It’s time for medical schools to teach the health effects of climate change.
When Monica’s daughter was in the pediatric ICU, Monica was terrified. After six hospital admissions in 2018 for asthma, the young girl had gotten every test, procedure, and medication that the specialists at the local children’s hospital could offer. When asked why her daughter had so many severe attacks, Monica had a clear answer: “She can’t go outside in the heat.”
High heat diminishes outdoor air quality. The combination of high temperatures and ultraviolet radiation transforms compounds in car exhaust into ozone, a chemical essential to blocking the sun’s radiation when high up in our atmosphere, but a potent lung irritant when closer to the ground. Ozone exposure has been linked to increased long-term risk of death from pulmonary disease; people like Monica’s daughter who have pre-existing lung conditions are most susceptible. In urban environments with both higher temperatures and more traffic, like Monica’s home of South Providence, low-lying ozone production is inevitable on a hot summer day. It’s no wonder the girl so frequently struggles to breathe.
And she is not alone. The World Health Organization estimates that 88 percent of the global health burden of climate change falls on children under 5 years old. However, climate change and hot days are not just pediatric and pulmonary problems: heat waves harm maternal health and fetal development, cause more deaths than any other natural disaster, and can even interact with psychiatric medications.
Despite the known association between heat and increased ozone, the medical team never told Monica and her daughter that high temperatures could trigger asthma attacks. Not one physician ever advised her to keep her daughter inside on hot days. They certainly never said that over time, there may be more of these toxic hot days due to climate change.
This might be because their doctors did not know enough about the effects of climate change on asthma. In a 2015 survey of American Thoracic Society members, only 38 percent of the 915 respondents reported that they felt moderately or very knowledgeable about the health effects of climate change. In our 2019 survey of first-year medical students at the Warren Alpert Medical School, only 10 percent of respondents felt confident discussing the topic.
Although projections show that climate change will continue to cause more frequent and more extreme hot days worldwide, few medical schools are educating the next generation of physicians in how this will impact the health of their patients. In fact, it was not until June 2019 that the AMA released a statement stressing the importance of climate change education—but offered no guidelines for implementation.
A Climate-Aware Curriculum
Climate change will be the single largest risk factor for new disease patterns in the coming century. It not only will increase the frequency and severity of hot days, but also change the habitats for ticks and mosquitoes, which are vectors for diseases like Lyme and Zika. Rising sea levels and severe weather events will restrict where people can live and the availability of food and water, leading to geopolitical and health consequences associated with new population distributions.
These effects are most severe among already vulnerable populations, and extend beyond just health outcomes. On top of coordinating medications, emergency department visits, and transportation, Monica has to pay extra for air conditioning throughout the summer so her daughter can breathe in the hotter temperatures—another cost on an already financially strained household.
Physicians will be the first line witnessing these health effects, and medical schools have a social responsibility to ensure that future physicians are educated about climate change. We need to know how to work with patients and health systems toward solutions that reduce the effects of climate change. We need to lead advocacy efforts for local and national legislation that mitigates further environmental damage and builds resilience in the underserved communities most affected by these deleterious consequences.
The Washington Post reported last summer that Rhode Island is the first state whose average annual temperature has risen more than 2 degrees Celsius over the past 100 years. As Brown medical students and Rhode Island citizens, we are responding to the urgent need for climate change education by integrating it into the curriculum at the Medical School. We successfully campaigned for an introductory lecture on climate change and health for first-year students during the Health Systems Science course. We created an elective on climate change and health that debuted last August and will continue to be offered in fall semesters.
Together with undergraduates, medical students, and even attending physicians, we delve into climate change education by inviting guest speakers to foster critical discussions on topics like reproductive, respiratory, and mental health in the era of climate change, and sustainability within the health care system. Finally, to disseminate this information to the medical community at Brown and beyond, we are developing a podcast series that covers topics such as asthma, direct heat-related morbidity and mortality, changing infectious disease patterns, natural disasters and pregnancy, and migration due to climate change and climate disasters.
Ultimately, we aim to provide a broad framework for thinking about climate change as a risk amplifier for a multitude of pathological processes. We hope to empower students to think critically about the domestic and global populations that will be most affected and to carry this knowledge into their careers as trainees and attending physicians. More medical schools are joining this cause by the day. Together, we can ensure that the next generation of physicians has the education necessary to advocate in partnership with families like Monica’s.
