Sarah Hsu is a fourth-year medical student at Brown University and a graduate student in primary care population medicine. She is a founding leader and vice chair of Medical Students for a Sustainable Future and co-host of the podcast Code Green: The Climate Smart Health Professional. She is a 2021 Switzer Fellow.
Gaurab Basu is a physician with a master’s in public health. He is co-director of the Center for Health Equity Education & Advocacy at Cambridge Health Alliance, an instructor at Harvard Medical School, and a health-equity fellow at the Harvard TH Chan School of Public Health’s Center for Climate Health and the Global Environment. He was named to the 2021 Grist 50.
It is the beginning of summer, when new medical residents begin their rotations. It is also already a summer of record temperatures and rising heat-related emergency room admissions. Heat poses a major public health threat — deaths related to heat among adults 65 and older have almost doubled during the past two decades.
Climbing temperatures and more frequent storms and wildfires pose specific risks to people with chronic health conditions, and clinicians can help them prepare for these situations so they don’t end up in the emergency room. Yet most medical professionals never receive any climate-related training. It’s time for that to change.
Historically, the doctor-patient relationship has been confined to the exam room: We are trained to focus on the person in front of us and the problem they’re experiencing today, not what’s going on outside the window, whether it’s a developing hurricane that could cause humanitarian disaster or pollutants from dirty energy systems floating in the air. This traditional model of medicine is not enough for the climate crisis.
One recent study linked 37 percent of heat-related deaths to climate change. Heat and air pollution also increase the risk of heart attacks, strokes, childhood asthma attacks, premature labor, low birthweight, cancer, and dementia. Recent research from Harvard University showed that in 2018, particulate matter air pollution resulted in 8 million (or one out of five) deaths worldwide and about 350,000 deaths in the United States.
The U.S. needs climate-informed clinicians who are better equipped to understand that energy blackouts from severe weather will mean our patients with diabetes won’t be able to refrigerate their insulin; that our sickest patients are at risk of severe illness and death during dangerous wildfires, hurricanes, and heat waves — and that helping them to prepare is part of our responsibility.
Doctors can be a part of the solution by creating a registry of patients at greatest risk of getting sick during extreme weather and having our clinical teams reach out to them to create a response plan. For instance, if we take care of children with asthma, we might reach out to their families in advance of a heatwave to ensure they have a place to cool down and plug in their nebulizer if they lose electricity. If we have pregnant patients coming for an appointment, we can ensure they have a safe way to get to the clinic in lieu of walking or waiting in the heat for a bus. There are numerous proposals out there on how we can reform health insurance policy to better reimburse interventions to prevent climate-related disease.
Climate-informed clinicians will not only be able to provide better care, we will be far more likely to lead climate innovations and reduce the carbon footprint of healthcare delivery.
The U.S. healthcare system emits up to 8.5 percent of the country’s greenhouse gas emissions. Hospitals and medical offices require intensive energy for lighting, heating, and cooling. Providing healthcare also requires a massive amount of supplies, much of which is wrapped in plastic packaging or single-use plastic devices that contribute to the nearly 14,000 tons of waste U.S. healthcare facilities produce each day.
The two of us have been advocating for better practices within our institutions. At Cambridge Health Alliance, Gaurab serves on a committee that regularly meets with senior leadership to tie the hospital’s social mission to climate solutions. Sometimes those meetings involve discussing the efficiency codes of new construction, but sometimes the issues are even more basic: For instance, Gaurab has asked the driver of the shuttle bus that frequently idles by the hospital’s main entrance to turn off its engine. He doesn’t want a patient who’s been discharged after treatment for COPD — a disease of the lungs — inhaling exhaust as they are leaving the hospital.
At Brown University, Sarah often stays late on her rotations teaching peers how to sort medical waste to lessen its carbon impact — often, in the rush of treating trauma, regular trash is thrown in the red biohazard bin, which requires a more carbon-intensive disposal. Sarah discovered this when, as part of her master’s thesis, she went dumpster diving through a day’s worth of emergency room waste to figure out what was being thrown out, how many items were unused, and what could have been reused. Of the 1,600 pounds of waste sifted through, nearly 85 percent found in the red bins didn’t belong there, and over 200 items in the trash were unused or unopened. She has advised hospital teams across the country on conducting waste audits and has successfully advocated for sustainability training for all third-year medical students at Brown.
Doctors can even consider the environmental impacts of the anesthetics used in surgery. Studies show that inhaled anesthetics emit an amount of greenhouse gases that can be orders of magnitude higher than alternatives like intravenous propofol. Anesthesiologists can be trained to be mindful environmental stewards by turning off the gas valve when anesthetics are not in use in the operating room, which reduces wasteful and unnecessary emissions. All of these interventions require a clinician’s expertise to ensure that more sustainable choices support, rather than harm, patient care.
Climate education can create a culture change, so that physicians understand that the health of the planet is deeply intertwined with the health of our patients. This should not have to take a determined extracurricular commitment; it should be at the foundation of training in medical school. A survey by the Academy of American Medical Colleges showed that only 19 percent of medical schools had delivered a climate curriculum within the last three years.
One of the most important reasons for climate training is to help clinicians become more effective advocates for health equity in our communities. Health professionals are one the most trusted messengers of climate action. We can show up to city council meetings and our statehouse and make the argument for policies that will stabilize the climate, decrease air pollution, and protect our patients. We can make clear that communities of color and poor communities are far more impacted by the harms of climate change.
People trust doctors to possess the knowledge and skills needed to keep their loved ones healthy. But our dangerously warming planet has changed what a clinician needs to know. Climate change must be at the core of medical education so healthcare professionals can look our patients in the eye and be worthy of their trust.
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