Why psoriatic disease belongs to the global climate agenda

By Abhinand Krishnashankar
Manager, Economics and Policy, Environmental Defense Fund
 

As a person living with psoriatic disease and as someone who makes a living calling for ambitious climate action, I posit that psoriatic disease belongs on the global climate action agenda as a serious noncommunicable disease (NCD). As the Conference of Parties (COP), the largest annual climate conference among nations, sets off in Antalya, Turkey this year, I am hopeful that we will see ambitious integrated action at the intersection of climate change and health as the outcome of the meeting.

Climate professionals and health practitioners need to work together

In last’s climate conference, a collective of 34 academic institutions, philanthropies, health and environmental organizations under the umbrella of the ‘Global Climate and Health Alliance’ (GCHA) launched a set of recommendations for policymakers underlining the links between climate change and physical, mental, and planetary health. 

While studies forecast the cost of NCDs to the global economy in the form of lost productivity and healthcare expenditures through 2030 to run up to $47 trillion, climate change will only add to this economic toll. Notably, low and middle-income countries are projected to face a disproportionately higher share of these costs. Their increased vulnerability to climate risks and their already overburdened healthcare systems, linked to underinvestment and high demand, offer possible explanations. 

So, where does psoriatic disease come into the equation here and why does it deserve attention?

Psoriatic disease is a systemic condition affecting multiple body sites, predominately the skin, the joints, or both. A third of people with skin manifestations of psoriatic disease (psoriasis) will develop a type of inflammatory arthritis affecting joints and tendons (psoriatic arthritis). Psoriatic disease is an NCDs affecting over 100 million people worldwide, that has long been overlooked or dismissed as a skin condition. Psoriatic disease is also increasing risks of developing other serious NCDs (comorbidities), such as cardiovascular disease, type 2 diabetes, obesity and depression. 

Though the exact cost of climate change in exacerbating psoriatic disease is unknown. What is clear is that placing psoriatic disease and other diseases affecting the skin high on the global climate agenda is both urgent and necessary.

Below I outline three specific risks posed by climate change and environmental pollution to people living with psoriatic disease and related NCDs and call for greater recognition of these interconnections in decision-making processes, and medical practice.

Air pollution may compound and exacerbate predisposition to and incidence of psoriatic disease when combined with genetic factors 

It is already known that air pollution leads to heightened risk of developing NCDs - on top of the risk presented by psoriatic disease. That spells a double-edged sword for more than 50% of the global population of people living with psoriatic disease, in Asia.

Today, 99% of the world breathes air considered unsafe according to guidelines from the World Health Organization, and the risk posed by air pollution holds true across regions. California, for example, reports annual average PM2.5 (particulate matter smaller than 2.5 microns) levels that are within accepted limits according to the WHO guideline value for most of the year, large parts of the State experience hazardous air quality during wildfire season. Researchers found that, within 5-8 weeks of one such wildfire, inpatient visits among people living with psoriatic disease experiencing flare-ups peaked, along with an increase in inquiries about it in clinics, even if these increases were not observed immediately after the event. 

There is also a growing body of evidence linking short-term and long-term exposure to nitrogen dioxide (NO2) and volatile organic compounds (VOCs), emitted from fossil fuel combustion, and new incidence of psoriatic disease, especially for those with a family member who lives with psoriatic disease. This calls for stronger awareness among healthcare professionals on the role of indoor air pollution from household activities such as combustion of fuel wood, and ambient air pollution sources like occupational exposures and road dust, as explanatory variables in the incidence or worsening of psoriasis.

Extreme heat attributable to global warming from climate pollutants is a concern  for people with psoriatic disease

Over this decade, extreme heat has become one of the largest climate-related health risks in Europe, where temperatures have been rising almost twice as fast as the global average since the 1980s. As temperatures continue to rise, extreme heat may create additional health challenges for people living with psoriatic disease.

While the effects of temperature on psoriasis vary considerably between individuals, emerging evidence suggests that extreme heat may worsen symptoms and affect disease activity in some people living with psoriatic disease. High temperatures can also increase itching and place additional strain on the body’s ability to regulate heat.

Climate change has also been linked to risks associated with certain types of keratinocyte cancers and melanoma. Separately, studies have reported an increased risk of some skin cancers among people living with psoriatic disease, although this association is complex and may be influenced by factors including treatment exposure and disease severity.

These risks should not be assumed to have a direct or cumulative relationship. However, they underline the importance of understanding how a changing climate and increasing exposure to extreme heat may affect people living with chronic diseases like psoriatic disease.

Climate change-induced extreme weather events disrupt critical access to care for people living with psoriatic disease and its comorbidities

Extreme weather events and climate change can also affect pharmaceutical supply chains, from manufacturing and transportation to the availability of raw materials. Disruptions can contribute to shortages, delays and additional costs throughout the supply chain. 

The consequences can be particularly serious when extreme weather causes widespread disruption. Hurricanes, floods, wildfires and other climate-related disasters can damage healthcare infrastructure, interrupt transport and supply routes, and displace whole communities. 

For people living with psoriasis and psoriatic arthritis psoriatic disease who depend on continuous treatment and regular access to healthcare, the consequences of these disruptions can involve much more than just worsening of skin symptoms. 

Psoriatic disease requires lifelong management. Interruption of effective treatment can lead to loss of disease control and relapse. Extreme weather events can disrupt healthcare services, pharmaceutical supply chains and production and distribution of medicines. Prolonged disruptions in supply chains risk adding to the health burden for people already at increased risk of serious comorbidities, including cardiovascular disease, obesity, type 2 diabetes, depression and anxiety. 

These challenges are, of course not unique to psoriasispsoriatic disease. People living with many chronic diseases depend on continuous treatment and functioning healthcare systems. But for the millions of people living with psoriatic disease, climate-related disruptions represent another potential barrier to maintaining consistent care and can be life-threatening in a longer term.

This makes climate resilience a healthcare issue as well as an environmental one. Disaster preparedness and recovery plans should consider the needs of people living with chronic diseases, including how they will continue to access medicines and essential services when normal systems are disrupted. As extreme weather events become more frequent and severe, protecting continuity of care must be part of how health systems prepare for a changing climate.

Climate action needs the voices of those with lived experiences

As healthcare systems adapt to the growing impacts of climate change, the people who depend on them should be part of shaping that response. The lived experiences of people with psoriatic disease constitute a valuable source of knowledge for the design of care systems that are holistic, inclusive, and compassionate. These insights can help inform healthcare systems that are more resilient, inclusive and responsive to people’s needs.

The large network of advocacy organizations today, often with limited resources, working to embed the voices and experiences of psoriatic warriors across national, regional, and multilateral health policy decision-making levels, has valuable lessons to share in fulfilling the UN Climate Change Executive Secretary’s call to put people at the center of climate action at COP30. 

The psoriatic disease and NCD movements, and the climate movement are natural allies and have much to gain from working closely together to champion our shared interests. Climate change and environmental pollution directly worsen the quality of life of people living with psoriatic disease, and now, more than ever, we need more climate champions in the healthcare sector to ensure a healthy, liveable planet for ourselves and our future generations.