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Aug 14, 2023Liked by Jeremy Faust, MD

I love this essay. You raise excellent points. Thank you.

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Thank you! It has led to a collaboration with two highly respected Native Hawaiian researchers. More soon!

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Agreed. But Maui officials knew from a study done in 2018 that Lahaina was one of several spots on Maui that could suffer a wildfire. Despite it being waterside, it is on the leeward side of the island where the winds are hotter, drier, and faster. Also the National Weather Service issued a Red Flag Warning Sunday of that week that went unheeded.

“A red flag warning is a forecast warning issued by the National Weather Service in the United States to inform the public, firefighters, and land management agencies that conditions are ideal for wildland fire combustion, and rapid spread. After drought conditions, when humidity is very low, and especially when there are high or erratic winds which may include lightning as a factor, the Red Flag Warning becomes a critical statement for firefighting agencies. These agencies often alter their staffing and equipment resources dramatically to accommodate the forecast risk. To the public, a Red Flag Warning means high fire danger with increased probability of a quickly spreading vegetation fire in the area within 24 hours.”

There are 65 firefighters in Maui County that fight on 3 separate islands. They have no off-road equipment. 18 live in Lahaina, 17 lost their homes. And Hawaii Electric (HECO) compounded the tragedy by not shutting down electricity. At least 10 poles were downed by the winds , leaving downed live wires that impeded escape.

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It is my hope that lessons will be learned from this tragedy. As I mentioned above, I've teamed up with some experts on this and we hope to have a couple of publications on this later this spring!

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I totally get wanting to be able to attribute deaths to factors resulting from climate change, under that umbrella, so that we can begin to record and thereby start to understand, in the aggregate and officially, the human cost of climate change. And, as you say, to (maybe?) muster political will to do something to prevent them. Though I can imagine the loophole this categorisation of deaths might give insurers in many future "natural" disasters.

It seems to me that writing "climate change" as the single cause of death might be like writing "poor diet," "exposure to toxins," "unfortunate genetics," "lack of exercise," or "smoking" as a cause of death for various cancers, diabetes, heart and lung illnesses, Alzheimers, and others, both because those factors probably led to the particular death and also because it's complicated, as is the effect of climate change, which doesn't strike everyone in the same way (so, as you mentioned, people who rely on dialysis and can't get there in a climate change-caused disaster are more likely to die from it than those who don't have kidney failure). Do we list "depression" instead of "suicide by ___" in some cases? Or, "the war on terror" for gunshot wounds among the serving military? Or, "being in the wrong place at the wrong time" for any number of causes of death, like drug wars, car accidents, floods, lightning, tsunamis, etc.? Or "public health communications failure" for some Covid-19 deaths? Probably these aren't all equivalent :-) and we don't need to track these distal causes, though we MIGHT want to track some of them.

I guess my question is, Should there be a separate code on death certificates for "climate change" IN ADDITION to the proximal death cause? It seems a rather difficult thing to parse out, although as I said I can certainly see why we'd want to.

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I agree with you that it's challenging. And that complexity is the reason why a lot of my peer reviewed research looks at excess mortality. We don't want to re-arrange deck chairs. But we also do not want to ignore this problem that is staring us in the face. Thank you for this contribution!

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