Student Perspectives

We welcome any health professional student to submit a Student Perspective on a topic related to climate change and health.

Perspectives should not be more than 500 words and references can be hyperlinked.

Perspectives are published monthly.

They will be reviewed by the Director of GCCHE and the Student Fellow.

Prior to submitting your piece, please make sure you sign up for the GCCHE Student Body. 

If you are interested in submitting a piece please contact Natasha Sood.

Expanding Access to Patient Education on Wildfires

Raj Fadadu, Serena Appignani Blacklow - University of California, San Francisco

July 31, 2022

Healthcare providers play a significant role in educating patients about improving their health and reducing their health risks.  For example, tobacco cessation counseling and motivational interviewing techniques have been shown to be effective tools for promoting healthy behaviors. With the growing climate crisis, it is important that both providers and patients are informed about the various health harms of climate change, including those related to wildfires.  However, there is currently a lack of patient-facing educational materials about wildfires and health. Providing access to educational materials can help facilitate patient counseling, even for providers who are not as familiar with this topic.  With support from Healthcare Without Harm and the University of California Center for Climate, Health, and Equity, we created a series of infographics about the health effects of wildfires.

We recently launched our Wildfires and Health Education Hub on the University of California Climate, Health, and Equity website.  The Hub features our series of “Wildfires & Our Health” infographics in English, Spanish, and Chinese.  These evidence-based infographics explain wildfire smoke, the health impacts on various organ systems, and steps people can take to reduce their health risks.  The website also has a list of resources for further education on wildfires and health for both patients and providers.

These infographics can be shared in a multitude of ways.  For example, they can be attached to after-visit or discharge summaries, shared on the computer during a visit, or displayed in waiting rooms as posters.  Each infographic also contains a QR code that can be scanned to direct the user to the main webpage.  We recognize that there is limited time during clinical encounters with patients, but we hope that providers can direct their patients to the website for further information so that they can engage with health education beyond their visit.

Healthcare providers play an important role in providing climate-informed health education.  They can teach patients about how changes in their local and global environments will impact their health.  They can also counsel patients one-on-one to provide individualized guidance for ways to reduce health risks.  Climate-informed education may also serve as inspiration for patients and providers alike to learn more about the climate crisis and ways to live sustainably, helping promote climate action."

Creating Climate Competency

Isabella Mak, Rohan Arora, Christian Shannon, Hannah Spotts, Martha Doxsey, Francesco Satriale

April 28, 2022

Studies show patients trust their healthcare providers to educate them on the health effects of climate change. While most physicians agree that climate change adversely affects human health, especially those conditions most relevant to primary care, many are unsure how to discuss it with patients. While the public views physicians as a source of credible information on this topic, the health implications of climate change have not yet been standardized and incorporated into our undergraduate and graduate medical education curricula despite decades of relevant research and literature. From a recent survey, the vast majority of medical students believe that climate change and its impact on patient health should be included in the core medical school curriculum.

Physicians have the professional responsibility to advocate for patients on the levels of both personal and public health. While we are not where we should be in terms of integration of climate science into healthcare, there are signs of progress. In addition to the policy recommendations by the American College of Physicians, the American Medical Association has adopted a policy to support physicians’ efforts in adopting environmentally-sustainable programs in their practices and sharing them with their communities. Advocacy for these changes have come from a variety of professional physician societies, showing that our advocacy efforts can and do lead to progress.

To build on the progress that has been made, there is a need to continue increasing awareness of the impacts of climate on health in both healthcare providers and the public. As a way of contributing to progress, our team of students built “C4: Creating Climate Competency in our Communities” to make information easily accessible and digestible for healthcare workers, students, patients, and the general public. The project was created with support from the American Academy of Family Physicians (AAFP) Foundation Emerging Leader Institute, which enabled us to dive deeply into the different mechanisms by which a warming climate negatively affects our health, assemble a wide base of resources applicable to each of our audiences, and share the work via our web domain at www.c4climate.org. The site is accessible on both desktop and mobile, making it easy to view and share.

By aiming to build climate competency across the healthcare and public sectors, we encourage you to start a conversation today with your neighbors, classmates, and anyone in your community. To back your knowledge and help facilitate that conversation, check out our website and provide any feedback for how we can make things better. To draw from our mission, it is our hope that using the knowledge outlined here and within our resources, we can turn climate competency into action that will save lives, reduce costs, and offer a better tomorrow.

In addition to the authors, the following students also contributed to the research portion of building C4: Kyra Chester-Paul, Milann Cox, Anna Brandes, and Maria Holstrom-Mercader.

Spotlight on Pharmaceutical Waste: The Impact on Climate Change and Health

Ladan Karim-Nejad, Pharmacy Student

March 28, 2022

When strategizing solutions to reduce the environmental impacts of healthcare, it is critical that pharmacy is involved. As medication experts, it is natural to integrate the impact of pharmaceuticals on the environment into pharmacy education, training, and practice. Sustainable Pharmacy Project, a pioneering student-led organization in pharmacy, galvanized students and professionals to start thinking about what happens to medications after they are prescribed. 

Using the cradle-to-grave approach, pharmaceuticals exist at many different levels of the environment. Hyderabad, a major manufacturing hub in India, has succumbed to environmental degradation caused by improperly treated wastewater. It resulted in heavy metal and industrial solvent pollution, toxic foam, high levels of antimicrobial resistance and dead fish, impacting the livelihood and health of the immediate communities.

Pharmaceuticals are also prevalent in agriculture in the form of pesticides and veterinary medicine. In 2004, three species of vultures were classified as critically endangered due to kidney failure after exposure to Diclofenac when feeding on livestock carcasses. This ecological catastrophe brings attention to drug metabolism. Many drugs undergo processes within the body to active metabolites or are excreted unchanged. The amount of drug that remains within various stores in the body and the effects of unintended drug exposure on the greater environment are still unclear.

Endocrine-disrupting compounds are another type of pharmaceutical pollution that has an ecological impact. Researchers have found evidence of feminized fish in 37 species of fish, such as the smallmouth bass inhabiting the Potomac and Shenandoah River systems.

In relation to human health, the impact of pharmaceutical pollution is still unknown. Numerous studies of the water systems in the United States show evidence of pharmaceuticals present in wastewater, surface water, and more. These pharmaceuticals range from antimicrobials, antihypertensives, steroids, and over-the-counter drugs. Yet, there has not been a public effort, with support from government and industry leaders, to implement preventative or recapturing measures.

Fig 1. Results from USGS Regional Stream Quality Assessment displaying cumulative maximum concentrations (ng/L) and number of pharmaceuticals detected at least once from 2014-2017.

Sustainable Pharmacy Project was created to begin addressing the gap in education and practice of the impact pharmaceuticals have on the environment among students, providers, and patients. Practices such as providing medication disposal counseling, asking what patients have at home to prevent stockpiling, and taking measures to deprescribe when possible, are all methods that encourage pharmaceutical pollution stewardship.

As an organization, we continuously partner with clinicians and students across various disciplines and around the world to increase dialogue centered on minimizing pharmaceutical pollution. By utilizing social media, online panels, webinars, and articles, we continue to generate momentum for innovatively addressing these issues. Our goal includes creating long-lasting change in pharmacy school curricula to ensure the next generation of pharmacists is equipped to make environmental conservation a priority as a part of patient care.

Disproportionate Impact of Climate Change on Marginalized Populations

Samuel Abimbola, MPH, Cyprus International Institute for Environmental and Public Health

February 28, 2022

The subject of anthropogenic climate change is one whose importance cannot be overemphasized. It is not ‘the next pandemic’; it is an ongoing pandemic. It is one of the foremost topics of discussion at global and national summits, with world leaders seeking to advance actions towards mitigating the causes and effects of climate change. The concept of climate justice, and by extension environmental justice, has sought to highlight the inequities that exist among countries both in their contribution to, and impacts from climate change. However, the social inequities that exist within-countries between high-income earners and low-income earners are less spoken of. 

Disparities in emission

An examination of the data on the production of greenhouse gas (GHG) emissions as well as other emission indices, reveals a large disparity between the Global North and South, with Low and Middle Income countries contributing significantly less to global emissions than richer countries. The per capita CO2 emission, a more equitable yardstick in measuring global 

contribution, shows that countries whose emission levels exceed the global equity average are almost exclusively clustered in the Global North. Furthermore, the richest 1% of the global population used two times as much carbon as the poorest 50% over the last 25 years, according to a recent report from Oxfam International.

Disparities in the burden of impact

The burden of climate change is certainly, but not equally, felt by everyone. Poorer countries, marginalized and/or migrating populations, and socioeconomically disadvantaged people are disproportionately affected by climate change, with women and children being most vulnerable. Though causally multidimensional in nature, the result is the same: poorer communities or individuals are more exposed to the impact of climate change, more susceptible to injury and damage caused (both direct and indirect), least able to adapt to or recover from the impacts suffered and least likely to be covered by governmental safety nets. They are more likely to suffer from direct impacts of extreme weather conditions and simultaneously the mental pressure (indirect effect) this presents. Yet, while some attention has been given to disparities between countries, less attention has been given to within-country disparities and how this affects climate change, justice and climate response.

The impacts of climate change should not be generalized, for in so doing we blur the lines which distinguish how such impacts are felt by low-income countries/earners in comparison to high-income countries. The effects are different; harmonising these stories into a single narrative does not paint a realistic picture. It is inspiring to see how much has been achieved through policies and action calls toward mitigating GHG emissions in the last 11years. It will be just as great to see how much of the gaps (inequalities) between high-income and low-income earners or countries can be closed by the year 2030.

Climate Financing and the Power Asymmetries between Global South and Global North

Kruti Patel, M.Sc. in Epidemiology (c), University of Ottawa

January 25, 2022

Climate change poses a significant challenge to the health of the global population. It exacerbates the vulnerabilities linked to the socio-environmental determinants of health and produces health risks that may lead to an additional 250 000 deaths per year between 2030 and 2050, according to the World Health Organization. Disadvantaged populations (e.g. women, children, minorities, impoverished communities) experience the greatest burden of the climate-sensitive health risks as they are already in unstable conditions. Specifically, populations in the Global South experience substantial harms resulting from climate change due to their decreased capacity to adapt and mitigate the impacts. The consequences of climate change are unfairly borne by the Global South countries, as it is the Global North countries that have greater contributions to the global carbon dioxide emissions and climate degradation. The Global North countries are responsible for 92% of excess carbon emissions as of 2015. The majority of climate-related harm experienced by the Global South can be attributed to the damaging practices of the Global North. 

It has been a trend throughout history for the Global North to exploit the Global South for their gain (e.g. neoliberalism, colonialism). Power asymmetry between the Global North and Global South is at the core of the disproportionate climate-related harm experienced by the latter. Nevertheless, ahead of COP26, Global North countries pledged $100 billion annually in climate financing to support mitigation and adaptation activities in the Global South. These funds will go towards supporting vulnerable countries to establish climate adaptation measures. From this, it may appear that the Global North is working to make amends with the Global South concerning climate adaptation. However, recent reports have indicated that Least Developed Countries and Small Island Developing States are facing barriers (i.e. funder requirements, long timelines, complex reporting, and data collection) in accessing these climate finance supports due to complex procedures. Certain Global South states may not have the fiscal and systemic capacity to adhere to the complex requirements of the donor countries, which creates uncertainties for climate financing. Global South representatives indicated that they required support in accessing funds and would benefit from a climate finance advisor. The imbalance of power, again, has ensured that Global South countries struggle to keep their populations safe from climate change threats. It is true that not all Global South countries will struggle in navigating the climate finance system, but the issue remains that the current system provides inequitable access to important funds.

It is vital to address the history of power asymmetries between the Global North and Global South when considering climate-health education. The atmospheric colonization of the Global South has imposed climate change threats onto populations that are already disadvantaged in comparison to the Global North. The power imbalances have been drivers of inequalities across the globe and require the attention of today’s medical and public health trainees. Applying a climate justice lens to climate-health education is crucial to ensure the peril of vulnerable populations is properly understood and addressed to improve their health. 

The Lancet Countdown Report: A Code Red for a Healthy Future

Karly Hampshire, University of California San Francisco

November 30, 2021

More than ever, health was a central theme at this month’s COP26 summit. For years, activists in the health community have been working to reframe climate change not as an issue of drowning polar bears and endangered species, but as one deeply personal-- a health crisis. With the international community still reeling from the emotional and economic toll of COVID-19, that reframing is gaining traction. In 2020, 47% of world leaders commented on the health dimensions of climate change in their statements at the UN General Debate, a number double that of 2019. 

Research on the intersections between climate change and health has also soared in the past decade; original studies on health and climate change increased 11-fold between 2007 and 2020. That huge swath of research is summarized annually in the Lancet Countdown Report, a report that represents the consensus of leading international researchers from 43 academic institutions and UN agencies. This year’s 6th annual report is a 44-page summary covering 44 health indicators, including climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. For those with limited reading time (or attention span), the report is also available as a U.S. brief (13 pages), as a summary for medical professionals (3 pages), and as various regional reports. Below, we summarize select findings.

Dengue, drought, and disease: Oh my!

Perhaps the most relevant section for health professionals, the first section of the report summarizes the most up-to-date evidence in five key areas: health and heat, health and extreme weather events, climate-sensitive infectious disease transmission, food security and undernutrition, and migration and rising sea levels. 
 

Heat: Those of us who have used high outdoor temperatures as an excuse for not exercising will feel affirmed; a new heat and outdoor exercise indicator described a global increase of hours in which temperatures exceeded the threshold for safe outdoor exercise, with those in the low-human development index (HDI) country group losing an average of 3.7h per person per day in 2020. Associations between heat and mental health have long been theorized but are hard to study across cultures; another new indicator found a 155% increase in negative expressions on Twitter during heatwaves relative to 2015-2019. Young children and older adults are especially vulnerable to the health effects of heat; heat-related deaths in those >65 reached a record high, with an estimated 345,000 deaths in 2019. 

Extreme weather events: Drought and wildfires threaten large areas of the Earth’s surface, with up to 19% of the global land surface affected by drought in 2020 and 72% of countries with increased wildfire exposure compared to 20 years ago. Both have direct and indirect health effects via smoke/dust exposure and food insecurity. The health effects of drought are summarized below:

Infectious disease: In the last few centuries, thanks to improved sanitation and antimicrobials, the global burden of disease has shifted away from infections and towards noncommunicable diseases. However, climate change threatens those advances, especially in low-income nations. Driven by changes in sea surface temperature and salinity (Vibrio), and mosquito habitat suitability (Dengue and Malaria), many infections are on the rise, as shown below: 

Food insecurity and undernutrition: Even as population grows, crop yield potentials are trending downwards due to rising temperatures. For example, there has been a 6% reduction in crop yield potential for maize compared to the 1981-2010 average. How does that translate into food insecurity for people? According to one analysis, every 1 degree C of increased temperature translated into a 1.4% global increase in the probability of severe food insecurity. 

Migration: Sea levels are projected to rise up to 2m above current levels within 80 years, threatening the 570 million people who live within 5m of sea level. The resulting migration and displacement would have profound effects on livelihoods, access, and mental health. 
 

Inequity seeds inequity 
Colonialism and inequitable policies have resulted in disproportionate health harms for low-income countries. Though it is the high-HDI countries have contributed the most to climate change, when analyses are stratified by HDI (a UN-defined index that captures life expectancy, education, and standard of living), lower HDI is correlated with higher morbidity and mortality almost across the board. For example, people living below the poverty line, outdoor workers, incarcerated people, people of color, and historically redlined communities are disproportionately exposed to heat. This is due to factors like the urban heat island effect, unsheltered working conditions, and lack of air conditioning access. Climate change therefore exacerbates existing inequalities.

Money talks, but who is listening? 
As demonstrated by the report, the health-related costs of continued fossil fuel combustion are enormous. For example, the 2018 California wildfires were responsible for an estimated $32 billion in health costs (and by the way, half of those health costs were for people residing outside of California, reinforcing the fact that we are all in this sinking boat together). However, budget calculations for climate action rarely include these indirect health costs. Perhaps this is why 65 out of 84 countries reviewed for the report were still using public funds to subsidize fossil fuels. 

The buzzwords of the climate community: mitigation and adaptation
The Earth’s surface has already warmed 1.1 degrees Celsius relative to preindustrial levels. To prevent catastrophic, irreversible levels of global warming and meet the goals set by the Paris Agreement, we will need to cut greenhouse gas emissions by half by mid-century. Including health costs and climate action co-benefits in cost-benefit calculations, pushing for divestment from fossil fuels, especially in the healthcare sector, and raising the alarm among healthcare professionals are critical for reaching that increasingly elusive benchmark. 

Regardless of the steps we take today, health systems and human health are vulnerable to the threats posed by climate change. However, only 52% of the 91 countries assessed have national health and climate change plans in place. Partially, this is due to a climate-health financing gap, a lack of investment in building resilient health systems. The COVID-19 pandemic has illustrated how lack of planning and lack of funding can conspire to lead to wholly unprepared health systems when disaster strikes; with increasing climate disasters, it is important that access to essential services are not impaired. Building evidence-based, global coalitions like the Lancet Countdown Report team is one step in the right direction. 

COP26: Climate Solutions for a Healthy Future 

Donald De Alwis and William O’Connor, University of Maryland School of Medicine

October 29, 2021

Last month, an open letter calling for climate action as a prescription for good health received signatures from organizations representing over 45 million health professionals worldwide. The letter comes at the heels of an editorial published in over 200 medical journals internationally, calling for swift and just climate action as a public health imperative. The writing is on the wall - climate solutions are health solutions. As medical students, we need bold action at COP26 because the health of our future patients, and that of our own families and communities, hangs in the balance.

In Baltimore, where we live and study medicine, the impacts of climate change on health are inescapable. Heat waves, air pollution, and flooding exacerbate chronic health conditions and disproportionately impact patients in historically redlined (i.e., hotter, more polluted, and more flood-prone) neighborhoods in the city. The emotional and financial stress of experiencing repeated extreme weather events (say, a basement flooded by municipal sewage every year after heavy rainfall) can have lasting mental health implications for communities and families. 

Compounding these impacts are the health-related economic costs of climate change-related disease, including short and long-term medical care, prescription medications, and missed work-days. A 2015 study estimated that tick-borne Lyme disease – which has an expanded range thanks in part to climate change - adds nearly $3,000 to an insured individual’s medical bills per year. With over half of Americans already experiencing medical financial hardship, climate change is a threat multiplier that affects everyone, but acts like a regressive tax on the physical and economic health of patients least able to adapt.  

Strong climate commitments at COP26 will encourage our cities to reduce emissions and build resiliency against the effects of climate change. We are excited by the prospect of cleaner air, more walkable neighborhoods, and widespread resilience against extreme weather events in Baltimore and around the world. This means healthier patients with fewer medical bills for climate change-related illness – a win for individuals, communities, and the healthcare systems that serve them. 

Medical students today are preparing to enter the workforce in a world with increasing climate change-related disease. On top of this, the projected increases in extreme weather events may lead to disrupted medical supply chains, hospital power/water outages, and an inability to transport critical patients to hospitals for treatment. These factors challenge our ability to provide high-quality care to those most in need. We fear that without tackling the upstream problem – climate change – our generation of health professionals is destined to fight an uphill battle against the compounding downstream health effects that climate change has on our future patients. To better protect the health of our communities, tomorrow’s health professionals need the leadership and political sway of world leaders today. This is the crucial opportunity presented by COP26.  

When our community members suffer the blows of climate change-related illness, health professionals tend to their wounds. It is undeniable that climate change is affecting our patients right now – but as medical students, we are training into a system that has vastly underestimated its impacts. Climate change is a health emergency – at COP26, we need our leaders to treat it as such.  

The Green New Deal, Infrastructure Bill, and Reconciling the U.S.’s Climate Agenda

Harrison Goodall, Emory School of Medicine

September 30, 2021

Since the first Resolution for A Green New Deal was put forth by Representative Alexandria Ocasio-Cortex and Senator Ed Markey in 2019, it has been a paradoxically polarizing and unifying topic among different factions of American society. The Green New Deal itself is not a set of specific policies but rather an amalgamation of goals, aspirations, and ideas on how to curb climate change and be better equipped to tolerate the effects of a changing climate. When I think of the Green New Deal (GND) I think of three large principles: creation of 100% clean energy, a just transition away from fossil fuels, and massive public sector investments. Many climate related bills and policies currently in the legislature are based on these foundational principles.

         There are four bills currently in the national legislature that have Green New Deal in their names (GND for cities act, GND for Public Housing Act, GND for Public Schools Act, Resolution to create a GND) along with many more bills addressing clean energy, just transition and public sector investments (such as the Environmental Justice for All Act, Build Green Infrastructure and Jobs Act, Civilian Corps for Jobs and Justice Act). Throughout the summer of 2021, Biden and the legislative branch sought to include climate related policies in the 2021 Infrastructure and Investment Act. While this infrastructure act was approved by the Senate in August, its scope was narrowed substantially from its original form, resulting in the exclusion of many GND related policies. The result is an Infrastructure Bill that largely focuses on physical infrastructure improvements and leaves out the sweeping, comprehensive policies that are needed to expand clean energy and curb emissions in the U.S.

The Infrastructure Bill includes provisions such as $150 billon for clean energy and climate change protections,  $60 billon for investment in clean energy transmission, $47 billion to increase community resilience against natural disasters + respond to extreme weather (in the form of increased funding to FEMA, DoA, Army Corps of Engineers), and provisions for increased electric vehicle charging stations, improved port and airport infrastructure, and increased investments in clean drinking water and environmental remediation efforts. While all these policies are a step in the right direction, none of them will result in the dramatic restructuring of the U.S.’s energy sources and infrastructure needed to meet goals of carbon reduction and neutrality by 2030 and 2050.

While the Infrastructure Bill is a step in the right direction, the House and Senate are working to create stronger policies to curb climate change through the budget reconciliation process. While these policies are still being written in committees, this process has potential to revolutionize our energy sector, vastly increased investments in public infrastructure and address the unequal burden of climate change. Through policies such as clean electricity payment programs, clean electricity tax incentives and tax credits, increased land and ocean conservation efforts, increased investment in affordable and public housing, creation of a civilian climate corps and increased labor protections, this budget reconciliation cycle may put American on a path to a greener future than ever before and bring the GND to life.

It is a time for both hope and action – use your voice to call your representatives and tell them you support inclusion of clean energy tax initiatives and credits and increased green infrastructure and investments to help turn these crucial policy proposals into law.

The Planetary Health Report Card: an Opportunity to Make Change in Medical Schools

Megan Duckworth, Warren Alpert Medical School of Brown University 

August 17, 2021

There is overwhelming evidence of a changing climate; unprecedented heat waves, hurricanes, droughts, and wildfires provide near-daily reminders of its impact on ecosystems and human health. The scale of human health impacts is hard to overstate, and ranges from reproductive, endocrine and infectious diseases to pulmonary, cardiovascular, and renal pathology. Both the World Health Organization and the Lancet in its 2020 Countdown Report have recognized the urgency of the situation, calling climate change the greatest global public health threat of the century. Despite this, only 15% of medical schools globally include climate change in their curricula. 

Medical students internationally are joining a grassroots effort to incorporate planetary health into medical curricula and to engage universities in planetary health work: the Planetary Health Report Card (PHRC). This effort is a student-driven, metric-based initiative inspired to catalyze change in medical schools by assessing medical schools’ commitment to planetary health across five domains: curriculum, research, community engagement and advocacy, support for student-led planetary health initiatives, and campus sustainability. The first report card, published in 2020, included 13 schools; in 2021, the report card grew to include 62 schools across four countries. 

Students form teams to tackle completing the PHRC, dividing up the metrics and providing detailed explanations to support each grade. Students aim to work together with administrators to maximize the beneficial impact of the effort, and facilitate creating institutional memory to track improvement over time. 

Several schools have already successfully implemented changes, including curriculum overhauls, the creation of a Planetary Health Task Force including medical school Deans, students, and community members, and the formation of student sustainability groups. 

If you are interested in being a part of the effort to ensure future physicians understand the scale of this public health crisis and are equipped with tools to care for their patients, you should consider leading the PHRC at your school. We are currently recruiting medical students to lead PHRC teams; please join us on Slack or email us to learn more. Orientation will be held on October 2nd, 2021 and will be recorded. The 2022 PHRC will be published on Earth Day-- look out for even more schools to share their results. The PHRC is also holding its first Symposium on October 16, 2021, which will include detailed results of PHRC efforts at schools across the US, Canada, the UK and Ireland. Join us if you want to feel inspired!