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 (https://policybase.cma.ca/documents/policypdf/PD10-07.pdf).
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:
- 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
- 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
- Understand the disproportionate impact of environmental damage on Indigenous health and the need to prioritize Indigenous knowledge and leadership in policy decisions
- Recognize one’s own responsibility, working at the frontlines of patient care, to communicate environmental health risks to individuals and the community
- 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.