The Future of Climate Change: The HEART Initiative

Imagine yourself as a family physician seeing a 68-year-old woman with type 2 diabetes, chronic obstructive pulmonary disease, hypertension, and chronic knee pain. While these medical concerns are well-managed, things for your patient are tough socially. She has become increasingly isolated since her husband passed. Her apartment is in an older building with good heating but no air-conditioning and near to no sidewalks, green spaces, or public transit routes in the area. She often requires friends or a cab to drive her around.

How can you assess and mitigate the acute and chronic environment-related health risks faced by this woman, and other patients like her?

Now imagine you are a public health consultant for a remote First Nation community. Industrial standing ponds have caused an uptick in mosquito populations and there have been behavioural changes of traditional game food sources. Heavy spring melt caused flooding last year, making the highway impassable and requiring food and supplies to be airlifted in. The community is concerned about the infringement of land rights for pipeline projects and associated environmental risks. Social isolation and economic stagnation have contributed to rising mental health concerns.

What recommendations can you make to the regional health authority to minimise environment-related health risks to this community?

While both are difficult to answer, they point to the future of healthcare: one centered on climate change and its integration in public health. This has been recognised globally by many health institutions, including the World Health Organization (WHO), The Lancet and its Commission on Planetary Health, and the Global Climate and Health Alliance. A decade ago, on World Health Day 2008, the WHO Director-General Margaret Chan stated that “climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health.”

In Canada, the Lancet 2017 Countdown Report for Canada described multiple urgent climate-related health impacts from food insecurity in the Arctic, to increased heat-related illness and respiratory disease, to stress and displacement from natural disasters such as floods and wildfires. The Canadian Medical Association (CMA) released a policy on Climate Change and Human Health in 2010, and the CMA passed more than 20 related motions since (

Not quite convinced? Watch this short video by Climate Guides or this TED talk by Dr. Courtney Howard.

The link between environment and health begets the question, in what domains should the emerging physician be competent? Distilling the key skills to practice in a climate-changing world will be subject to debate. Nonetheless, medical students can start with fulfilling these roles:

  1. Have knowledge of the health impacts and risks of climate change, including extreme weather events, changing infectious disease burdens, water and air pollution and threatened food security
  2. Be able to identify acutely-impacted groups, including children, the elderly, those with medical comorbidities, people living in poverty, migrants and displaced persons, or remote and rural communities
  3. Understand the disproportionate impact of environmental damage on Indigenous health and the need to prioritize Indigenous knowledge and leadership in policy decisions
  4. Recognize one’s own responsibility, working at the frontlines of patient care, to communicate environmental health risks to individuals and the community
  5. Advocate in collaboration with other stakeholders for local, provincial or federal policies that benefit health by improving environmental outcomes, or that promote sustainable development while reducing the burden of illness (e.g. active transport, plant-rich diets)

Given these challenging tasks, the medical student should not be obligated to seek out these learning experiences on their own accord without guidance.  There is a clear role for medical education to build capacity; “integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world.” (Maxwell & Blashki, 2016)

Students across Canada are responding to this gap in medical education. The Canadian Federation of Medical Students’ (CFMS) Health and Environment Adaptive Response Task force (HEART) was created in 2016 to provide national leadership, communication, and advocacy among Canadian medical students on current issues in climate change and environmental health. The HEART team has developed a set of curricular competencies on planetary health, created educational materials, advocated for curricular integration and completed a preliminary evaluation survey of national curricula.

Their goal is that every medical school integrates some aspect of climate change, environment and health competencies into their curricula by 2020. This is necessary. Major leaders in medicine, from the WHO to the CMA, recognise the crucial health challenges posed by global climate and environmental changes. Medical students, from the IFMSA to the CFMS, are increasingly concerned and keen to raise awareness among their peers and communities. What will you do as part of this movement?

This article was written by Finola Hackett, University of Alberta Class of 2019, HEART Chair (2017-18 and 2018-19) and Tiffany Got, University of Toronto Class of 2021, HEART Committee (2018-19). Edits were contributed by HEART 2017-18 members:  Julia Sawatzky, University of Alberta MD Class of 2021, Itai Malkin, University of Ottawa MD Class of 2019.


6 thoughts on “The Future of Climate Change: The HEART Initiative

  1. While both are difficult to answer, they point to the future of healthcare: one centered on climate change and its integration in public health.

    Dear Hearts,

    Obviously, actually managing the climate is beyond the scope of medicine.

    As a citizen, of course, each person will engage with debate and policy formulation to the extent, and from the direction, with which he or she feels comfortable. Democracy will speak. That is our collective responsibility.

    But the issue is also largely irrelevant from a practical medical point of view. There are all sorts of climates in the world. Dry, hot, cold, wet, infested with this or that, virus, bacteria or insect. It is a simple truism that doctors must be aware of the factors which are specific to their regions and the populations who live there.

    From the practical point of view, therefore, it does not matter why one region possesses such and such characteristics, the doctor simply has to function optimally in the given circumstances. It is his or her job to train themselves to do so.

    Naturally, there will be public discussions on possible improvements, etc. and doctors may be legitimately called upon to offer expert testimony on projected outcomes. But every time we witness, a doctor leaving medicine for politics, there is a special social loss which can not be compensated

    The patient, clearly, wants help right now. She doesn't want a speech on weather patterns. She wants a doctor who can evaluate her case and make real improvements. She may be ready to change her life patterns and that will be so much the better, but beyond the bounds of what can be hoped for through information and teaching, it is the doctors principal function to provide real, immediate, hard science intervention.

    Simply stated : If doctors can not do that, what are they good for ?

    Of course nothing is perfect. Medicine has limits.

    But there are three strategies. Each has its place, but they must be balanced by the individual.

    1. Attempt to teach people to live healthier lives.

    A very good thing, but people will still get sick.

    2. Attempt to change the environment (of which climate is a component). Fine. Admirable. But people will still get sick.

    3. Pay really close attention to the state of medical science and practice as hard as you can to become expert in using all the tools available, to treat the people who do (for whatever reason), get sick.

    Strategies one and two involve all sorts of people, in fact, ideally, they involve all people.

    Strategy three is the exclusive domain of the doctor. Not to put too fine a point on it : We need more doctors working with real patients. This is the one place where only a doctor will do. It would therefore seem that the typical doctor's efforts should be heavily slanted towards this third method.

    There is no lack of medical work to be done. No matter how narrow one's focus, there is still more than one person can master.

    So the question must now be asked (and the answer, of course, will be highly personal) : Will I be a better doctor if I spend one more hour studying medicine, or studying climate change (or economics or political science or anthropology or ethnic cooking or the art of the fugue) ?

    I think I know what the rational patient would respond.

    Best Regards,

    Gordon Friesen, Montreal

  2. F68.10

    Honestly, while do tend to believe in climate change (though I haven't looked seriously at the issue as it's not one of the things I have to worry about in my daily life), I feel very queasy when reading this article. It may well be the climate change will impact health in various ways. However, 1. I feel that we are building castles in air with this specific genre of medical / climate change literature and 2. it doesn't feel right to invoke health when it comes to an issue that will have a myriad number of consequences, notably political tensions on water management and water consumption. It really feels to me like we're having our priorities messed up thinking like this.


    Thank you for this article. Here at NOSM we now have a task force on 'Climate Change and Health' providing advice to the Dean and Board of Directors. Our scope is:
     Measure and reduce NOSM related greenhouse gas emissions.
     Measure and reduce the environmental footprint across all NOSM related
     operations.
     Advocate for adaptation and mitigation actions as they relate to climate change
    and health.
     Introduce planetary health concepts in NOSM related education and research.
    Anyone interested in learning more OR helping us out, please contact me.
    As an EM MD for 35+ years, I have always found the most satisfaction (and been able to help the most) by taking the time to look upstream to see why patients were being injured. Now it is climate change - wetter winters =more snow on roofs=more people falling off roofs. Dryer/hotter summers = more forest fires = more asthma/COPD attacks and more displacement = mental health issues. Climate change is a medical problem.

    1. F68.10

      "Climate change is a medical problem."

      No! No! No!

      Climate change is a social, political and economical problem. And as such it has medical consequences.

      Very different!

  4. – wetter winters =more snow on roofs=more people falling off roofs. Dryer/hotter summers = more forest fires = more asthma/COPD attacks and more displacement = mental health issues.

    Wow. That is a perfect summary. Pristine in its efficiency and comprehensive in its scope. I agree entirely. Above all, I am gratified to know that we will no longer have to find budgets to fund people to demonstrate these things.

    People can get back to proving that climbing stairs is a benefit, and fruit is a positive in diet.

    Waiting times at the ER are bound to decrease substantially.


    Gordon Friesen, Montreal


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