Climate change

Climate change refers to long-term changes in temperature, patterns of weather, sea levels, and the intensification of extreme weather events. Human behavior and industry are the primary drivers of climate change. Climate change has been linked with changes in human health such as heat-related illnesses, cardiovascular disease, asthma and other respiratory illnesses, insect borne diseases, and changes in food sources and water safety [1]. The cascading exposures related to climate change also heightens the risk for mental health outcomes such as depression and posttraumatic stress disorder, as well as ecological distress such as climate anxiety [2]. Finally, climate change is linked with large-scale weather-related events (e.g., tornados, hurricanes, wildfires, earthquakes, polar vortexes, and droughts) which results in injury, death, economic loss, infrastructure damage, and psychological trauma.

Moreover, climate change disproportionally impacts communities of color, low-income communities, and vulnerable sectors of society such as children, older adults, and those with existing health conditions [3] widening existing disparities. In preparing for and responding to the growing climate emergency, the need to plan and provide mental health and psychosocial support (MHPSS) is more pressing than ever before, yet few scalable approaches to assessing, triaging, and treating the impacts of climate change on health and mental health exist, particularly outside of emergency management and disaster situations.

Wearable technology and biofeedback

Wearable technology refers to a class of devices involving sensors worn by human subjects (e.g., smart watches and patches). Technology penetration data worldwide has primarily focused on larger devices such as cellphones (8.06 billion users worldwide) [4] laptop computers (47% worldwide) [5] and tablets (20% worldwide) [6]. Yet, emerging data has found that 21% of American adults wear a smartwatch and 2.69% of adults globally [7] meaning over 215 million people worldwide already use, and have access to, wearable technology. The primary challenge regarding user access to wearable technology is deeply rooted in energy equity- specifically access to stable electricity (90.4% worldwide) [8] and broadband internet (60% worldwide) [9]. While the wearable technology space advances quickly, it does not do so evenly across geography, income, and urbanization. However, new advances in alternatively powered (e.g., solar and kinetic) wearables positions this technology at the precipice of bridging the access gap.

Smartwatches and other wearable technology have been used an effective method of collecting passive data related to human physiology, including metrics often used as indicators of stress and disease (e.g., temperature, heart rate, respiratory rate, ECG). In fact, several study protocols to utilize data collected from wearable devices to diagnose disease exist (e.g., COVID-19 or cardiovascular indicators) [10, 11] and a recent scoping review found 53 studies that used wearables to assess the impact of extreme climate related weather events [12]. However, the utility of wearable devices far extends passive monitoring and post-hoc data analytics. Wearables offer a unique ability for predictive algorithm development and the ability to push low-intensity just-in-time interventions to help self-manage symptoms in real time when the intervention is needed; and further triage those who needed higher levels of intervention. To that end, wearable technology has been underutilized in this space.

Biofeedback is one such intervention approach that can be deployed via wearable technology in an easy and cost-effective manner. Biofeedback is a technique in which patients use data about their own physiology to improve their mental, physical, and emotional health [13]. Biofeedback is an effective method of treating mental health symptoms and managing chronic illness [14]. More specifically, heartrate biofeedback has been successful in treating depression, anxiety, and sleep disturbances in patients with chronic illnesses [14]. Psychophysiological psychotherapy, in which stress management training is used in conjunction with physiological data presentation is particularly effective in stress based psychological disorders (e.g., anxiety and posttraumatic stress disorder) [13]. Wearable devices are one mode of delivery for biofeedback that is increasingly accessible and user friendly. Expanding the capacity of wearable technology to include screening, triage, and low-intensity just-in-time interventions is the next frontier for mobile health that will expand, and speed, access to interventions thereby enhancing health and mental health equity.

Implementation

Precision medicine is based in the principle that patients biophysiological, environment, and lifestyle should be considered to create personalized medical and mental health treatment plans. Biofeedback and self-managed interventions via wearable technology offers a unique opportunity to personalize approaches to treatment. Biofeedback deployed via wearable technology relies on personalized algorithms and artificial intelligence using data collected via a worn sensor. These devices also have the ability to trigger reminders and link access to intervention materials based on biometric data such as heartrate, sleep, respiratory rate, galvanic skin response, and body temperature. Low-intensity interventions (e.g., relaxation techniques or access to educational materials regarding diet, exercise and sleep information) may help individuals self-manage symptoms of stress in real time and develop long term habits that improve modifiable health behaviors linked with the onset and maintenance of chronic diseases. Presenting individuals with information about their health and symptoms can help them identify patterns, triggers, and detect when greater levels of intervention are necessary.

More effectively triaging patients allows those with critical needs to be receive access to care faster and with greater precision thereby reducing the strain on the health and mental health care system. Presenting users with data regarding their health and mental health symptoms creates greater awareness, enhances autonomy and decision-making allowing users to make changes in health practices, and returns health data to the user creating stronger partnerships between patients and health care systems. In addition, creating remotely accessible resources via wearable technology, artificial intelligence, and app based mobile health resources increases access to quality care in hard-to-reach communities that are traditionally left underserved by the health and mental health system. This is uniquely important in deploying interventions following climate related disasters when physical access to communities remains restricted or difficulty because of environmental or structural hazards. While more information is still needed to determine the degree to which low-intensity interventions can improve and stabilize symptoms; and which profiles of users require higher intensity intervention, better understanding the nuances of this approach could revolutionize the ways in which we assess, triage, and treat the health and mental health impacts of climate change in diverse populations.

Conclusion and implications

Climate change and climate related disasters impact millions of people around the world, including an estimated 13 million deaths each year [15]. There is an urgent need to rapidly develop and disseminate large scale approaches to assessing, triaging, and treating the health and mental health impacts of climate change and climate related disasters. Leveraging just-in-time interventions, such as biofeedback and self-management strategies deployed via wearable technology, could reduce the strain in the health care system and improve wait times for treatment by triaging patients who can self-manage health and mental health symptoms and prioritizing patients who require higher intensity interventions. Rapidly generating knowledge regarding symptom profiles, trajectories of symptoms over time, as well as risk and protective factors will enhance our ability to build scalable and targeted health screening and triage approaches for this growing need. Lastly, focusing on deploying technology more equitably and ensuring sustainable access to traditionally underserved communities is an essential next step to improving health and mental health equity as it relates to climate change.