By Cecilia Xu
Honourable Mention, Writing Competition 2017

Prompt 3: Describe an aspect of medical school or medical practice that we do poorly, and discuss how we could best remedy this.

In 2009, The Lancet published a landmark report declaring climate change to be the biggest global health threat of the 21st century (1). It was the first report published in a medical journal of this calibre to draw attention to the effects of climate change on human health, both now and into the future. These included water and food insecurity, extreme weather events such as heatwaves and floods, and increased burden from infectious, psychological, and cardiorespiratory diseases. In 2015, a follow-up report was released (2). Unfortunately, projected outcomes were even more severe than originally anticipated. We are now in the midst of a global health emergency.

I became aware of climate change as a health issue during medical school – but not through the academic curriculum. Rather, I’ve had the privilege of attending conferences and symposiums, being a member of Doctors for the Environment Australia, and having conversations with colleagues who share my concerns. But caring about the environment should not be a niche interest. We are all inhabitants of this planet, and what happens to this planet is everybody’s problem. Considering the impacts of climate change on health and the future of medical practice, I would argue that it is especially crucial for doctors to be informed on this matter.

Eight years have now passed since the first Lancet report, yet we are only just beginning to see changes in the medical curriculum. At Monash, the concept of climate change and health is touched on in the first year introductory lecture on Population Health, and second year students may elect to participate in a two-week Prevention Science program in lieu of a rural placement, including one session on climate change. Before this year, this was the extent of climate change teaching in the curriculum.

In August 2017, Monash introduced a seminar on climate change and health for second year students. I had the pleasure of attending this seminar, and found it to be highly informative. However, the turnout from the students was poor, with only a quarter of the cohort in attendance. I was disheartened by this, but unsurprised — Theme II (population health) lectures have a history of being poorly attended. Based on my discussions with preclinical students and my own experience of being one, I can think of a few reasons why. Although these issues are applicable to population health teaching as a whole, my discussion focusses on climate change, as I believe it is an especially deficient area in our learning.

Firstly, social issues taught by academics tend to focus on problems and technical concepts. Medical students are, above all, doers. We are quick to grasp the links between climate change and poor health, but without practical, relevant solutions, we can feel lost and disempowered. It is crucial to emphasise that we are powerful. Many believe that health will be the gamechanger in the climate change political debate. Doctors will play a key role in educating the public and advocating for change; learning strategies on how to harness this voice effectively would be invaluable.  Many lifestyle habits that benefit the environment, such as using active transport and increasing intake of plant foods, are also conducive to better health (3). These planet- and people-healthy habits could be encouraged in both ourselves and our future patients. Furthermore, doctors are leaders in their workplaces and can spearhead initiatives for more sustainable hospitals. Western Health anaesthetist Forbes McGain is a prime example of this. He conducted research on surgical and intensive care equipment that allowed the hospital to drastically reduce its environmental footprint. Focussing on practical solutions will help students to see the importance of this teaching and prepare them for their future roles in society.

Secondly, population health content is excessively segregated from the rest of the curriculum, which reinforces the myth that it is not as important. In keeping with the effective integrated structure of our MBBS program, I would like to see climate change incorporated in all aspects of our learning. A potential strategy may be to brief all lecturers to consider climate change in their teaching and to include it wherever it may be relevant. If students hear the population health messages echoed throughout their curriculum, they are far more likely to engage in the content.

Lastly, population health content is considered less examinable. And let’s be realistic, nothing motivates medical students to learn like EXAMS. But assessing understanding of social science-related topics using EMQs has its shortfalls; these are often deftly navigated by memorising a few key formulas and statistics. A better mode of assessment may therefore be a short assignment or research project, allowing students to explore an aspect of climate change and health of their choosing.

From the beginning of our medical training and throughout our careers as doctors, we are told to first do no harm, and secondly, to do good. If we are to truly take this as our creed, we must be responsible global citizens and use our position to influence positive change. We must all be environmentalists for the benefit of our patients. We must be informed of the science behind climate change, so that we can be active voices in the public conversation. We must be prepared for the changes in medicine due to climate change, so that we can effectively care for our future patients. And we must do our best to mitigate the effects of climate change, both at a personal and political level, to protect the health of all people around the globe for generations to come.

Climate change is no longer a distant, scientifically tentative issue belonging only in the realm of tree-huggers and left-wing politicians. The 2015 Lancet report release was optimistically titled “Tackling climate change: the greatest opportunity for global health.” It is my hope that doctors, students, and medical schools will seize this opportunity without delay.

In preparation for writing this article, I spoke with Monash curriculum directors and current students from various year levels.  All ‘Climate and Health’ publications by The Lancet are freely available here:

http://www.thelancet.com/climate-and-health

References

1. Costello A, Abbas M, Allen A, Ball S, Bell S et al. Managing the health effects of climate change. Lancet 2009;373:1693-733
2. Watts N, Adger WN, Agnolucci P, Blackstock J, Byass P et al. Health and climate change: policy responses to protect public health. Lancet 2015;386:1861-914. Published online 23 Jun 2015. DOI: 10.1016/ S0140-6736(15)60854-6
3. Friel S, Dangour AD, Garnett T, Lock K, Chalabi Z et al. Public health benefits of strategies to reduce greenhouse-gas emissions: food and agriculture. Lancet 2009;374:2016-25. Published online 25 Nov 2009. DOI: 10.1016/S0140- 6736(09)61753-0