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“I feel paralyzed by the inevitability of climate change… and what it means for health.”

Anyone involved in teaching, and especially teaching medical students, has had moments where the students teach them something important. I got the comment above after a brief chat about environmental medicine during an off-the-cuff campfire discussion while on a wilderness medicine outing. That was around 2012, and since then, I’ve been involved in teaching about Climate Change and Human Health – including recently at the WMS medical student elective in Roanoke, VA. I start off many of my talks with an open discussion, and the anxiety students feel about climate change and how it might affect their community and (future) patients is palpable.

The experience with climate science varies greatly in a typical medical student class – some students remark they are “just here to listen”, while others have spent a few summers studying sea floor samples at Woods Hole Oceanographic Institute. So, as with many scientific discussions, we start with defining the state of the science, its limits, and identifying where it might overlap (or deviate) from popular media and political discourse. 

One of my favorite slides to help in this discussion is from The Global Carbon Project and is updated annually. It aggregates scientific knowledge about carbon emissions and carbon sinks in dozens of areas. True to science, the graphic includes gaps in scientific understanding – represented as a “budget imbalance.” Assume the graphic you are referring to here is the one below? Can you please provide link to area in website where graphic appears? And though infographics are rarely the most popular after-dinner entertainment (I often give this talk during or after a meal), this one seems to generate some attention and questions. Students reflect on both the breadth and complexity of our understanding of carbon in the environment, and to be frank, how ridiculously little remains unknown, or, at least, unmeasurable.

Next, we have to link these graphs to observed climate events. The difficult-to-understand difference between “weather” (specific events) and “climate” (a recorded average and changes, over time) is key to understanding: for example, how a single storm or hurricane can’t be directly linked climate change, but a trend in the number and severity of hurricanes over years can. The Union of Concerned Scientists compiled the below summary of the relationship between extreme weather events and climate change. The impressive bibliography and summary of sources for the chart is also available on that website.

After this scientific background on climate change, the students and I delve into the health effects that are being observed. One student – as if paraphrasing the WMS’ tagline “combining your profession with your passion,” called this topic “tying our hobbies to our career.”

The Medical Society Consortium on Climate and Health, as well as The Lancet and American College of Physicians, have expansive resources, review articles, and compendiums of primary research which publish and compile research related to the health effects of climate change, which include: 

• Extreme temperatures

• Wildfires

• Mosquito- and tick-borne infections

• Water-related infections

• Food-related infection and agriculture

• Mental Health and Well-being

• Outdoor Air quality

Even at such an early point in their career, medical students often have personal experience with environmental events and the intersection with health. A few years ago, many had been present for Hurricane Sandy, and the devastating effect it had on the New York City health care system and hospitals. More recently, an Australian student recounted managing patients coming from fire-ravaged areas of New South Wales, many in respiratory distress, while others experienced panic from the emotional trauma of surviving.

Lastly, we get to ruminate on these topics, and discuss ways to address the health effects.

I usually challenge students to start “in their own house.” There’s always interest in learning about some ways to control carbon in your own life (spoiler alert: the choice of what car you buy and how you commute has the biggest impact), but unfortunately the net impact of those changes, even in a large group, is small. But if we take our “house” to be “health care” – well, it bears mention that the health care industry has annual energy costs of $9 billion, and health care is the second-most wasteful industry behind food waste. We discuss the Boston Green Ribbon Commission Health Care Working Group – a group of 22 hospitals working together to decrease greenhouse gases through managing energy use (green buildings), chilled water, steam, natural gas, and purchasing “clean energy.” Their goals for 2020 and 2030 are aggressive, but an interim report found that during 2011-2015, they had already achieved a net greenhouse gas decrease of 6%, and realized cost savings of $15 million – enough to cover Massachusetts Medicare for 1,357 enrollees!

We also talk about mitigating the health effects of climate change by preparing front-line services for events like severe weather and flooding, and changes in the range of vectors such as mosquitoes and the infectious diseases they transmit, also brought about by climate change.

And lastly, we discuss the importance of physician-as-teacher. As anyone practicing wilderness medicine knows, managing health in austere environments, and in the weekend warrior, so often comes back to being educated about and prepared for what might happen. So, we discuss opportunities to meet with concerned lay audiences, or even seek out more with the Medical Society Consortium on Climate Health or Health Care Without Harm (which worked with the Boston group). And, as always, how to be ready and willing to engage a patient on these topics, at the bedside or the trailside. A great resource to consider is the American College of Physicians “Patient FACTS: Climate Change and Your Health” handout. 

The WMS Medical Student Elective is an important opportunity for the WMS to directly engage students, not only in the study of wilderness medicine, but also to emphasize teamwork and improvisation in healthcare, and to appreciate the overlap of wilderness and wellness. Not every student will practice in austere environments, but these themes are universal to the physician experience. Specifically, including topics like “Climate Change and Human Health” offers perspective to the interplay of environment and our health, and ways to preserve that relationship. Every year, it’s one of those topics that earns the comment “we never learned about this in medical school”. And though this year we will miss this particular opportunity (the 2021 WMS Elective was cancelled due to COVID-19), the message to those students is as relevant as ever: climate change can be understood, its health effects mitigated, and physicians are in an ideal position to be leaders in the challenge to preserve our environment and our good health. 

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