In order to advocate for the inclusion of climate change curriculum into medical education, and to highlight the crucial role of healthcare professionals play in treating the effects of climate change on health, the student group UBC Medical Students for Climate Action collaborated to develop climate action learning modules that are now part of the curriculum at UBC’s Faculty of Medicine. The series of learning modules were created by students Montana Blum, Lise Van Amerom, Keiko Patterson, and Sarah Poteryko and they cover topics ranging from infectious diseases to heat stroke to mental health, all of which are impacted by climate change. The group aims to educate medical professionals about the effects of climate change on health and to promote advocacy and action within the healthcare industry.
In this interview, Montana, Lise, Sarah, and Keiko share their perspectives on the role of healthcare professionals in climate action and the steps that medical schools can take to prioritize climate curricula in their education and training.
Words by Aylin Turker, Digital Content Creator
UBC Medical Students for Climate Change (Keiko, Montana, Lise, Sarah)
Can you tell me more about the group of UBC medical students for climate action?
Montana: Our group was born from a research project that started in our first year of medicine. We came together as a research group inspired by the lack of a climate change medical curriculum in our first year. We all had different interests and desires to learn more about how climate change and health are related early on, but there wasn't that much visibility or set aside curriculum content. So we started as a research group, and this last year, we decided to try and expand and become our own established club. So that is how the UBC Medical Students for Climate Action club came to be. The reason why we wanted to move in that direction and expand from the research-only side of things was so that we could include more medical students throughout the years who weren't doing research with us into the space of having conversations about climate change and health and be more engaged across all four years.
What motivated you and your fellow UBC medical students to create these climate action learning modules?
Montana: This kind of ties back to our creation as a club and as a research group. We all had different backgrounds that had situated us in a space of being curious about climate change in health entering medical school. Some of us have different rural experiences, some of us have had to pay closer attention to the wildfires, or some of us have traveled to places and seen extreme air pollution and how that impacted health before coming to medicine. When we got to medicine, I think there was some expectation that those contexts would be included, but when we didn't see much of it I think that was the main instigator that sparked our curiosity. UBC has a built-in research block for medical students that are quite flexible. So this allowed us to really pinpoint our own unique research questions about climate change and health. And we all worked on different research questions to ultimately create the content that is now on our website and available to all other students.
Lise: I grew up in Kamloops where we are exposed to all the wildfires every summer and it is, unfortunately, becoming more and more frequent as the years go on. I even remember from a young age being in elementary school and meeting people in Kamloops in the summer who had been forced to evacuate from other centers around BC and move to Kamloops with basically nothing with them because of the fires. So I think there's definitely an emotional impact of disasters related to climate change from a pretty young age for me. Like Montana was saying, once we came into medical school and kind of thought about and learned a little bit about the impacts of climate change and how it relates to health, I felt like that a point of inspiration to think maybe as a group, we could do something about changing our community or our world for the better.
B.C Forest Fires 2018
Kamloops Forest Fires 2003
Vancouver ranked worst air quality in North America in 2018 after the wildfires
/https://www.thestar.com/content/dam/thestar/news/world/analysis/2022/04/28/the-next-global-mental-health-crisis-is-about-climate-change/_1_climate_covid_web.jpg)
Can you give me an example of one of the topics covered in the learning modules?
Sarah:
We focused on four modules, one for each of us took on a research question, looking at the patient populations that are most impacted by climate change, what sort of diseases are likely to be seen an increased frequency because of climate change, and then the health care system itself and its contributions to climate change.
Finally, the mental health impacts of our climate. My research topic included the specific diseases that are impacted and it broadly looked into infectious diseases, from air pollution from wildfire smoke, and then extreme temperatures. With the extreme temperatures on the module, there's an overview of what heatstroke looks like, the ways to prevent it, and then examples of real-life or local occurrences in 2021. For instance in Lytton BC, during the heat dome over 600 people passed away, and of those people over half had seen a doctor in the previous month. So, the module goes over some of the challenges with addressing the heat dome, and then what to do in future interactions. Thus, the goal of the modules really is to break down what's happening and what future physicians can do.
How have faculty members responded to your group's suggestions to include these modules in the curriculum?
Montana: We've had a supervisor for four years, who's the head of the Global Health Division at UBC Medicine, Dr. Pradesh Kapoor, and she was instrumental in helping us get our research off the ground. There's also been a number of different student clubs that have some kind of climate health focus, for example, the environment or the climate planetary health integration project. They've also helped us during this process and we've been able to come together with them to try and work towards that curricular integration goal.
Sarah: It's been really positive. Just this January, it was given the go-ahead to put these modules into the UBC curriculum starting next year. It definitely took some time in the sense, as Montana mentioned, initially, there wasn't relatively any climate change education. Over the past few years, as we've built the modules, we're sort of at a place now where I think it'll lead nicely into the curriculum. So I'd overall say it was positive.
How do you think the medical profession can play a role in addressing the climate crisis?
Lise: As we’ve been learning about how climate change impacts health, and how it is a social determinant of health in a lot of ways, I feel that medical professionals have a role to play in addressing the climate change crisis and more than that an obligation as it is our duty to do no harm. While there are various areas for health professionals to speak about climate change, the first step is just helping our patients to adapt to climate change crises, like Sarah was just talking about, with regard to the heat waves that have happened. In those times, we know that there are certain populations that are more vulnerable to heat waves, like elderly populations or people with more co-morbidities. So as a physician or other health care worker, being able to recognize patients that are more at risk and being able to talk to them about ways to mitigate those impacts is very important. For example, staying indoors when it's really hot during the day or having a cooling system of some kind - just helping educate our patients to be a little bit more aware of how these crises could be impacting their health.
There's also a role to play in mitigation. The Healthcare system is a pretty large contributor and has a pretty large footprint in terms of climate change and in terms of the waste that's produced. The toxins that go into the environment from education, procurement, energy use, water use, etc. So again there are a lot of ways as healthcare professionals where we can look at our own clinic or hospital and think about different projects that we can implement to reduce those impacts. Lastly, as we have a special voice as healthcare professionals in terms of being able to speak about the impacts of climate change and health, there’s a different lens we bring to the table in the climate change discussion as a whole. So, for those that are interested in being advocates, speaking up, and getting involved politically, it is a really great way and could potentially have a really big impact on our community.
What steps do you hope to see UBC and other medical schools take to prioritize climate action in their education and training of future healthcare professionals?
Lise: The first and biggest piece that I see is education in order for healthcare professionals to be able to recognize the impacts and to speak to their patients. Involving more topics on climate, health, or planetary health in the curriculum would be a really great place to start. They've taken some steps now to start to do that, but there's still some room for improvement. It would also be nice to see the faculty support medical students in different endeavors. Whether that be through funding different projects related to climate change and health or providing support for political advocacy, even though that is kind of a non-traditional role. Finally, raising voices and promoting projects about these subjects, either on social media or in general in their newsletters and outlets would be great as well.
Montana: There are a lot of different physician groups that are involved in climate activism in BC and across Canada. There is a big emphasis on advocacy healthcare as a healthcare professional in our curriculum. It's one of our core competencies that we are encouraged to leave our medical school training with. However, it would be nice to see a little bit more of a blend between that political piece and advocacy from the instructors that are actually interacting with us, and whom we have the privilege of getting to learn from. Sometimes it feels a bit divided being an actual student in the program.
Keiko: For instance, there's the Canadian Federation for Medical Students (CFMS). Each year they do a Canada-wide campaign. In the past, they've done universal contraception, and this year they are trying to go for the decriminalization of opioids. That could be an avenue where potentially I'd like to see some sort of nationwide campaign for climate change and health. Also, in that process, though, CFMS kind of teaches medical students how they can have more of a political voice or write to MPs, etc. - kind of bridging the gap between being taught medical knowledge in school and having a political role.
How do you think climate change will impact the health of people around the world and how can the medical profession help to mitigate these impacts?
Keiko:
Climate change needs to be viewed as a risk multiplier on already existing health, people's backgrounds, and the inequities that they face.
In terms of how I see that changing around the world, air pollution can be an example. As it continues to increase with greenhouse gases, we might continue to see an increase in different respiratory diseases. There's a lot of forest migration that's happening right now due to changes in climate - more so environmental, whether that is flooding, wildfires, water contamination, etc. We'll see more of an acute response, with medical responses being necessary, in those cases. Also, there are more insidious aspects of climate change on health, like mental health. One thing that's starting to be brought up in society is the impact of feeling anxious about futuristic changes in climate. There are more studies being done on Indigenous populations in Northern Canada and looking at how over time their landscape is changing, whether that's loss of the ice caps or just changes in their ability to get to and from home because of environmental changes. We'll see a lot more impacts of mental health on people as time proceeds.
In terms of healthcare mitigation, in addition to what has already been said, there is a perspective from a systems level to not only continue to incorporate education for medical students on climate change and health but also to have us integrated more into our clinical practice. When we take patient histories, it will become pertinent to ask questions such as were you exposed to chemicals and asbestos in your past, where did you grow up, were you exposed to any wildfires, etc. In terms of mental health screening, asking how has the patient been feeling about the impacts of climate change and health is also going to be important to kind of recognize those things that need to be integrated into clinical practice. A personal example of this topic is my research on the impacts of spending time in nature on mental health. Dr. Melissa Lam introduced a BC parks prescription program where you can actually prescribe to patients who spend time in nature. Continuing to try to make that more nationwide,
... encouraging more green spaces to be more accessible to lower socioeconomic status areas, and realizing how all of these efforts are not just for the planet but also for our overall health is key. We are all interconnected.
Can you describe any challenges or barriers you faced in creating and implementing these learning modules?
Montana: We all had some learning to do about knowledge translation and how to showcase the information and highlight it in a way that is easily digestible and that doesn’t leave people with an overwhelming sense of climate doom. We tried to make our content action-oriented and include case examples. Having a balance of statistics and facts as well as tangible case studies showcasing a specific town or community that might have been impacted by climate change was key. In addition to that, as none of us had experience in website design that became an issue. However, we had the opportunity to work with a website designer who became very helpful. The time management of trying to get this project up and running, while we doing our advanced clinical duties on top of school, and also wanting to make sure we were doing everything the right way without having a solid background in content design or medical education was the hardest part. It's been very much a learn-as-you-go process.
Keiko: I guess one future challenge we see is with the website. Because the climate is such an evolving field, how is our website going to be updated relevant in the coming years? How do we make sure that it's still something that people find engaging? We just don't want it to be another kind of medical education or climate education product that isn't used, for years to come. We are definitely thinking about longevity, and we have some students in the years below us that are part of the club and are going to be part of our executive team moving forwards. We also have Dr. Kapoor, who has been our supervisor and such a force in terms of helping us not have the product die, but it definitely keeps going.
How do you see the role of healthcare professionals evolving as the climate crisis continues to unfold in upcoming years and decades?
Keiko: There are four main things I can touch on.
One is that right now we're seeing a lot of acute climate crises. Whether it's the flooding, the wildfires, or COVID-19, a lot of healthcare providers take code. The COVID-19 pandemic, for example, was a kind of unexpected acute response from healthcare professionals. Moving forward now that we know that these crises are increasing in frequency, trying to become more proactive and building up our response plans now is crucial.
Two, as climate change continues to evolve, the healthcare system itself is going to have to take more responsibility for how big of a contribution it is doing as an emitter of greenhouse gases. That is going to require a lot of restructuring of current policies in place, such as waste management, to try to be a model for what we would like to see.
Three, in terms of reconciliation, there are certain things that as healthcare professionals we're trying to work toward with Indigenous peoples regarding the evolving climate change. For example, the wildfires in BC are predominantly impacting different groups. Recognizing that and deciding on whether it is more funding or whether it's more collaboration with Indigenous groups is needed, more attention is going to have to be brought to that issue to ensure we are helping those communities adapt and mitigate these changes they're going to first see.
Fourth is having more of a political voice. Currently, the only one that I'm aware of, is that there was one lawsuit that officially said that climate change was the reason for the death of a young boy in the UK and it was due to air pollution. Moving forward as healthcare professionals, we're going to have to say more specifically how the changes in climate change can really impact health. It's not just necessarily saying “it could” but rather saying that “this can lead to certain co-morbidities with cardiovascular health or respiratory health”. When we're labeling someone who has died, the words in the conversation around it needs to change to actually have a bigger effect - saying that climate change can lead to death and certain other negative medical outcomes.