Translating Global Research into Clinical Action
By: Taylor Lord
I spent my first morning interning at Planetary Health Alliance sifting through articles and websites and becoming acquainted with the field of planetary health. As I sat at my desk, reading about the partners that make up the alliance — the network of organizations with creative programs, educational initiatives, and research in environmental and human health — I was simultaneously struck with feelings of inspiring optimism and overwhelming helplessness. This oppositional force and tension is something I have become acquainted with during my two years of college. The more I learn about the solutions created to confront the health and environmental challenges threatening our world, the more I want to lean in and join the movement. At the same time, the more aware I become of the magnitude and complexity of the problems we face, the more I feel a tendency towards drawing back and staying put. These problems are born within entrenched systems, and thus the necessary solutions must operate on a large and complex scale; but large and complex is intimidating. To me it feels as if the systems in which we live are a steady tide, relentlessly beating against the hard work and efforts of individual organizations and people. What difference can I, or other individuals, make when it seems like our society promotes behaviors and structures that impede change? I appreciate that this is a very pessimistic way to start a blog post, but I promise this is not a litany of my existential crisis; there is a point, so keep reading.
I know I am not alone with these thoughts. In fact, my Global Health professor last semester told a story illustrating how this feeling of helplessness overwhelms everybody at some point. When he visits hospitals to give lectures to medical professionals about structural and cultural competency, many medical providers are more receptive to the concept of cultural competency than to that of structural competency. While cultural competency is the ability of providers to understand and effectively deliver health care according to the different cultural needs of their patients, structural competency is the ability to navigate and deliver healthcare to meet the different needs of patients due to health inequalities at the neighborhood, societal and policy level. Resistance to the structural, he notes, comes from a feeling of powerlessness in the face of the societal and political violence — entrenched racism, poverty, environmental degradation — that affect health. What can doctors do when faced with a victim of structural violence when they work within a health system that is inherently tied to a larger, flawed structure? Of course this question is dangerous when posed as a hypothetical; it has undertones of a throw-your-hands-in-the-air-and-give-up kind of question. When a feeling of powerlessness becomes paralyzing, the status quo prevails.
So when a similar question popped into my head during my research on planetary health, I decided to turn it on its head, from a hypothetical one to a practical and purposeful one. What can individual clinicians do to translate the global research and action driven by public health and environmental initiatives into everyday medical practices, and can those local practices in turn affect desired changes to the larger system?
Selfishly, I look for the answer to this question as guidance for myself, as the doctor I hope to be someday. I both did my own research and posed the question to health professionals. Below is a compilation of my findings as well as the insights from those conversations.
As pediatrician Dr. Pearl Riney of West Cambridge Pediatric and Adolescent Medicine said, “Physicians carry a lot of weight and it’s an important voice.” Dr. Riney elaborated on the importance of physicians taking legislative and lobbying roles within their communities and the wider government. “When policies are being made, their voice is important.” And effective. Dr. Mona Hanna-Attisha from Hurley Medical Center in Michigan is a widely known, illustrative example of a doctor initiating environmental change. In 2015, after researching the Flint, Michigan water crisis, Dr. Hanna-Attisha became the lead voice in advocating for Flint’s residents, especially children affected by lead poisoning, fighting for access to clean water. Similarly, I was happy to see that this past February, The Medical Society Consortium on Climate and Health, which represents 550,000 physicians coordinating to inform the public on issues of climate change and human health, testified at the EPA Listening Session Hearing in Kansas City. The event is representative of a high-level way of physicians creating connections, posing preventions and using their voice. I hope that this consortium, along with others, provides a streamlined opportunity for local health issues to be vocalized and then funneled into legislative, systematic change in environmental policy.
The Environmental Nutrition Approach:
During one of my Googling sessions, I came across Health Care Without Harm, an international organization committed to transforming health care worldwide to reduce the health sector’s environmental footprint and become a leader in environmental health and justice. One of their program initiatives entitled Health Professional Engagement: environmental nutrition approach particularly caught my eye. It provides substantive educational resources and action plans for individual health providers to incorporate healthy food system education into their treatment plans for patients, as well as ways for them to assume advocacy and policy roles. In response to my overarching question, not only does the environmental nutrition approach provide individual physicians with concrete steps to incorporate environmental initiatives into their practice; it represents a coordination of everyday actions uniting to confront the larger nutritionally — and environmentally — unhealthy food system. It shows how individual actions can prompt changes to the larger system.
Making the Abstract, Personal:
When it comes to translating environmental research into everyday actions and change, the abstract problems that are exposed by the planetary health field must be transformed into the personal, pressing issues that mobilize action. This was a recurring theme in my conversation with Dr. Amy Porter, a third-year resident at Cleveland Clinic Children’s Hospital. Dr. Porter spent time in South Africa working with HIV and TB-infected labor migrants. During her time, she learned about the community service year required of all physicians in South Africa. Each clinician, before starting his or her practice, must live in a rural or urban underserved community and care for patients in that area. As Dr. Porter described, “as a result you end up getting a much clearer sense of access to clean water, what is causing pollution, what is being done in terms of trash burning vs. piling etc. All of these things become more accurately visible. In the cities it is easier to be less aware of what is going on…the community services year forces you to be more in touch with the environmental issues.” The personal experience of a community service year brings a new perspective on the environmental connections to health and thus sheds light on the everyday role of providers in mediating environmental issues. The lived experience of a community service year gives doctors an anthropological lens through which to observe firsthand the lives of patients from different areas, and pushes them to ask their patients questions that provide concrete data and local outlooks. As Dr. Porter elaborated, “I think that taking the time to deeply understand what patients are going through makes you have more perspective on the environmental issues the community is facing.” Comparably, I was glad to know that in the United States, 30 states now offer loan forgiveness programs to encourage physicians to practice in rural and underserved areas.
I am grateful for the opportunity to write this blog post; it has pushed me to grow my understanding of what is being done and can be done by the medical field each day to work towards a healthier planet on a large scale.
I would like to thank Dr. Pearl Riney, of West Cambridge Pediatric and Adolescent Medicine and Dr. Amy Porter of Cleveland Clinic Children’s Hospital for taking the time to talk with me and share their insights.
Fields, Leslie. “Doctors Speak at EPA Hearing · The Medical Society Consortium on Climate and Health (MSCCH).”
“Flint Water Crisis Fast Facts.” CNN. Cable News Network, 9 Apr. 2018, https://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html
“Health Professional Engagement | Health Care Without Harm.” Health Care Without Harm, 2018, https://noharm-uscanada.org/content/us-canada/health-professional-engagement
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the Planetary Health Alliance or its members.