Medical education programs explain how climate change affects health

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Madhu Manivannan, a third-year student at the Emory School of Medicine, is at the forefront of a new approach to clinical training. Manivannan, co-chair of Emory Medical Students for Climate Action, was among the first class of Emory medical students to experience the birth of a refined curriculum ― solicited and partially created by the students themselves. The new curriculum addresses the many ways the climate affects health: from air pollution to its effects on the lungs and cardiovascular system at heat-related kidney disease.


Madhu Manivannan

“We’ve known that climate affects health for decades,” Manivannan said in a recent interview. “The narrative was that icebergs were melting and by 2050 polar bears would be extinct. The piece that’s different now is that people associate climate with increase in asthma and various diseases. We have a way of communicating directly that it’s not a distant thing. It’s happening to your friends and family right now.”

Hospitals, medical schools and public health programs are stepping up efforts to educate the next generation of physicians as well as seasoned medical workers about one of the most pervasive and insidious health threats of our time – climate change – and about the specific ways it might affect their patients.

Although climate change may seem like a distant threat to many Americans, Marilyn Howarth, MD, a pediatrician in Philadelphia, is trying to make sure doctors are better prepared to deal with a growing number of health issues associated with global warming.

“There’s not a lot of education for pediatricians and internists on environmental health issues. It hasn’t been an integral part of medical school education or residency training,” said Howarth, associate director of the new Philadelphia Regional Center for Children’s Environmental Health. said. “With the growing attention to our climate, we truly recognize that there is a real gap in knowledge among physicians, both in pediatrics and in adult care.”

Scientists have discovered that climate change can alter just about every system in the human body. Studies To display that more extreme weather events, such as heat waves, thunderstorms and floods, can aggravate asthma and produce more pollen and mold, triggering debilitating respiratory problems.

According to American Lung Associationultrafine particles of air pollution can be inhaled and then travel through the bloodstream, wreaking havoc on organs and increasing the risk of heart attack and stroke. Various types of air pollution also cause climate change by trapping heat in the atmosphere, leading to problems such as sea level rise and extreme weather. Moreover, in a new study Posted in Nature, scientists warn that global warming is forcing animals to migrate to different areas, increasing the risk of new infectious diseases jumping from animals ― like bats ― to humans, a process called “zoonotic spillover” that many researchers believe is responsible for the COVID-19 pandemic.

Philadelphia Regional Center for Children’s Environmental Health

One of the latest initiatives to disseminate information about children’s health to healthcare providers is the Philadelphia Regional Center for Children’s Environmental Health (PRCCEH), part of the Children’s Hospital of Philadelphia (CHOP) and of Penn Medicine. CHOP and Penn Medicine are jointly funding the center’s work, which will include training healthcare providers on how to better screen for climate-induced health risks and treat related conditions, such as lead poisoning and asthma.

Outreach will focus on providers who treat patients with illnesses researchers have linked to climate change, Howarth said. The center will provide clinicians with access to seminars and webinars, as well as online resources to help physicians treat environmental diseases. For example, physicians at the CHOP Poison Control Center are developing a toolkit for physicians to treat patients with elevated blood lead levels. Scientists have linked extreme weather events linked to climate change flooding that keeps metals away from river banks where they were previously confined, making it easier for them to contaminate homes, floors and yards.

The initiative builds on CHOP’s Community Asthma Prevention Program (CAPP), which was started in 1997 by Tyra Bryant-Stephens, MD, its current medical director. CAPP deploys community health workers to homes armed with asthma management supplies and counseling. The new center will use similar tactics to provide patient education and resources. The goal is to reach as many local children at risk as possible.

The future generation of doctors is fueling the growth of climate change education

Lisa Doggett, MD, Co-Founder and Chairman of the Board of Texas Doctors for Social Accountability, announced in March that Dell Medical School at the University of Texas at Austin, Baylor College of Medicine in Houston and the University of Texas Southwestern at Dallas had all decided to start offering a course on environmental threats. Emory’s new curriculum has become more comprehensive each year since its launch, in part due to the contributions of students like Manivannan. Faculty members tasked her with approving new additions to the curriculum on how climate affects health, which in 2019 consisted of a few slides on issues such as extreme heat exposure and air pollution. air and their effects on delivery outcomes.

Climate change material has now been woven into 13 courses. It’s discussed at length in relation to pulmonology, cardiology and gastropneumology, for example, said Rebecca Philipsborn, MD, MPA, FAAP, environmental and health studies program manager at Emory.

The program has only been integrated into the Emory program for 2 years. Philipsborn said the school plans to extend it to the clinical years to help trainees learn to treat conditions such as pediatric asthma.

“Over the past few years, there’s been so much momentum, and part of that is a testament to the fact that we’re already seeing the effects of climate change and how they’re affecting health care delivery,” she said. .

At least one medical journal has recently stepped up efforts to educate doctors about the links between health issues and climate change. Editors of family practice, of Oxford University Press, have announced plans to publish a special issue on the climate crisis and primary health care in September.

Of course, not all climate initiatives in medicine are new. A privileged few have existed in obscurity for decades.

But only now are doctors seeing the connections between health and the environment broadly, according to Aaron Bernstein, MD, MPH, acting director of the Center for Climate, Health, and the Global Environment at Harvard TH Chan School. of Public Health (C-CHANGE), Boston.

C-CHANGE, founded in 1996, was the first center in the world to focus on the effects of environmental change on health.

“It’s taken 20 years, but what we’re seeing, I think, are the fruits of education,” Bernstein said. “There’s clearly a wave building here, and I think it really started with education and people younger than those in charge taking them into account.”

Like the Philadelphia center, the Harvard program conducts climate and health research and educates people from high school students to health care veterans. Bernstein helps lead Climate MD, a program that aims to prepare healthcare workers for climate crises. The Climate MD team has published several articles in peer-reviewed journals on how to better treat patients with environmental health issues. For example, a article on patient mapping in hurricane areas helped shed light on how systems can identify climate-vulnerable patients using public data.

They also developed a tool to help pediatricians provide “climate-informed primary care” ― guidance on how to assess whether children are at risk for harmful environmental exposures, a feature not part of standard pediatric visits.

Like the other programs, Climate MD uses community outreach to treat as many local patients as possible. Staff work with providers in more than 100 health centers, particularly in areas where climate change disproportionately affects residents.

The next major step is to incorporate some of this into clinical practice, Bernstein said. In February 2020, C-CHANGE organized its first symposium to address this issue.

“The key is to understand climate issues from a supplier’s perspective,” he said. “Then these issues can really be brought to the bedside.”

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