As a medical student fumbling with the fundamentals of interviewing patients and taking medical histories, the realities of being a doctor seem like a far-off dream. My colleagues and I work hard to prepare ourselves to be equipped to address the increasingly complex health care issues that will affect the lives of our future patients, from inequities in access to quality care to multidrug resistance.
The most pressing of these issues is climate change, a growing environmental emergency that will have devastating health impacts. Food shortages induced by climate change are alone expected to account for more than 500,000 additional deaths globally by 2050. Regardless of their personal interest in climate change or their belief that advocacy about it is within the scope of medical practice, physicians will be on the front lines of confronting its effects.
Action on climate change has been paralyzed by denial, misunderstanding of its urgency, and a sense of powerlessness in the face of an existential threat. This is why it is especially important for medical schools to integrate climate change into their curricula so future physicians understand the challenges and are prepared to use their positions as care providers, educators, and advocates to tackle this threat.
Yet a recent search of the Association of American Medical Colleges Curriculum Inventory showed that no medical schools report including content related to climate change.
Some schools have begun to address this gap. The University of California, San Francisco, for example, has introduced elective courses covering topics such as food security and sustainability. It also integrated case studies on global climate change into a mandatory first-year course.
“Global warming is the biggest public health threat of the 21st century and is going to change life on earth as we know it. It is an essential part of any 21st century medical school curriculum,” said Dr. Thomas Newman, co-founder of a Climate Health and Inquiry course launched in 2017, in a UCSF article about the course.
Medical schools already have what some see as overloaded curricula. It is difficult to argue that they should add more material. Yet the medical curriculum lends itself to promoting eco-medical literacy and sustainability over all four years of education. During the preclinical years, this could take the form of connecting pathophysiology to climate, such as how climate change contributes to cardiovascular disease. A health policy course could be an opportunity to discuss relevant climate change policy action and opportunities for student engagement. During clerkships, the focus could be on how to identify and communicate with patients who are especially vulnerable to the effects of climate change, as well as diagnose and manage climate-related physical and mental health issues.
There are at least three major ways that climate change will affect the practice of medicine and for which medical education must prepare future physicians.
First, climate change will directly and indirectly affect individual and population health. Extreme weather events like drought affect physical and mental health, but also affect social determinants of health such as water and food security, air quality, and housing. Given that marginalized communities are most susceptible to the effects of climate change, it will widen existing health disparities. Physicians will need to work with patients to manage climate-induced health burdens, educate them about their risk factors, and help them develop contingency plans in case of environmental emergencies.
Second, climate change will require an unprecedented degree of adaptation to unexpected and changing threats. Diseases previously thought to be unrelated to climate, like chickenpox, are turning out to be climate sensitive. The geographic distribution and seasonality of various infectious diseases will change. Extreme weather events of increasing severity will strain our capacity to deliver care. Future physicians must be prepared to handle these challenges in both the clinical setting and, more broadly, work collaboratively within their communities to plan and implement pre-emptive strategies.
Third, physicians and the rest of the health care sector must be aware of and accountable for their collective contributions to climate change. The U.S. health system is the seventh-largest producer of carbon dioxide globally. It released 614 million metric tons of carbon dioxide equivalents in 2013, which would generate between 123,000 and 381,000 disability-adjusted life years of adverse health effects in the future.
My generation of physicians must envision a new sustainable health system to reduce its substantial carbon footprint. Possibilities include expanding telemedicine, integrating environmental impacts into cost-benefit analyses of health services, and committing to carbon neutrality. Future physicians must also advocate for changes to health infrastructure that make health care facilities more resilient to climate damage. Without physicians lobbying for the greening of the health system, the good we accomplish could be outpaced by the damage we inflict.
Climate change is the context in which today’s medical students will practice medicine. This threat will intersect with every facet of our patients’ lives and impose barriers to health delivery we will have to navigate. Medical students can’t afford the luxury of choosing to be interested in climate change the way we will select our medical specialties. It is an urgent reality we must confront with the knowledge and skills we acquire in order to innovate, advocate, and care for patients and communities affected by climate change.
Anna Goshua is a first-year medical student at Stanford University School of Medicine.