Student Opinion: Planetary Health is The Biggest Missing Piece from Medical Education Today
Riya Bhatia | riyabh@stanford.edu
2024 Planetary Health Campus Ambassador
Last June, I woke up to a thick gray haze. As I walked to a babysitting job, the smell of smoke — with a hint of burning plastic — filled my nostrils. Upon arriving, I was told not to let the kids play outside because the “wildfires” were making it hard for them to breathe. What wildfires? I silently wondered — we were in Illinois (a state which has yet to experience a local wildfire), after all. A quick internet search revealed that smoke from Canadian wildfires had traveled across three states. Climate change is increasing the prevalence of hot, dry weather; this in combination with changing land use patterns has led to larger, stronger wildfires which have severe ramifications on human health. Did you know for example, that PM2.5 pollution from wildfires specifically, is ten times more harmful to children’s respiratory health than other air pollutants and even than PM2.5 from other sources? The parents were right to be concerned.
The Impact of Climate Change On Our Health:
According to medical experts, climate change will be the most significant determinant of health for a child born today. From extreme heat to high levels of air pollution, children are most vulnerable to the inescapable impacts of climate change. Heat waves are not only linked to increased mortality rates in children under one, but they also increase suitability for disease transmission. In fact, 9 of the 10 most suitable years for dengue transmission globally — which is heavily impacted by climate (temperature, rainfall, humidity) — have occurred since 2000. In Asia and Latin America, dengue is a leading cause of death among children. While children are much more vulnerable, they are not the only ones affected by climate change. Globally, 8.34 million people die every year due to air pollution. Moreover, the World Health Organization estimates that between 2030 and 2050, over 250,000 additional deaths will occur per year from consequences of climate change, including undernutrition, heat stress, and malaria. That’s grim but what’s worse is that because these are not the only health impacts of climate change — increased respiratory disease, increased toxin exposure, elevated transmission of other infectious diseases are just a few other examples — this number is likely going to be much higher.
The Impact On Health Care Systems:
These climate-change-driven medical issues are impacting healthcare systems in many ways, including:
- Overcrowded Emergency Rooms: Studies have found links between high ambient air pollution and increased rates of emergency room visits for conditions including myocardial infarctions, chronic obstructive pulmonary disease, asthma, and heart failure. Also, since 2008, heat-related emergency room visits have increased by 3.55% per year. Overcrowding in EDs increases mortality rates because doctors are less able to provide critical care in an efficient manner.
- Disruptions To Care: Climate disasters like floods have seen an 83% increase in the last 20 years. Due to these extreme weather events, more and more healthcare facilities are dealing with issues like infrastructure damage, supply chain delays, disruptions to transportation, and fickle water resources. This makes it difficult for providers to give care and for patients to get care (they may have to travel farther to an undamaged facility or deal with road closures). Moreover, these disasters have interrupted supply chains, leading to shortages of medication and other critical medical materials.
In other words, healthcare facilities are and will increasingly struggle to provide care for their communities.
So why do only half of United States medical schools require students to learn about the health effects of climate change? And why, when the World Health Organization has called climate change the largest threat to human health, do just 16% of teaching hospitals have clear plans to prepare for the impact of climate change on their mission and communities?
The answers are complex. One study suggests that schools prioritize more detailed traditional biomedical knowledge over topics such as the intersection between climate change and health. That’s not to say that we should stop teaching doctors foundational biomedical content, we just need to find a way to add Planetary Health to their education. But some might argue that medical students already have so much to learn, and it’s hard to add even more to their never ending list of things to memorize. However, incorporating climate change into medical curricula wouldn’t just be about memorizing names of pollutants or even solely about understanding biological impacts of pollutants. Learning about the changing climate’s impact on health fosters critical thinking, discussions of ethics, sustainability initiatives, participation in public health, adaptability, and community engagement — all vital skills with wide-reaching applications for physicians. Furthermore, because climate change isn’t impacting everyone equally — in the US, the biggest predictor of whether you live near toxic or contaminated waste, water, or soil is your race — this education would likely also emphasize critical health equity topics including majority culture bias, demographic factors’ impacts on health outcomes, and culturally competent care.
So what can I do if I’m a medical student or educator looking to incorporate Planetary Health into my education?
Whether you are a student, educator, or administrator, start by evaluating the unique current situation at your institution. Use tools like the Planetary Health Report Card to identify where your school stands. The Planetary Health Report Card’s assessment asks questions like “Does your medical school curriculum address the relationship between extreme heat, health risks, and climate change?” and “Does your medical school curriculum introduce strategies to have conversations with patients about the health effects of climate change?” Students and educators answer with a number from 0 to 3 (0 being no and 3 being yes, with case specific answers correlating to 1 and 2 ). This tool helps clarify what needs to be added to the curriculum and what is already covered.
What happens after this initial assessment will vary depending on your role.
If you are a medical educator or medical school administrator, here are three different methods of incorporating climate change into medical education:
- Create elective courses on sustainability and climate health. However, it’s imperative that ALL physicians be taught about the environment’s impact on our health. So, if you choose this route, these courses must be mandatory.
- Another model for climate health education involves weaving climate health content into existing coursework. This is an efficient way to ensure that every graduate is prepared to provide appropriate care in the face of climate change.
- Finally, there are free “mini curriculums” available online that provide specific specialties with climate health education that is most relevant to their subsection of medicine.
If you are a student, here are some ideas for bringing Planetary Health into your education:
- Get online! There are plenty of online resources from podcasts (like this one by Lancet) to journals (Lancet also has a journal) to websites(check out the Planetary Health Alliance’s website) filled with information. There are even case studies (available here), which can help you connect clinical skills to Planetary Health cases.
- Start a club or group! Learning about climate change’s health implications can be scary and it helps to have other people. Plus, creating a group will help expose your peers to the field of Planetary Health.
- Encourage leaders at your institution to incorporate climate change into your curriculum. This might involve identifying natural places in your specific curriculum where Planetary Health could be addressed or encouraging your school to arrange for guest speakers to teach about the topic or pushing for your school to understand the importance of Planetary Health or connecting with faculty who may be interested/able to help.
The Takeaway:
Climate change is threatening our health, burdening our healthcare system, and disrupting providers’ ability to give care. Medical educators must prioritize integrating Planetary Health into curricula today so that tomorrow’s doctors are prepared to provide care on a changing planet.
Author: Riya Bhatia
Riya Bhatia is a 2024 Planetary Health Campus Ambassador and a first-year student at Stanford University. She is a passionate environmentalist, deeply interested in the intersection between climate change, health, and humanity. Previously, Riya has researched the health impacts of high tropospheric ozone levels and written a policy brief suggesting governmental initiatives to reduce ground-level ozone. Currently, she is working to deepen her understanding of the link between a person’s environment and health outcomes with a focus on justice. In addition to her academic interests, Riya enjoys swimming, hiking, baking, and reading.
