Written by Bryan Medina, MD, Primary Care Physician, UCLA Health
As a family physician in Los Angeles, I am seeing the health effects of our changing climate unfold in real time. I recall admitting a 78-year-old with worsening congestive heart failure, disoriented and hypotensive in a stifling apartment without air conditioning, and it occurred to me that seasonal weather is no longer just a backdrop, it is a clinical stressor. I began to keep a look out for more climate related patterns. Children with asthma flaring and elderly adults with dizziness and falls every time the AQI skyrocketed. Outdoor workers presenting with dehydration and acute kidney injury after record-breaking heat waves. Then came the fires.
In January 2025, the Palisades and Eaton Fires ripped through parts of Los Angeles County, burning thousands of structures, displacing tens of thousands of residents, and blanketing the region with hazardous smoke and ash. The resulting air-quality disaster did not only affect the burn zones. Study data show that indoor PM 2.5 levels rose across homes throughout the region, even those more than two miles from the fires. We all felt the impact and our health took a toll and only time will tell the lasting effects on physical and mental health.
As family physicians, we sit exactly where climate, environment, and health collide. The losses to homes, lives, and community remind us that these disasters are not happening somewhere else. They are affecting our communities and our patients right now. We must acknowledge how environmental change quietly reshapes disease patterns and disproportionately affects patients with comorbidities, young and elderly, and socially vulnerable populations.
On a clinic level, we can build practical protocols. We can remind patients with COPD or asthma to refill inhalers before wildfire season. We can check in on elderly or homebound patients during extreme heat or hazardous air days. We can coordinate with community partners to share clean air shelter and cooling center information.
Action steps
Our patients are already living in a changed climate and evolving communities. As family physicians, we have the opportunity and responsibility to recognize climate and environment as determinants of health, to document them, and to act. For patients, and for the future of equitable primary care, silence is not neutrality, it is omission.
References
The Lancet Countdown on Health and Climate Change. (2025). 2025 global report. https://lancetcountdown.org/2025-report
American Academy of Family Physicians. (2024). Climate change and environmental health (Position paper). https://www.aafp.org/about/policies/all/climate-change-environmental-health.html
American College of Cardiology. (2025, April 1). A new threat to cardiovascular health: Climate change, extreme weather and wildfires. https://www.acc.org/Latest-in-Cardiology/Articles/2025/04/01/01/Cover-Story-A-New-Threat-to-Cardiovascular-Health
California Air Resources Board. (2025). Health effects of California wildfire PM2.5 across the lifespan. https://ww2.arb.ca.gov/sites/default/files/2025-09/Research%20Contract%2019RD005%20Final%20Report.pdf
UCLA Fielding School of Public Health. (2025, September). Research reveals extent of L.A. air quality impacts from January 2025 fires. https://newsroom.ucla.edu/stories/research-extent-of-air-quality-impacts-la-california-wildfires
Yale School of Public Health. (2025, January 22). In California wildfires, climate and health collide. https://ysph.yale.edu/news-article/when-climate-and-health-collide
