley' in Louisiana, lower-income communities and communities of color are plagued by the health impacts of nearby industries. We need to start listening to the people in these areas most affected by global warming and environmental degradation and work alongside them to build community resilience.

You’ve advocated for a 'multisolving approach' to climate and health. Could you give us some examples?

Dr. Barry: I'm a big believer in this idea of multisolving, or essentially taking a systems approach to climate and health. Through this lens, we can find solutions that solve multiple problems at once. For example, transitioning to clean energy not only mitigates climate change, but also improves health for communities by reducing local pollution. I also have a colleague, Dr. Steve Luby, who's focused on reducing emissions from brick kilns, which are ubiquitous in Bangladesh and are incredibly polluting and carbon-intensive. Reducing these emissions also helps mitigate the local health impacts, such as respiratory disease.

You’ve also championed the role of women in global health – what advice would you have for female global health leaders concerned about climate change? How could they take the lead on this crisis?

Dr. Barry: First of all, we need more women leaders in climate health. Since women and children are probably the most vulnerable sector to climate change, they need to have their voices at the table. Yet right now, the number of women in leadership positions in climate health or climate, even climate science, is grossly inadequate. The problem goes way back.

The first person who discovered that carbon dioxide was a greenhouse warming gas was named Eunice Foote, but she wasn't allowed to present her data. Her male supervisor had to present it. This has really been a persistent problem – that women are not put into leadership positions in climate.

Even today, many women are engaged in climate advocacy, but when you look at major decision-making gatherings such as COP 26, there were only a handful of women leaders out of something like 140 leadership positions.

So that's my advice – we need more women in leadership positions because I think they could take the lead on the crisis. I think it's been shown that when you have women in leadership positions around climate there are better outcomes — and at the very least, a diverse and more robust discussion around solutions.