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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  • The irrational denial continues. We don’t see any physicians in the US questioning the denial, secrecy, and the costs of burying certain inconvenient data points. Climate change, and rampant development has already brought some new diseases to the US, yet the public, medical professionals, and media appear to be unaware. One particularity virulent disease is Valley Fever, a result of fungus spores in airborne soil. The number of these cases has been ignored downplayed or “misdiagnosed.” As these diseases grew more common, the medical industry even told patients it was cancer, and subjected them to unnecessary tests, procedures, and fear. We can see the growing number of dust storms, yet nothing about the diseases they carry.

  • What would be more useful is for her medical school to teach critical thinking and the ability to understand the difference between ‘political’ science and actual scientific method science. Consensus science is/has been a fixture in medicine and frequently has been shown to not stand up to the test of time/actual science. Have awareness of your bias and preconceptions, look for the potential harm/unintended consequences that your solution may bring. Weather is very complex. Climate is orders of magnitude more complex. When the data/models show even a basic semblence of validity, I’ll be more likely to listen to the (extremely compomised/biased) alarmists. In the mean time, teach critical thinking and the ability to always ask, “Am I wrong?”

    • I agree 100% with your sentiment about teaching critical thinking, but you are totally missing the author’s point. The deniers of science are blind to the changes we are seeing every day in medicine as well as in the weather, which are closely linked. The medical profession has to be prepared for the changes we are seeing, new diseases, diseases we used to feel rare, because we don’t see them this far north are increasingly being see, as well as changes in the timing of the emergence of disease patterns. I totally agree with the original author in that we need to rethink our standard teachings in medicine in the US, there are diseases that we need to now include in our differential diagnoses that were never really there before!

  • A first-year medical student is neither knowledgeable nor experienced enough to offer any substantial input on what medical schools should teach.

    • Some of the comments in this thread illustrate the need for climate change education in the medical community is not only appropriate, but essential. It will be especially imperative for members of the psychiatric/social psychologists. With increasing levels of CO2 in the atmosphere, environmental disasters will reduce quality of mental and physical health. I would like to think the profession has some grasp on how to speak to and treat patients in the near future.

  • You go to the medical school to be a doctor not a politician, curriculum already packed and docotrs and students already work more than 12 hours a day, every one is using medicine for political agenda, go help some patient first offfff

    • A physician has to have the knowledge to properly manage his/her patents. lacking proper knowledge about the changes we are seeing, in daily practice, due to climate change is like holding one hand behind out backs. The author does not suggest that physicians become more politically involved, this is not an issue or politics, although it seems to have become one because of the rabid science deniers.

  • The U.S. has some of the cleanest air and water in the world. However, there are some companies in specific areas of the US that need some improvement. That said, it’s time for the rest of the world to step up and take some responsibility … India? China? for example. The US can not single-handedly save the world from climate change.

    • It is true that we have made significant advances in the US in the area of public health, because of clean water and air. Perhaps the greatest advances in pubic health came from them. I see the effects of global climate change though every day. I am not trying to convert physicians into political activists, but the physicians of the future need to know about the implications, the changing disease patterns, etc. True, the US can not change all the world, but we do have to set the best example for the rest of the world to follow.

  • I remember my idealistic first couple years of medical school too.

    I had a fellow medical student that would go on long tirades to whomever would listen about how every physician, regardless of specialty should know, understand, and stay current on oral contraceptives because 50% of the population we see, presumably should be on them. Well at face value this is a reasonable argument, but I’ve never really been able to see the value in my practice as a trauma surgeon when somebody is bleeding to death (or for another example, a pediatric oncologist seeing a nine-year-old with a Wilms tumor) to know the ins-and-outs of oral contraceptives.

    Some of the points you present could be applied broadly to other equally as pressing public and global health issues: application and availability of vaccines, resources for substance abuse and mental health, and lack of a uniform way healthcare is paid for, to name a few.

    And at the risk of sounding greedy, at some point when you finish medical school and training, you have to think to yourself, how am I going to get paid? How am I going to pay off my loans and debt? How am I going to support my livelihood? While preventive health no doubt has the most widely appreciable effect, unfortunately you’re not going to be able to pay your bills with it.

    • There is no question that the cost of medical education is too high. The average medical school graduate in 2018 was over $200,000 in debt. If we ever see a change in health care, one area which MUST be address is education, and public health. The ACA did attempt to address issues of public health, those areas were among the first to be attacked by the politicians. Let us not get into the political argument that waters down the need for physicians to know of the implications of climate change, the author’s initial discussion. Yes, there are many areas which need to be addressed, that doesn’t mean that she doesn’t have a good point.

  • I really hope doctors I see studied medicine and not food security.

    If anything administrators and young people like Anna should be taught opportunity cost. The opportunity cost of using med school time on items like these is enormous.

  • Although I totally agree, this subject needs to be taught well before someone enters medical school. The problem is that it has become such a hot, pardon the pun, political issue with such vehement deniers, that I am afraid it will not likely get off of the ground until it is too late, if it isn’t already.

  • Where in the curriculum do we put climate change? Medical school is already packed, and training is already tight as it is. Adding another topic that is, frankly, outside the scope of physicians is not feasible. It is easy to say that this will affect the health of patients, but it is not something that your doctor can help you with. There are already plenty of non-medical topics that doctors have somehow been made to be responsible for, and I don’t think we should be the ones responsible for pleading to hospital administrators to cut down on our waste generation and carbon emissions.

  • It’s true that medical schools don’t tend to highlight issues like climate change in their curriculum. But where I study, we had to read about the implications of climate change as part of our curriculum in Preventive and Social Medicine.
    Bangladesh is already bearing the brunt of climate change and the medical schools here tend to highlight on diseases that are re-emerging due to it.

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