A country doctor from Gummersbach tries to unite what must be united: a healthy life for the individual and a healthy climate for the land.
The doctor is also a bit shaken: the night before, Dr. Ralph Krolewski nearly fell headfirst into a car. It came at him the wrong way, upside down, wheels up, bouncing towards him. He, the passionate cyclist who, out of conviction as a country doctor in Gummersbach, makes 90 percent of his house calls by electric bike. But he is fine, as is the drunk driver, at least physically. In this way, Krolewski can explain why a general practice in Gummersbach is crucial in the fight against the climate emergency.
Because climate change kills. Heat waves kill people in summer. Not in faraway India, but here. “People with pre-existing illnesses are two to four times more likely to die on hot days,” she says. “With each heat wave, excess mortality can be determined. Up to 20,000 additional deaths have been recorded for the summer of 2018 on days with more than 30 degrees. “It is a classic heat stroke, but there are also increases in heart attacks strokes and kidney failure.
There were 20,000 heat deaths in Germany in the summer of 2018
Even in the country, according to Dr. Ralph Krolewski, therefore you need heat protection concepts. In his practice, he has upgraded the garage: with a moisture misting system for cooling. Worse still: in the big cities, the heat is up to six degrees higher. The State Office for Nature, Environment and Consumer Protection has calculated that only in Cologne, after a few hot days, 62% of citizens experienced heat stress advised, the body can no longer recover.
What would help: drinking fountains, fresh air corridors, green facades and roofs, street trees, small watercourses, as well as places of refuge in churches, clear parking lots, subway stations. “In Germany we are at the beginning, as there are no specifications or obligations for the municipalities,” says Krolewski.
For Krolewski, this is a reason to wake up the medical profession. And not only them. He soon learned that people can change the world after all, in the Ruhr area.
As a medical student, the now 66-year-old worked in the municipal clinics of Dortmund, met friends with lung stone dust, the burden of smog and sulfur dioxide.
In the Ruhr area he learned that people can make the world a better place
But he also experienced how the sky over the Ruhr became blue again and the air cleaner. Now perhaps his most important patient is a little older than Revier or fighting the effects of the Chernobyl reactor catastrophe. Climate change is upon the world, the biggest conceivable patient.
“I have always followed what happens at the United Nations level,” he says. And it was there: at the 2018 climate summit in Katowice, in Madrid in 2019. Since then there has also been the association “KLUG – Climate Change and Health.”, in which medical professionals from Germany network. “Climate change is being trivialized for a dramatic development,” says Krolewski. “The whole system is changing: the atmosphere, the soil that nourishes us, the oceans, the ice sheets, the biosphere, the web of life. And between these Earth systems there are a multitude of powerful interactions.”
Not only when, like last year, the forests around Gummersbach are burning after a long drought and Krolewski, who is also a medical psychologist, has to treat traumatized firefighters temporarily trapped by the flames.
The big politics, the thick reports for the climate conferences that he writes are useless if they do not have an individual effect. “What do you do with your knowledge in practice every day?
I found an answer to that,” says Krolewski: the climate consultation hour. “Prevention includes a risk assessment. So I can say: Dear Ms. Müller, your risk of having a heart attack or stroke in the next ten years is 23 percent.
But if you change something about exercise and diet, you can cut your risk in half.” Physical activity and diet goals are in writing. “Then she has the feeling: I myself can do something for my health without taking pills.” Also, given the classic distribution of roles: “Whoever decides the saucepan decides the health of the family.” a low-meat diet also leads to a better climate balance.
Nutrition, exercise, urban development and international politics
Changing mobility is even more difficult than changing diet: 30 percent of patients have pain in the musculoskeletal system. “We live in an absolute lack of exercise. Among people ages 18 to 85, 54 percent are below the minimum level of physical activity. For young people from 14 to 18 years old it is more than 80 percent.”
With medicines and operations there is nothing to do, they enrich doctors and pharmacists, above all: walking or riding a bicycle is the best recipe. “The risk of stroke and heart attack is reduced by a quarter, dementia by a third, the psyche is better, the risk of cancer is reduced by 10 percent. Moving people strengthens the immune system, muscles, heart, and circulation,” says Krolewski. And protect the climate. Therefore, all Dutch people get 19 cents per kilometer when they cycle to work: their share of the health benefit.
“So Britain has changed the traffic rules: the weakest road users now have the greatest rights there.” In Paris, the diet in bistros and canteens is changing in a large area. Public services should be within walking distance. “That would also be possible in Gummersbach,” says Krolewski.
What works in Gummersbach also works in Kranenburg and Schermbeck. As a green member of the district council, practice on these boards. “The Netherlands has been doing this for 50 years. You may remember what the cycle highway between Arnhem and Nijmegen will do for the health economy. We must plan the healthy cities of the future now.”
The health system itself also needs to rethink
Next to the patient and the balloon, this is the intermediate level: local politics. And there is another point where Krolewski wants to start. In his own industry: “The health system is responsible for 5.5 percent of emissions in Germany. And every superfluous service we provide uses COtwo free,” says Krolewski. “Anyone who only serves the merry-go-round of capital is behaving unethically.” Because the same applies to the practice of every field doctor: “We are the practice of the world community”.
She has been sitting in the waiting room for a long time: he serves people from 54 nations. And see his bike there. And if she has to wait a bit in the treatment room, she can look at the bookshelf. Some books are front-cover: Eckard von Hirschhausen’s Book of Happiness, “The Nutritional Compass,” the “Hippocratic Oath,” “Planetary Health,” and a few more: “Creating Opportunities for Conversation,” Krolewski calls it. . people that his own Welfare also helps the greatest of all patients: the balloon.
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