“Doctor, will global warming make my allergies worse?”
Are UK medical students prepared to answer this question?
Questions like “Doctor, will global warming make my allergies worse?” will soon be inevitable as doctors are faced with the health effects of climate change. The World Health Organization estimates that in 2012, about one in eight deaths globally was a result of air pollution exposure. This is a direct effect of climate change: two words so prevalent that to many, they have lost their impact. Many medical students are unaware of the threats that it poses to human health and its implications for medical practice.
Healthcare systems are part of the problem of climate change. The NHS is the largest public sector emitter of carbon. Climate change will also cause problems for healthcare systems that are already under pressure. Rising financial costs, the number of patients with chronic illness, and the regulation of carbon emission will affect our ability to provide quality healthcare into the future.
Healthcare systems could also be a part of the solution. Doctors are among the most respected professions and our involvement in communicating the health effects of climate change could “be a driving force for public engagement in climate solutions.” But this can only happen if climate change, and the way it relates to health, is made a core part of the medical curriculum. Only a few medical schools in the UK, however, offer teaching on the subject.
The medical curriculum
Some medical schools already offer teaching on climate change. Bristol, Cambridge Leeds, Leicester, Liverpool, Norwich, and Sheffield offer sessions as part of student selected component modules. Norwich offers a few core lectures and Liverpool integrates learning outcomes into problem based learning.
Over the past year, a group of clinicians, students, and medical academics have articulated the basic knowledge and skills medical students need to protect health and provide quality care under changing environmental and financial conditions. Sustainable health is achieved by “delivering high quality care and improved public health without exhausting natural resources or causing severe ecological damage.” The Sustainable Healthcare Education Network proposes that medical students should understand the inter-relationships between human health and the environment, and that they should have the knowledge and skills to improve the sustainability of the health system. A nationally developed consensus curriculum makes suggestions for the kinds of knowledge and skills needed (box 1).
Teaching students about climate change benefits their future practice and the public’s health. Teaching medical students about sustainable practice has relevance to the prevention of chronic diseases—particularly in areas such as diet and transport. Additionally, learning about the health effects of climate change develops students’ perspectives on health and helps them gain a more holistic picture of patient care. Sustainable healthcare is not a stand alone topic—it should be considered within each medical specialty. For example, the wide scale effects of air pollution on health should be considered when learning about respiratory medicine.
Box 1: Learning outcomes for a sustainable healthcare system
Describe how the environment and human health interact at different levels
Doctor as scholar and scientist
- Outline the dependence of human health on global and local ecological systems, which supply essentials such as air, water, and a stable climate.
- Discuss the contribution of human activity and population size to global environmental changes such as climate change, biodiversity loss, and resource depletion.
- Describe the mechanisms by which human health is affected by environmental change, for example, through changes in disease vectors, exposure to extreme weather, migration, and reduced food security.
- Describe features of a health promoting local environment, in community and healthcare settings, to include access to green spaces, clean air and an active travel infrastructure.
Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems
Doctor as practitioner
- Define the concept of environmental sustainability.
- Explain how trends in demographics, technology, and climate and resource availability might affect our ability to provide healthcare into the future.
- Describe, with examples, the different types of environmental impact resulting from healthcare provision, and how these may be measured.
- Identify ways to improve the environmental sustainability of health systems—in individual practice, in health service management, and in the design of care systems.
- Identify potential synergies between policies and practices that promote environmental sustainability and those that promote health.
Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment.
Doctor as professional
- Explain how the health impacts of environmental change are distributed unequally within and between populations and the disparity between those most responsible and those most affected by change.
- Recognise and articulate personal values concerning environmental sustainability, given the relationship between the environment and the health of current and future generations.
- Discuss ethical tensions between allocating resources to individual patients and protecting the environment upon which the health of the wider community depends.
- Demonstrate awareness of organisational sustainability policies and the legal frameworks for reducing carbon emissions.
Sustainable clinical care pathways such as “green nephrology” support the change to sustainable patient care while improving care quality and efficiency. It involves conservation of water in haemodialysis, developing the online service RenalPatientView, which allows patients to track their own blood tests, and introducing telephone clinics for follow-ups. This reduces the need for results to be printed out, and saves travel time and costs for patients.
The Royal College of General Practitioners, the Royal College of Psychiatry (RCPsych), the Severn Deanery, and Eastern Deanery have funded sustainability fellows. The RCPsych fellowship, for example, aims to research innovations and new models of care, and stimulate adoption of sustainable practices in mental health by working closely with the Centre for Sustainable Healthcare. Educating students would open up opportunities for them to get involved in these programmes or even set up their own projects locally.
What are the barriers to teaching?
One of the barriers to including climate change in the curriculum is the aversion of medical schools to incorporate new topics into an oversaturated course. In many schools the level of demand from students is low because of ignorance about climate change and its effect on healthcare. Even when climate change and sustainability are taught, there are few opportunities to apply practically the knowledge.
The General Medical Council (GMC) states that the role of a doctor is to “protect and promote the health of patients and the public.” However, the GMC has not yet considered including climate change as a compulsory component of the curriculum. Why has this not happened? Perhaps because the curriculum is oversaturated, or there is no demand, or perhaps because of reluctance to change a curriculum that has been refined so much? The integration of climate change within medical school education across the country still has a long way to go, but the sustainable healthcare learning outcomes (box 1) can help establish “eco-medical literacy—the ability to access, understand, integrate, and use information about the health related ecological effects of climate change to deliver and improve medical services.” This is an important aspect of empowering students to combat future health challenges related to a changing climate, and to improve population health today by focusing on prevention of chronic conditions and a better quality of care for a lower carbon cost.
Box 2: What can you do to help?
- Inform yourself on the evidence base of climate change and its health effects
- Complete the BMJ Learning modules on climate change 
- Follow WHO reports on climate change
- Start a conversation with those around you about climate change
- Contact Healthy Planet, the Centre for Sustainable Healthcare, and the Sustainable Development Unit for internships.
- Tell your tutors what and how you want to learn about climate change
- Join or set up a Healthy Planet or Medsin committee
- Be realistic about practical, achievable, and individualised actions
- Be positive about benefits of sustainability instead of adopting scare tactics about climate change
- Motivate using narrative examples of success stories
1Norwich Medical School, University of East Anglia, UK
Correspondence to: firstname.lastname@example.org
Provenance and peer review: Not commissioned; not externally peer reviewed.
Competing interests: None declared.
- Smith Research Group at Brown University. www.katherinefsmith.com/outreach.html.
- World Health Organization. Climate change. www.who.int/heli/risks/climate/climatechange/en/http://www.who.int/heli/risks/climate/climatechange/en/.
- Sustainable Development Unit. Policy and strategy 2014. www.sduhealth.org.uk/policy-strategy/legal-policy-framework/climate-change-act.aspx, www.sduhealth.org.uk/documents/publications/1237308334_qylG_saving_carbon,_improving_health_nhs_carbon_reducti.pdfhttp://www.sduhealth.org.uk/documents/publications/1237308334_qylG_saving_carbon,_improving_health_nhs_carbon_reducti.pdf
- Centre for Sustainable Healthcare Education. Case studies: UK medical school teaching on sustainability, climate and health. 2013.
- Charlesworth K, Ray S, Head F, Pencheon D. Developing an environmentally sustainable NHS: outcomes of implementing an educational intervention on sustainable health care with UK public health registrars. NSW Pub Health Bull 2012;23:27-30.
- Centre for Sustainable Healthcare: Green nephrology. http://sustainablehealthcare.org.uk/green-nephrology/about.
- Royal College of Psychiatry: sustainability. 2014 http://www.rcpsych.ac.uk/discoverpsychiatry/blogzone/drdanielmaughan/sustainability.aspx.
- BMJ Learning. Climate change and health: the basics of climate science and the impacts of climate change: http://learning.bmj.com/learning/module-intro/climate-change-health-science-impacts-.html?moduleId=10017515http://learning.bmj.com/learning/module-intro/climate-change-health-science-impacts-.html?moduleId=10017515.
- BMJ Learning. Climate change and health: the role of the healthcare professional: http://learning.bmj.com/learning/search-result.html?&moduleId=10017629http://learning.bmj.com/learning/search-result.html?&moduleId=10017629.
Cite this as: Student BMJ 2014;22:g2758