Preparing Medical Students for a Warmer World

The World Health Organization has called climate change "the greatest threat to global health in the 21^st century." Similarly, the United Nations' ninth Secretary-General, Antonio Guterres, refers to climate change as "the most systemic threat to humankind." The scientific evidence for warming of the climate system is "unequivocal" according to the Intergovernmental Panel on Climate Change (IPCC), a scientific and intergovernmental body under the auspices of the United Nations.

As medical students and future medical professionals, my peers and I feel a profound responsibility to keep our future patients safe and healthy -- and the links between climate change and health present a compelling argument for including climate change in medical curriculum to prepare doctors for a changing ecological landscape of disease.

As the medical community becomes more open to the idea of including climate change in the medical curriculum, it's critical that educational institutions figure out strategies to effectively teach climate and health concepts in an already crowded course load.

At the Icahn School of Medicine at Mount Sinai, Dr. Perry Sheffield and I are working to seamlessly integrate climate and health concepts into existing medical courses through our Climate Change Curriculum Infusion Project (CCCIP). By weaving the material into existing course lectures, rather than having a standalone "climate change module," we can better highlight the interconnectedness of climate and health concepts with current medical school competencies while also contributing towards the sustainability of the project moving forward.

The ecological disruption induced by climate change has already had an observable impact on human health. More episodes of extreme heat, increased frequency of natural disasters, and changing patterns of infectious disease are only some of the known interactions between climate change and human health. More broadly, climate change has been referred to as a "threat multiplier."

Powerful new reports released this fall have deepened our understanding of the threats to health and survival from climate change, and the short time available to us to mount an adequate response.

The drumbeat began in October with the U.N.-based International Panel on Climate Change's special report, Global Warming of 1.5deg C. It warned that a 2deg C rise above preindustrial temperatures - as envisioned under the Paris Accords - would subject the world to dangerous levels of harm and should be abandoned as a target; rather, we need to keep temperature increases to 1.5deg C. The report stressed that doing so would require urgent, sweeping, society-wide action in all countries, while projecting a window of only 12 years during which to get carbon emissions to zero.

Weeks later, the congressionally mandated U.S. Global Change Research Program released its Fourth National Climate Assessment, detailing the impacts of climate change in each region of the United States. It cited "growing challenges to human health and quality of life, the economy, and the natural systems that support us" and projected economic losses in the billions of dollars, should climate change not be brought under control.

It was followed by the health journal Lancet's Countdown: Tracking Progress on Health and Climate Change 2018, which provided a global report and a U.S. focused brief, both emphasizing extreme heat and its impact on labor productivity and the spread of disease.

In light of these new reports the need for the Climate Change Curriculum Infusion Project is more relevant and pressing than ever with its goal of supplementing existing medical school lectures with relevant climate and health content from up to date medical and public health literature.

On average, this means adding no more than two or three slides to specific lectures exploring topics relevant to the health impacts of climate change.

For example, in the Medical Microbiology course taken by first year students, an already existing lecture on Lyme disease and other vector-borne microbial diseases inspired the creation of lecture slides detailing how changing climatic conditions are favoring habitat expansion of the Lyme-carrying tick Ixodes scapularis.

This content was substantiated by data and research provided by the Center for Disease Control, a resource we frequently used when developing our Microbiology slides. Though not directly related to the impacts of climate change itself, our course content has also served to highlight the detrimental health effects of fossil fuel combustion, one of the leading causes of climate change. This included, for example, adding slides to our Neurology course detailing emerging research on the link between exposure to nanosized particulate matter commonly released from car exhaust and neurodegenerative diseases like Alzheimer's.

After positive feedback from both students and faculty, the CCCIP has now expanded to several pre-clinical medical courses including Medical Microbiology, Brain & Behavior, Pulmonary Pathophysiology, and Immunology. Climate change content was even added to the Art & Science of Medicine (ASM) course as part of a broader conversation on the social determinants of health. This ASM content specifically introduced students to the importance of asking vulnerable patients, especially those reliant on life-support equipment, whether they have adequate support during extreme weather events like heat waves, which are becoming more frequent and kill more Americans on average than any other form of severe weather.

As part of this discussion, students were educated on the various resources New York City offers to protect residents from the health impacts of climate change, including cooling centers around the city, flood vulnerability maps, and special accommodations provided by electrical utilities to patients with life-support equipment.

Despite existential warnings and boisterous calls for action from world leaders across varying disciplines, the medical community has only recently begun to highlight the interrelations between climate and health. In 2015, the United Nations' Paris Agreement inspired the Health Educator's Climate Commitment--a pledge signed by 118 health professional schools across fifteen countries to prepare the next generation of health professionals to effectively address the health impacts of climate change. A recent query, however, of the Association of American Medical Colleges' (AAMC) Curriculum Inventory, a database aggregating institution-reported curricular activity, indicated that schools are not currently reporting any explicit inclusion of climate change education.

Our Climate Change Curriculum Infusion project is being refined and further developed, with our overall goal being to strengthen medical curricula to equip the next generation of physicians with the knowledge necessary to navigate a warming world and advocate for sustainable solutions to complex problems. Now more than ever, in this anti-regulatory and polluter-friendly political environment, the medical community must come to grasps with the imminent health threat posed by the uncontrolled release of greenhouse gases. And we need to make sure today's medical students are ready for this challenge as future doctors.

Our patients, and the planet, depend on it.