Health Care and Climate Change
Climate change has been called the “greatest public health challenge of the 21st century,”1 with ramifications making the COVID-19 pandemic seem transient. This global pandemic provides important perspective on how we can respond to external challenges, even when science is politicized. It also shows us how important it is that healthcare providers and systems proactively work to prevent far-reaching climate-change related disasters and public health crises that pose more risk to particular populations and communities. The pandemic has forced each individual, industry, and government across the globe to reckon with its immediate repercussions. Along the way, we have seen the value of collective action, the human and economic consequences of collective inaction, and the power of prevention in “flattening a curve.”
Climate change demands the same urgent, collective action. Now is more important than ever for healthcare providers, educators, researchers, and academic institutions to lead on curbing the climate crisis. The world looks to healthcare providers for advice on how to respond to public health threats such as COVID and climate change. As advocates for the vulnerable and underserved, we need to continue highlighting at-risk populations and develop strategies to mitigate adverse effects which will disproportionately impact those least able to deal with them. Accordingly, we urge individual SGIM members and the collective organization to increase awareness of the following:
- health impacts of climate change,
- informing related treatment choices,
- educating health professionals, and
- advocating for policies and practices that address the health effects of climate change.
By highlighting concrete examples of SGIM members’ work, we hope to encourage further discussion on how SGIM as an organization can effectively address the growing specter of climate change.
Education on Climate Change
At the University of Colorado School of Medicine, SGIM member Dr. Beth Gillespie partnered with faculty from emergency medicine to offer one of the first medical school electives on climate and health. The two-week course gives students a broad overview of fundamental topics including climate science and communication; water-, vector-borne, and heat-related illness; water and food security; extreme weather; air quality; healthcare systems; and international governance. The first week, students break out into small groups after morning lectures to work through relevant problem-based scenarios. Written by course directors, each scenario has learning objectives designed to complement topics addressed by experts in their lectures. Beyond these scenarios, students are expected to lead one journal club discussion on an article from the literature, and to write an op-ed then share it with peers for feedback. Other activities from pre-COVID offerings include a local field trip to the National Science Foundation Ice Core Facility and three-day mountain retreat to the YMCA of the Rockies.
Fellowships in Advocacy and Equality
The University of Colorado also supports a rotating climate policy fellow for recent residency graduates; these fellows help direct the above-mentioned course. Dr. Gillespie is also working with fellowship directors to pilot a mid-career fellowship option to allow teaching faculty access to the network of experts in communications, research and policy while being able to continue their “day job” of clinical and academic obligations.
Another example of such fellowship training comes from Dr. Gaurab Basu, a longtime SGIM member and co-director for the Center for Health Equity Education and Advocacy (CHEEA) at the Cambridge Health Alliance. Centering the professional responsibility for clinicians to leverage change in their communities, Dr. Basu teaches on principles of advocacy across the continuum from physician trainees to mid-career healthcare professionals. CHEEA exemplifies this effort by featuring programs, such as the Health Equity Scholars, that educates mid-career healthcare professionals on knowledge and skills to advocate for health equity, including featuring climate change as a case study on the importance of advocating for change.
Leadership in Professional Societies
As SGIM members know, professional organizations give us platforms from which to advocate for a variety of issues. Long-time SGIM member Dr. Matt Hollon responded to the compelling position paper on Climate Change and Health published by the American College of Physicians in 2016 with a plan to improve awareness. After becoming governor of the Washington ACP Chapter, Dr. Hollon made it his goal to put climate change advocacy into action. Through this position, he engaged colleagues and the community through multiple routes, including speaking at state ACP chapter meetings, regional SGIM meetings, and university grand rounds; as well as engaging the public in editorials and social media. This leadership position allowed him to work closely with his state medical society to build coalitions with other state chapters of health profession societies thereby leveraging support and advocacy for specific state government policies and legislative actions.
Collective Advocacy with Professional Societies
As an organization, SGIM has officially partnered with the Medical Society Consortium on Climate and Health, an organization of more than 29 prominent member societies, such as the American College of Physicians, the American Medical Association, and the National Medical Association, that represent more than 60% of total practicing U.S. physicians. The Consortium “has pursued a three-pronged strategy of organizing, empowering and amplifying the voices of doctors and other health professionals” to address climate change and its impacts on human health. In June 2019, the Consortium developed and released the U.S. Policy Action Agenda on Climate, Health and Equity endorsed by almost 150 health professional societies and 500 hospitals in the Health Care Climate Council.2 The document includes 10 specific policy positions to address the causes of climate change, support healthy alternatives, prepare for environmental and social stressors likely to result from climate change, and support meaningful economic changes to limit impacts, and to help health systems engage in prevention and response. The Consortium will also offer an annual conference for interested healthcare providers from all levels of training and practice. Collaboration with the Consortium will continue through the SGIM Health Policy committee and the designated liaison, Dr. Bill Weppner.
What We All Can Do
Some challenges seem so sweeping as to be unsurmountable—but, as we write this, vaccines for the COVID-19 pandemic are being administered as a result of an amazing response by scientists and researchers. Similarly, we see glimmers of hope as more people and professional organizations confront the health risks of climate change. And while we may hope for a technological solution, it doesn’t take a luddite to realize this likely won’t be sufficient. So, what can we do as individual physicians and members of SGIM?
Taking inspiration from the work of our above-cited colleagues and the innumerable projects starting and flourishing around the world, we encourage SGIM members to look at what they are doing individually and seek ways to incorporate discussions on climate change into their work. This is the foundation of advocacy: individual actions in our lives and practices at our home institutions that serve as practical examples. In clinical settings, this can be talking to patients about “co-benefits” that help to support a healthy life and healthy environment, such as incorporating human-powered transportation and increasingly plant-based diets. In educational settings, we can apply skills in curriculum development, case-based lectures, and other collective teaching formats to teach trainees about the current and expected health effects of climate change. We can find venues to share our concerns with the public regarding our concerns as health care providers. As part of regional and national conferences, we can propose workshops, educational innovations, and other forms of academic work to support the understanding of academic internal medicine teachers and leaders in addressing climate change. We can use virtual venues such as GIM-Connect to share curricula and ideas.
And, of course, this is just the beginning! For more actions and resources, SGIM membership can use to address the health effects of climate change, please refer to the Q&A by Drs. Eric Bass and Bill Weppner in this issue of the Forum.3
At the “top tier” of advocacy, SGIM pursues formal lobbying regarding national policy. While a global climate crisis may be outside the limited bandwidth that SGIM lobbying efforts focus on, we as an organization can continue to collaborate with other academic and healthcare organizations to lend our name and weight to policies addressing root causes of climate change. As part of this, we proposed a policy statement to the SGIM Health Policy Committee that offers to clarify SGIM’s stance on climate change and streamline ongoing work by Health Policy Committee members as they review positions from outside organizations seeking potential endorsement. As physicians, educators, researchers, and leaders, we are obligated to respond to the evidence. There is ample evidence that unfortunately, humans and our activities have caused the impending climate crisis. Organizations like SGIM provide us a professional home in which we can acknowledge this, then collaborate and share ideas on solutions.