• Jacob Bourne

An Environmental Hippocratic Oath? Medical School Curriculum Adapts to Climate Change

It’s increasingly apparent that climate change is taking its toll on human health and the future projections are grim. While commonly thought of as a planetary emergency linked to extreme weather events and sea-level rise, health experts now view climate change as a human health emergency as well. As a result, some medical schools are adapting curriculum to the emerging reality.



public bath during heatwave
People bathe to keep cool during a June 2015 heat wave in Calcutta, India. Credit: Shutterstock/Saikat Paul

The most salient threat is the danger heatwaves pose to health. This summer, the unprecedented heatwave in the Pacific Northwest where temperatures exceeded 115 degrees Fahrenheit in some areas, resulted in nearly 200 deaths in Oregon and Washington, and hundreds more in British Columbia, where the mercury topped out at over 121F in Lytton.

It’s not just the high temperatures. Many areas like the U.S. South, Midwest and Eastern regions are becoming muggier. The combination of heat and humidity can be deadly, according to a study in Science Advances. It turns out that there is a limit to how much the body can endure. Exposure to high heat coupled with high humidity, known as wet-bulb temperature, occurs when the body’s primary cooling mechanism — evaporation through sweat — doesn’t function. The upper threshold of the body’s ability to shed heat in these conditions is 35 degrees Celsius or 95F. Unfortunately, such scenarios are already playing out in some areas, and it’s expected to get much worse as climate change progresses.


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Weather station data has shown that incidents of wet-bulb temperature conditions have more than doubled in frequency since 1979 in subtropical locations, the study found. Another study in the Annals of Nutrition and Metabolism linked heatwaves to acute kidney disease, with those lacking air conditioning or who work outdoors such as farmers especially at risk.

A study in The Lancet Planetary Health showed climate change is causing an expansion of conditions suitable for mosquito-borne diseases. For instance, malarial spread will increase by between one and six months annually in Africa’s tropical highlands, the Eastern Mediterranean and the Americas. The number of people globally at risk of malaria and dengue is expected to increase by up to seven billion people by 2070, compared to 1970 to 1999 averages.

“The predicted expansion towards higher altitudes and temperate regions suggests that outbreaks can occur in areas where people might be immunologically naive and public health systems unprepared,” the authors stated.

The mounting health risks necessitate changes to medical education. The University of Southampton School of Medicine is filling in the gaps, modeling an approach developed by the Icahn School of Medicine at Mount Sinai. During its most recent academic session, Southampton Medical School launched a Medicine, Climate Change and Sustainability Infusion Project to highlight the importance of considering climate change impacts in various healthcare contexts.

New courses include Introducing Environmental Health; Climate Change and Sustainability in Practice; and Becoming a Sustainable Physician. The content covers topics like asthma, nutrition, cardiovascular risk, temperature regulation, planetary health and global public health.

Notably, the healthcare industry's being very energy-intensive results in a high carbon footprint. As such, the curriculum will also address how clinicians can make their practices more sustainable. The efforts to make medical education more applicable to the current state of the planet were made in collaboration with other schools such as Mount Sinai and the International Medical Education Collaboration on Climate and Sustainability, which provides open source curriculum materials for duplication by other institutions.

Although the health impacts of climate change are far-reaching, as is the case with other disasters like the SARS-CoV-2 pandemic, the most vulnerable in society stand to bear the greatest burden, such as those with pre-existing conditions, low incomes and communities of color. The World Health Organization offers a free online course for the general public that covers impacts on human health, the status of international climate change negotiations, policies and health inequities.


As climate change destabilizes the biosphere, evolving healthcare education systems to address the impacts are crucial aspects of climate adaption.


With a trend of companies' pledging efforts to protect the planet underway, it seems timely to update the Hippocratic Oath to not merely cover environmental impacts on human health, but also lessening the healthcare industry's impact on the environment.


 

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