Bringing climate change into medical school

Every day, doctors and health professionals navigate the frontlines of climate change. They are often the first to see the impacts on their patients – tropical diseases in cool northern climes, stress from extreme heat.

Yet few have been trained to spot the many ways climate change is affecting health.

“Learning about climate change in medical school shouldn’t be an afterthought; it’s fundamental to the practice of being a good doctor. If we make it standard to understand how diseases are changing because of climate change, we’ll be better prepared to diagnose our patients and provide appropriate treatment plans,” says Gaurab Basu, a primary care physician at Cambridge Health Alliance, a safety net healthcare system affiliated with Harvard Medical School.

Basu is leading efforts across Harvard University to bring climate change into health curricula, to help medical workers recognize the symptoms and inform public discourse.

As the Director of Education and Policy at the Center for Climate, Health, and the Global Environment (C-CHANGE) and Assistant Professor at the Harvard T.H. Chan School of Public Health, Basu has led the creation of a new interdisciplinary climate change and planetary health concentration that will launch this fall and be available to every student at the school.

“We see the benefits of having individuals with very diverse disciplinary backgrounds and lived experiences think and learn and create climate solutions together,” he says.

As Assistant Professor of Medicine at Harvard Medical School, Basu has helped insert climate change into every aspect of the four-year curriculum. He describes and evaluates this process in a new paper, published May 29 in PLOS Climate, called “Climate Change, Environment, and Health: The Implementation and Initial Evaluation of a Longitudinal, Integrated Curricular Theme and Novel Competency Framework at Harvard Medical School.”

Basu also runs a fellowship to teach health professionals around the United States the tools of community organization, to enable them to address climate change in their organizations and communities – the subject of a January study published in the journal Academic Medicine.

“I want to live in a society in which we are taking better care of each other,” Basu says. “All those values we have in medicine and public health are simply not possible without ambitious climate solutions.”

Basu recently sat down with the Salata Institute for Climate and Sustainability at Harvard University to discuss why climate lessons must be embedded in all health educations.

Why is it important to train doctors and other health professionals on climate and planetary health?

I had my climate awakening after the release of the Intergovernmental Panel on Climate Change 2018 report [on the impacts of 1.5 degrees Celsius of warming]. I’m a global health doctor and was working on issues of child nutrition and access to care around the world – delivering basic services, like access to clean water and food.

And the 2018 report catalyzed me. It was like a thunderbolt. I recognized then that climate action was critical to addressing all those things I cared so deeply about. There’s something very special about health. When you talk about people’s health, it’s about their humanity, it’s about their vulnerability, their hopes and dreams. And at the foundation of that is a special trust – people trust you to take care of them. And ultimately, I want to live in a society in which we are taking better care of each other.

After that report it became so fundamentally clear to me that all those values we have in medicine and public health are simply not possible without ambitious climate solutions.

Study after study has shown that doctors and health professionals are trusted messengers of climate change. Why do you think that’s the case? And how can they turn that into climate action?

Health professionals and doctors are at the forefront of this conversation because we see the human face of climate change. People tell us about their lives and tell us about the way these broader structural factors are impacting their health. I’d argue that health professionals have an opportunity and duty to tell these stories – anonymized, of course – to marry storytelling with rigorous data and to synthesize a broader narrative of the health threats that communities are facing.

Articulating the health impacts of climate change, the ways climate change is impacting day-to-day lives, can catalyze more effective solutions. As health workers, we must ensure that we’re present in the public forum, that we’re entering public decision-making spaces and influencing the structural policy changes we need.

Could you share an example from your own clinical practice? How do you care for patients impacted by climate change? How does climate change alter how you practice medicine?

There’s a patient I can describe to you, a healthy man of about 30, who was a sugarcane farmer in Central America before he came to the United States. He was having upper respiratory symptoms, acute shortness of breath; he thought he had a cold. He came to the emergency room thinking he would get some antibiotics and be on his way.

But he had a devastating, completely unexpected diagnosis. His kidneys were in failure, totally shutting down. He had to be hospitalized urgently and started on dialysis. Usually, with kidney disease, we expect to see long-term diabetes or high blood pressure; these are typically in older folks. But he was healthy and young.

Ultimately, we diagnosed him with a form of heat-triggered nephropathy. Back home he had been in the sugarcane fields day in and day out, attending to the crops in the heat. He was sweating so much that he was getting dehydrated every day. So, the blood flow to his kidneys was significantly impaired. His kidneys were slowly getting acute kidney injuries. He didn’t know he was putting his body at risk every day.

This was a dramatic diagnosis that’s completely upended his life. I became his primary care doctor after his hospitalization. I always remember walking into the room and seeing him for the first time. He was so scared. That clinical experience taught me the broad impacts of climate change and how intersectional it was with so many issues of health equity and vulnerability. I realized it was my responsibility to be thinking about how climate change is impacting my patients.

Another patient was brought to our hospital very confused. We didn’t know what was causing his sudden mental decline, then we found West Nile in his cerebrospinal fluid.

We don’t see much West Nile in Massachusetts. But we need to be developing a practice as medical students, residents, doctors, and health professionals to be analyzing the ways that climate change is changing disease patterns – whether it be infectious diseases or extreme heat or air pollution – and be prepared to make those kinds of diagnoses and create appropriate treatment plans. Learning about climate change in med school shouldn’t be an afterthought; it’s fundamental to the practice of being a good doctor.

You have a new paper this week in PLOS Climate describing and evaluating the new climate and health curriculum you developed at HMS. Could that work as a roadmap for other medical schools to implement a climate curriculum?

I partnered with a passionate group of medical students and we went through every single course that our med students take and embedded climate lessons within each course, creating a longitudinal, integrated, required curriculum over four years.

This was done as a novel competency framework. We have five major competencies at Harvard Medical School and then we have some learning objectives under each one. We went through a process where faculty, students, and deans all worked together to refine these competencies. We mapped every piece of curriculum back onto the framework. We want this to be a core principle of medical education that allows students to become effective clinicians no matter what field of medicine they go into. And the students deserve tremendous credit for their leadership and hard work on developing this curriculum.

Climate change affects nearly every issue we’re learning about in medical school, and so we wanted to put a climate lens on the curriculum. When students are learning about malaria, we insert information about how land-use changes, flooding, and changing temperatures are changing the distribution of mosquito-borne illnesses. When they’re learning about asthma, we look at how air pollution can impact that. We wanted to make sure they understood the health impacts of fossil-fuel infrastructure, transportation, and energy systems that are emitting pollutants. This is so that when they’re taking histories of their patients, they understand what the sources of recurrent asthma exacerbations are, how to counsel patients about heat, and so on, to integrate climate in that way. And I’ll emphasize that health equity is a core focus of our curriculum.

Is this type of education gaining traction in other schools around the world? Is there any resistance to this type of curricular change?

It is still in a fairly nascent phase, but increasing. The Association of American Medical Colleges did a survey and found that 55% of medical schools reported that the health effects of climate change were a required topic in their courses in 2022. That doubled from 27% two years prior. So that’s good: 55% of med schools have some content on the health impacts of climate change. But we’ve really got to do more. That survey is simply saying that it was a topic at some point, but we’re trying to make the argument that we can have this kind of longitudinal, more coherently designed curriculum, so that students develop a practice of understanding the various ways in which climate change is affecting health.

In our survey of Harvard medical students, 94.1% said that understanding how climate change impacts human health should be part of all students’ medical education. Students are certainly one of the major drivers in developing this. And I believe that in the coming years you’re going to see the teaching of climate change influence students’ decisions about where they want to go to medical school.

You also lead a fellowship for mid-career healthcare professionals on community organizing. Why is that an important skill for them?

Increasingly, a lot of health professionals worry about the health impacts of climate change. We see it impacting our patients in real life, with wildfires, heat waves, etc. We’re all connecting the dots. But climate change can feel so daunting and overwhelming. Plus, healthcare professionals are at unprecedented levels of burnout on the heels of COVID. These broad public health threats descending upon our patients are demoralizing. We can feel isolated, fragmented, lonely in this work. And that can create a sense of despair.

As we recognized those sentiments, we realized there were all these wonderful climate health organizations popping up across the country and that health professionals were wanting to get out and speak up for community-based solutions.

But you need skills to do that. So Pedja Stojicic [an instructor at Harvard T.H. Chan School of Public Health] and I created this fellowship. It’s been a wonderful partnership with Marshall Ganz at the Harvard Kennedy School, for groups of post-graduate health professionals in the midst of their careers. It is based on Ganz’s pedagogy in community organizing. We worked with him to reshape his Kennedy School course material into a 12-month fellowship. We just completed our third cohort of fellows and we’ve had 40 fellows each year. It’s very competitive to get accepted. Groups of three people who were already working together applied as teams. And we asked that one of those three be a community leader, a nonprofit leader, or a non-clinician. So, it could be a mix – such as a doctor and a social worker and environmental justice leader – and they applied with a project in mind. So, they all came in with a community-based project idea: things like increasing tree canopies, increasing sustainable food systems, decarbonizing hospitals. This was all on Zoom and they were located all over country.

We had four major goals. One was to teach the connections of climate and health. Number two was to help them develop community organizing skill sets that could be applied to their projects. Number three was to help them create a sense of purpose and to mitigate a sense of burnout. We measured that in the paper in Academic Medicine, about self-efficacy. And then number four was how we could help them develop local capacity; to train them as leaders so they can build teams in their local settings.

We were really excited about our findings. For instance, before the fellowship 37% of fellows felt “they were able to develop effective strategies in their local community to combat climate change.” After the fellowship, that increased to 92% feeling this way. By teaching these fellows about community organizing, I think we’ve supported them to find their voice, their role, and their sense of purpose.