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.

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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.

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  • In the UK, the Sustainable Healthcare Education Network convened dozens of clinical experts to articulate ‘priority’ learning objectives for medical and nursing education.

    1. Knowledge: Describe how the environment and human health interact at different levels.

    2. Skills: Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems.

    3. Values: Discuss how the duty of a doctor to protect and promote health is shaped by our dependence on global ecosystem functions

    Thompson, T, Walpole, S, Braithwaite, I, Barna, S Inman, A, Mortimer, F. ‘Learning objectives for sustainable health care’ The Lancet, 29 Nov 2014

    These are now referenced in the General Medical Council’s ‘Outcomes for graduates 2018’:

    Outcome 3 – Professional knowledge

    Health promotion and illness prevention

    25 Newly qualified doctors must be able to apply the principles, methods and knowledge of population health and the improvement of health and sustainable healthcare to medical practice.

    f outline the principles underlying the development of health, health service policy, and clinical guidelines, including principles of health economics, equity, and sustainable healthcare

    h evaluate the role of ecological, environmental and occupational hazards in ill-health and discuss ways to mitigate their effects

    https://www.gmc-uk.org/-/media/documents/dc11323-outcomes-for-graduates-further-reading-v1_0_pdf-75026208.pdf

    For more information, see http://sustainablehealthcare.org.uk/priority-learning-outcomes

  • I am a professor emeritus for public policy at Oregon Health and Science University in the department of psychiatry. My entire post-retirement professional time is devoted to the public health and mental health impacts of climate change, much of which is detailed in a series of articles published in Psychiatric Times (https://www.psychiatrictimes.com/climate-change). One of our key agenda issues is to develop and implement curriculum content for all health professional disciplines regarding the health and mental health impacts of climate disruption at all levels of training (UME, GME, CME):
    1. Acute effects associated with extreme weather events, sea level rise, heat waves, etc.,
    2. Longer term impacts such as eco-anxiety and the need for communities to be psychologically prepared and resilient in the face of climate change, and
    3. The indirect impacts that entail denial of the reality and immediacy of climate change (as evidenced by some of the comments to this article), the duty to warn, the duty to train, and the duty to protect, all of which are relevant and essential functions that physicians must consider.

    We have formed a group of psychiatrists and other mental health professionals, the Climate Psychiatry Alliance, to address many of these issues.
    It is very encouraging that Anna and her peers are expressing their expectation that the training programs that they are enrolled in should be taking up the responsibility of including such content in their curricula.
    Another great group is the Medical Society Consortium on Climate and Health, which is made up of many major medical societies, including the AMA, family physicians, internists, Ob-Gyns, dermatologists, respiratory physicians, psychiatrists, and others.
    We count on the next generation of health professionals to be in the vanguard of taking on the health impacts of global warming and the health of the planet.

  • Preventative health is risk mitigation on the part of payers. A creative and innovative physician can market those strategies for broad applications of risk mitigation and could with the right approach very well could pay bills with it. Smart systems will move towards risk mitigation and incentivizing upstream prevention since in the long run it’s less costly to prevent a problem than it is to fix one.

  • For everyone’s sake : realise that Climate Change paranoia is a hoax that simply supports trillions of dollars for politicians, institutions, and jobs. Our Earth can withstand a whole lot more than the brain-washed sheep give her credit for. We just are speechless against the powers of our Solar System, and should be grateful we are not heading into an ice-age. February 2019 was the coldest month on record !!! but that seems instantly forgotten with just one warmer-than-usual day.
    For a doctor to worry about temperatures rather than what is medically wrong with a patient, and to seem to be overwhelmed when every second sentence coming out of a patient that has the herd-words Climate Change in it, is a very bad omen for the quality of our future medical doctors. Mine has to be one (and is) who is more sensible and realistic, and stronger, than just being a push-over un-questioning follower who lacks scientific inquisition and guts. Sorry, very direct, but it is time that these truths are spoken.

  • The AAMC database does have some content. See our article Wellbery C1, Sheffield P, Timmireddy K, Sarfaty M, Teherani A, Fallar R.It’s Time for Medical Schools to Introduce Climate Change Into Their Curricula.
    Acad Med. 2018 Dec;93(12):1774-1777. doi: 10.1097/ACM.0000000000002368.
    At georgetown, we do have 2 required modules on climate change. I’d be happy to share our materials with you.

  • This sounds great, however current medical curricula, is not keeping up with even simpler public health issues and trends. The US has a growing physician shortage, which the media is downplaying. We see time and again, the medial industry refuse to acknowledge or even adapt to fact based issues. What we have now is an industry that is so out of touch, and market driven, that they pay physicians to market alternative facts.
    Climate Change is already causing public health issues, but the anti science rhetoric is more profitable and speaks louder.

  • In 1968, Paul Erlich, a Stanford University professor, published “The Population Bomb” that predicted mass starvation of humans, mass public health and disease issues, as well as other upheavals over the following 20 years. Imagine if medical schools in 1968 decided to change their curricula to deal with these predictions. None of it came to pass. Instead of massive starvation, we are dealing with obesity and diabetes.

    So go to medical school to study medicine. Study how to treat nutritional deficiencies as well as obesity. Study how to treat infectious diseases such as chicken pox and measles no matter whether their prevalence is due to climate change or due to the anti-vac movement.

    And for goodness sakes, if you want to impact the carbon footprint of the medical industrial complex, become an engineer rather than going to medical school.

    • Many medical, nursing, and public health schools are addressing climate change & the health impacts. Check out Global Consortium for Climate and Health Education. And thank you for your advocacy for current curricular content. Climate change is a public health threat that must be addressed across health professions.

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