by Aditi Malhotra

On a gray, drizzly January afternoon, more than 80 students gathered inside room M106 at Stanford School of Medicine for a lecture on how the changing climate affects children’s health.

Stanford physician-scientist Kari Nadeau, who focuses on allergies and asthma, discussed young patients she’s treated whose symptoms may be linked to climate-related stresses. She talked about a 12-year-old whose depression, insulin resistance and asthma seemed to be getting worse as a result of air pollution and extreme heat. She challenged the student audience to come up with possible diagnoses, and asked, “What can we do to improve the health of this child?” 

Her lecture was not part of regular coursework. It was the third in a series of 10 lunchtime lectures organized by two Stanford medical students to address a gaping hole in their school’s curriculum: the health impacts of climate change.

This lunchtime series marks the first time Stanford School of Medicine has addressed climate change in its teaching, to show how it affects different fields of medicine — including pediatrics, women’s health, infectious diseases, and nutrition.

Anna Goshua, a second year medical student at Stanford, developed the series together with a classmate. It was born out of frustration with the lack of training on climate change and health at their school, despite the growing evidence that disasters fueled by climate change had increased hospitalizations and emergency department visits. 

Ten climate change-fueled disasters in 2012 across the U.S. –  including hurricanes, fires, disease outbreaks and heat waves – led to 917 premature deaths, over 20,000 hospitalizations, and close to 18,000 emergency department visits, according to a  September 2019 study.

“It’s dangerous, to say the least, for us to walk into our collective future unprepared,” said Goshua.

That danger couldn’t be more apparent as the world faces a disease pandemic that is both a symptom of climate destruction and exacerbated by it.

Little training

The climate crisis affects people’s health in myriad interconnected ways, starting from birth. Every child born today will have their health defined by climate change, according to the November 2019 report on health and climate change in the British medical journal Lancet, which examines the impact of climate change in health globally. By their 71st birthday, the report found, their physical and mental health will be burdened by other hazards such as food shortages, spread of diseases from insects, like Lyme disease, lack of safe drinking water, droughts, floods and wildfires. 

It is clear some of these hazards are already biting. Ten climate change-fueled disasters in 2012 across the U.S. ―  including hurricanes, fires, disease outbreaks and heat waves ― led to 917 premature deaths, over 20,000 hospitalizations, and close to 18,000 emergency department visits, according to a September 2019 study.

And now the coronavirus pandemic, responsible for thousands of deaths in the U.S. alone, has added a new dimension to the consequences of climate-warming pollution. Alongside anxiety, heart disease and stroke, the health impacts of air pollution include aggravated asthma and weakened lung function. That means there are far more people with pre-existing respiratory conditions which put them at greater risk of dying from COVID-19. 

But very few American medical schools appear to offer training on the health consequences of climate change. There is no reliable way to know exactly how many schools teach classes on climate change and health. But when the authors of a 2018 research article searched a database of 150 schools’ curricula for climate-related keywords, they returned zero results. 

There is a growing awareness, however, among some schools at least, that more needs to be done to prepare future doctors.

In 2017, Columbia’s Mailman School, home to the first program on climate and health at a public health school in the United States, launched the Global Consortium on Climate and Health Education, an international alliance of 200 medical, nursing and public health schools and programs, with the mission to train health professionals across the world to respond to the health impacts of climate change. 

The aim is to collectively build resources ― such as slides, videos and online courses ―- for educational programs on climate and health in medical and healthcare institutions. Today, 134 schools and programs in America are members of the consortium.

Yale School of Public Health and the College of Medicine at the University of Illinois at Urbana-Champaign are among those offering programs and coursework at the intersection of climate change, medicine and public health. 

At the school of medicine at UCSF, individual departments — including infectious diseases and obstetrics-gynecology — have woven climate-health issues into lectures. Professors are holding discussions on topics such as cardiovascular health and changing air quality; mental health disorders related to extreme weather; and reproductive health and the environment. 

Arianne Teherani, professor of medicine and educational researcher at UCSF, created a curriculum plan in “sustainable healthcare education” in 2016, to teach students in medicine, pharmacy, nursing and dentistry at UCSF not only about environmental changes and their impact on health, but also the impact of the healthcare industry on the climate.

“We have to move fast to accept and apply the basic evidence that this topic impacts every single organ system, it impacts every single clinical rotation that students do,” said Teherani. “There has to be a way to latch it into what they’re already learning.”

In 2019, the American Medical Association, the largest association of physicians and medical students in the U.S., adopted a new policy to educate medical students, as well as doctors, on the health impacts of climate change.

Fighting for more instruction

Still, the response remains piecemeal and small, and for many students, the pace of change is far too slow. In this absence of action, some student-doctors are organizing to fight for the inclusion of climate change in their studies. 

Over the last year, more than 100 students from 34 medical schools and programs across the U.S. have come together to form a volunteer grassroots coalition called Medical Students for a Sustainable Future. 

Its mission, said Harleen Marwah, a medical student at George Washington University who is leading the coalition, is to provide support to participating students so they can coordinate efforts to push for climate change teaching.  

“We are the ‘Class of Climate Change’ that is going to be graduating into a health environment that already looks drastically different from what it did in the past,” said Marwah. “Thinking ahead, planning for the future, how critical climate change is to that future— these are things that are top of mind for a lot of medical students.”

At UCSF, students including Colin Baylen, Karly Hampshire and Nuzhat Islam have formed an interdisciplinary student group called Human Health + Climate Change. The group organizes panels, bringing together faculty experts on topics such as the climate-health emergency caused by wildfires; the links between climate change, migration and health; and the impact of the climate crisis on under-resourced communities. 

The students also created a Planetary Health Report Card, to analyze medical schools’ coursework and resources for climate-health training and award a grade to schools and programs based on their strengths and weaknesses. They gave UCSF a ‘B’ grade ― the school won points for its planetary health electives and a climate-based fellowship, but did not score well on community engagement. Students at another 15 medical schools in different parts of the country are now looking to follow UCSF’s lead and produce their own report cards.

One reality of research on climate change and its health impacts is that it is still quite young, said UCSF’s Teherani. Changes in the curriculum must also account for the developing science, the uncertainty of climate change and sea level rise in the future and acknowledge that scientific predictions cannot be exactly precise and will instead present a likely range of possible futures, said Teherani.

“It is okay, for example, for physicians to understand here is what we know and here is what we don’t know. It is okay for us to identify gaps in knowledge on this subject area, address that with patients, and also be asking ourselves how do we reconcile with that uncertainty on a personal level.” Arianne Teherani, professor of medicine and educational researcher at UCSF

“It is okay, for example, for physicians to understand here is what we know and here is what we don’t know,” she said. “It is okay for us to identify gaps in knowledge on this subject area, address that with patients, and also be asking ourselves how do we reconcile with that uncertainty on a personal level.”

Although progress is being made to standardize and formalize climate-health education, “I don’t see anything happening at the pace and scale we need,” said Caroline Wellbery, a professor in the school of medicine at Georgetown University in Washington DC, who studies climate change and health in medical education.

Centuries-old structures in American medical education are tough to tinker with, she added. “Traditions and longstanding education formats exert influence and by and large, institutions themselves are resistant, not impervious, to change,” she said. This is especially the case with climate change, where the impacts are “sweeping, multifactorial and long-range,” she added, which can make it difficult to get the case heard for the day-to-day relevance of climate change on patients. 

“While most medical providers see climate change as a major problem, we don’t necessarily see it as a problem for how we do our jobs,” said Aaron Bernstein, co-head of Climate MD, an initiative at the Harvard T.H. Chan School of Public Health to teach doctors and medical students how to talk to patients about climate and health. “It absolutely matters what we do on a day-to-day basis. And that knowledge has not been put out effectively to folks who are in medical education.”

But when it comes to understanding the health consequences of climate change, people are most likely to trust their primary care physicians, making it crucial for physicians themselves to be equipped with tools and knowledge they need to maintain that trust.

“We’re trying to bring climate change to the bedside so that clinicians see it as a part of their day job,” said Bernstein.

That continues to motivate Goshua to pursue the Stanford lecture series until her school catches up. Goshua and her classmate are currently administering a survey among attendees to determine how effective the course has been in changing student knowledge, attitudes and skills relating to climate change and its health risks. 

The pair hopes that the data they will collect will both improve the course and inform school administrators and faculty on the need and value of climate change education.

“The bottom line is we can’t ignore our climate reality and we need to adapt as quickly as possible,” Goshua said.