In this edition of the Macy Notes blog, I am honored to turn over the “microphone” to Karly Hampshire and Taylor Diedrich, medical students at University of California, San Francisco and Indiana University, respectively. Karly and Taylor each hold leadership positions within the Planetary Health Report Card, a student-led initiative to inspire planetary health engagement in medical schools. In celebration of Earth Day and in recognition of National Public Health Week, both of which take place during this month, I invited Karly and Taylor to talk about their meaningful work related to planetary health and to share their recommendations related to transformations in health professions education and how such change can lead to healthier lives for all. They are challenging all of us—but most particularly the leaders of health care and health professions education—to incorporate consideration of the climate crisis and its devastating impact on health in all aspects of decision-making and planning.
Healthcare in the Anthropocene: the Role of Medical Education in the Climate Crisis
By Karly Hampshire and Taylor Diedrich
For decades, talk of climate change conjured up images of melting icebergs and bleached coral, tragic yet removed from the everyday human experience. Recently, however, the human health threat posed by global warming and ecological destruction has crystallized in the public consciousness. Healthcare professionals are seeing increased numbers of asthma exacerbations driven by wildfire smoke, vector-borne diseases in expanded ranges, and youth suffering under the existential stress of an uncertain future. As the interface between humans and non-human animals erodes, arising from habitat destruction and other environmental factors, there is also recognition of the role of climate change in driving pandemics like COVID-19. The human face of climate change is growing.
Where do patients turn for information on these health consequences of global warming? Frequently, to their healthcare professionals. According to survey-based research, primary care physicians are often considered the most trusted source of information on the health effects of climate change, more than even the CDC or climate scientists. And yet, despite a growing movement of healthcare providers sounding the alarm on the health crisis posed by climate change, the modern healthcare workforce is largely unprepared to mitigate, diagnose, and manage the health consequences of climate change. Medical education has been slow to address this gap; though today’s trainees will inherit a health landscape riddled with natural disasters, emerging infectious diseases, and climate anxiety, most medical school curricula do not utter the words “climate change.”
Addressing this curriculum gap will require more than simply adding a planetary health or climate health elective. Rather, the effects of anthropogenic environmental changes on human health should be integrated into core medical school curricula. In addition to introducing content on key climate health intersections, curricula should center social determinants of health (which populations bear the brunt of health impacts of climate change and why?), healthcare sustainability (how can clinicians approach their clinical practice with a sustainability lens?), and clinical applications (how can a provider discuss climate change during a patient visit?).
Though the idea of reorganizing curricula to accommodate yet another topic area can be administratively daunting, meeting these needs does not require the addition of standalone lectures. Schools can integrate planetary health topics into existing courses, even existing lectures. For example, adding a few slides on the effects of climate change on respiratory health may seem inconsequential, but incorporating planetary health in all organ-based curricular blocks ensures students encounter the material regularly and often. In fact, an integrated approach to planetary health education is likely more effective than one that is standalone. As anyone who gets a daily climate change news roundup in their inbox can attest, being blasted with a long list of climate health consequences all at once can be hard to process. And in addition to being more cognitively manageable, a spaced repetition approach is better reflective of the broad, pervasive health consequences of climate change. However, to date, only a few medical schools have successfully integrated planetary health in their curricula.
To aid schools in understanding this curricular gap and addressing this urgent need for transformation in medical education, we have developed the Planetary Health Report Card (PHRC), a metric-based, student-led initiative to evaluate and inspire planetary health in medical schools. The report card evaluates medical schools on 51 expert-reviewed metrics in five categories—Curriculum, Research, Community Outreach and Advocacy, Support for Student-Led Initiatives, and Sustainability. Student-led and faculty-mentored teams apply the metrics annually, generating an institutional needs assessment and leveraging the results to catalyze institutional change. Originally founded by medical students at the University of California, San Francisco in 2019, the PHRC has grown quickly since its inception, with over 400 participating students and faculty mentors around the world. This year’s annual report, published on World Earth Day, includes over 70 medical schools from the US, UK, Ireland, Canada, Germany, Japan, and Malaysia.
Annual grades assist in identifying strengths and weaknesses across and within medical schools over time. Though it is unsurprising that most schools fare poorly in their initial evaluation (only one school, Emory University School of Medicine, managed to score an A), the results are not all bleak. Many schools already have an institute for interdisciplinary planetary health research, host conferences related to planetary health, and offer support for medical students interested in implementing planetary health initiatives at their schools. Programs to make lab spaces sustainable have been implemented, and many students report having access to environmentally friendly transport. However, there is much room for improvement, especially in regard to planetary health curricular integration and reducing campus environmental impact.
The PHRC provides a discrete entry point for students who want to engage with planetary health but are unsure where to begin. Within our international network, we facilitate dialogue among medical student climate health leaders and host dynamic events such as our institutional advocacy workshop and annual symposium, sharing ideas and success stories for effective change. Participating students have offered positive feedback; since enacting the PHRC at their schools, many report creating student interest groups, engaging in more constructive conversations with institutional decision-makers, forming new partnerships between community organizations and medical schools, and taking initial steps to integrate planetary health into their core curriculum. These changes are notable improvements, yet they are just the beginning. As we expand to other countries and health professional programs (pilots for pharmacy and nursing are underway), we hope the report card will continue to serve as a platform for urgently advancing curricular innovations that reflect the needs of trainees in a changing world.
Given the intertwined nature of climate and health and medicine’s moral imperative to “do no harm,” healthcare and its practitioners should be leading the way in decarbonization efforts. Yet, the US healthcare sector accounts for 8.5% of domestic US greenhouse gas emissions, a greater percentage than any other country. Educating trainees on sustainable clinical practices can ensure that future providers are guided by principles of sustainability and understand the optimal choices (for example, use of sevoflurane instead of desflurane, or dry powered inhalers instead of metered dose inhalers). But educating a new workforce takes time, something that is in short supply when it comes to addressing climate change. More immediately, medical education leadership can drastically cut emissions by reimagining the medical school, residency, and fellowship interview processes.
In-person interviews historically required applicants to take upwards of 10 roundtrip flights per application cycle, spending thousands of dollars and dumping thousands of pounds of CO2 into the atmosphere in the process. According to one Stanford-based study, average emissions from in-person residency interview travel exceeded one third of the average American’s annual emissions. Regardless of specialty, interview flight emissions exceeded the global average emissions limit necessary to keep warming below 1.5 degrees Celsius. Like most else across society, COVID-19 rocked these unsustainable business-as-usual practices to their core. However, though virtual interviews during the pandemic were born out of necessity, the conversion has proven to be a viable alternative to an inequitable and carbon-intensive application system. Permanently embracing a virtual interview system for medical training is low-hanging fruit for reducing healthcare-associated emissions and could catalyze similar transformations in other healthcare professions and sectors. In representing medical trainees, medical educators should protect their future, building on the momentum generated by the pandemic to create more sustainable and equitable interview structures. Visit interviewwithoutharm.com to learn more.
The world today is marked by uncertainty. Worn down by the acute problems of COVID-19 and political turmoil, the chronic threat of climate change can fall to the bottom of our “problem list.” But just as a patient’s social issues should not be eclipsed by seemingly more important medical ones, we must not put climate change on the back burner. Healthcare professionals are highly trusted by society, and by drawing connections between climate change and health, we can drive the social and policy change that we so desperately need. Mobilization begins with education; by prioritizing education for sustainable healthcare and in leading by example, we will prepare learners for patient care and systems transformation on a changing planet.