Below is the transcript of the following Academic Medicine Podcast episode:
Teaching Climate Change and Its Effects on Human Health
April 19, 2021
Read more about this episode and listen here.
Toni Gallo:
Hi everyone, I’m Toni Gallo, a staff editor with The Journal, and host of the Academic Medicine Podcast. In honor of Earth Day later this week, I’m talking to Doctors Kari Nadeau and Ari Bernstein about teaching physicians and trainees about climate change and its effects on human health. Both our guests have papers in the March issue of The Journal on this topic. Before we get into our conversation, could you each introduce yourself for our listeners?
Kari Nadeau:
Thank you. It’s an honor and privilege to be here. Thank you so much for doing this podcast and for making a special interest in Earth Day, which is so critical. My name is Kari Nadeau. I’m a professor at Stanford University, work in climate change and asthma, allergy, and immunology. I’m a pediatrician, I’m a scientist, I’m a mom, and I’m really grateful for being able to work in climate change and at The Journal focus on these papers. Thank you.
Ari Bernstein:
I’m Ari Bernstein. I’m the interim director of the center for climate health and the global environment at the Harvard T.H. Chan School of Public Health and a pediatrician at Boston Children’s, and I don’t think I could have said it any better than Kari did. It is terrific that The Journal has focused on climate and the education of medical students and residents and beyond, especially as we look at Earth Day and thinking about what we need to do to make sure that people in health care are doing everything we can to keep our patients out of harm’s way, and in fact, contribute to solving the climate crisis more broadly.
Toni Gallo:
I appreciate you both writing about this topic and joining the podcast to talk about it. The science has shown us that human activity is causing an increase in greenhouse gases, like carbon dioxide, in our atmosphere. As a result, we are seeing rising temperatures, warming oceans, rising sea levels as ice in the Arctic and Antarctic melt, more frequent extreme weather events like floods and droughts, increases in air and water pollution. Around the world, people have begun to experience the health effects of this rapid climate change.
Toni Gallo:
Could you start by describing what those health effects are and what that might look like for physicians in their everyday practice?
Ari Bernstein:
I think it, on the one hand, can be a little challenging to link a colorless, odorless gas in the Earth’s atmosphere to something that would matter to someone providing care in a clinic or in the hospital. But it’s absolutely the case that what we’re doing to the climate is directly affecting our ability to do our jobs. It can be hard to see on a day-to-day basis, but I’ll give a good example from my own experience, which was in February, after Hurricane Maria made landfall in Puerto Rico the prior September, we were still rationing IV fluids in Boston.
Ari Bernstein:
In fact, as best I know, every hospital in the country is rationing IV fluids, because the hurricane knocked out a supply facility, a manufacturing facility for saline bags, and this had a domino effect throughout health care. It caused lots of errors in medication administration, particularly in emergency departments to children because people were forced to … There were no IV bags, so people doing IV pushes, the medications, were seeing dystonic reactions. We know the science is quite clear that heat in the oceans, and the oceans are absorbing 90% of the heat that the greenhouse gases are trapping, is food for hurricanes.
Ari Bernstein:
So, we’re seeing much more powerful storms, we’re seeing downpours of biblical proportions like happened with Hurricane Harvey in Houston, which left five feet of rain in the span of a day or so. That has direct effects on our ability to deliver care, but of course, climate change matters to every aspect. Climate change shows up in premature birth. It shows up in whether or not a child has to go to the emergency room with asthma from ozone air pollution or extreme heat. It matters to mental health. It matters to nutritional security, housing security, which is a key determinant of whether children are leading healthy lives or not.
Ari Bernstein:
Really, for any piece of a physician’s career, climate change matters directly to care. The challenge right now, and why we wrote these papers, is we need to bring climate to the bedside. We need to make it clear to people in practice that we’ve got to pay attention to this if we’re going to, in fact, provide high quality care.
Kari Nadeau:
I think Ari said it excellently. In any field of medicine, this is currently or will in the future touch all specialty areas, all primary care from young to old to pregnancy and beyond. I think all of us in the health care profession and allied health care professionals need to learn and to be able to study what happens in climate change, both in the public health sector, as well as individual health for ourselves, for our families, as well as for our patients. Ari talked about, what are some of the major issues that people deal with during climate change? This is going to just increase in nature.
Kari Nadeau:
Some of these more systemic issues like increasing the temperature, increasing dust storms, that no one is immune to these aspects around the globe. Even though, in any one given area, you might suffer from extreme cold compared to warm, it’s still these extreme weather conditions that are reflective of global climate change. That’s something that we need to anticipate as health care providers, and I’m so glad that your Journal is focusing that with teaching and for medical students and residents and beyond. Thank you very much for making sure that this is top of mind.
Toni Gallo:
Well, it’s definitely a really important issue. Both of you mentioned some different vulnerable populations, whether it’s people living in poverty, the elderly, those with chronic health conditions, and how climate change is affecting these groups specifically and more than other groups. I wonder if you could talk about what that looks like and why calling attention to these health effects is particularly important for physicians.
Kari Nadeau:
Yeah. I think I’m happy to comment on that if that’s okay. I want to make sure that we do focus, and I know that Ari has the same opinion on the underserved, and especially pediatric and pregnant women. The WHO estimates that about 7 million people die annually from air pollution. Of that, we know that there are about 4.2 million pediatric deaths. In terms of a sensitive population, in terms of an underserved population, many of those children are in areas that they can’t necessarily escape from the PM 2.5, the particulate matter 2.5 microns, that’s associated with air pollution.
Kari Nadeau:
We know that people, unfortunately, of color, and especially those in poverty, they are going to unfortunately, be targeted by climate change, and that their health is going to be reliant, not only on access to health care, which is decreased if you are impoverished, or if you can’t get access, if you live in an area that doesn’t have access to health care, but in addition, not only are these structures in place that discriminate against the opportunities for the underserved and people of color to get access to health care when in need for climate change.
Kari Nadeau:
But unfortunately, when we look at toxic waste dumps, when we look at those populations that are already next to places where there’s going to have an increased amount of issues around climate change, for example, industry and toxic waste dumps, a lot of the populations that are black or people of color or the underserved, they live near those structures, and they’re going to be at much higher sensitivity towards dealing with the effects of climate change because of that. I think we have to focus actively on people and children and pregnant women that are in the underserved category to help them with climate change effects and mitigation.
Ari Bernstein:
Kari really hit the nail on the head. The image I use with students on this is, we’ve all heard of the straw on the camel’s back as sort of an idiom about how even small pushes on something that is already vulnerable can make a big difference. With climate change, it’s the air conditioner on the camel’s back. That’s the image I put out there. Any individual, as Kari pointed out, and who’s been marginalized in society because of discrimination, race-based discrimination, gender discrimination, socioeconomic status, they’re economically disadvantaged, chronic medical conditions, these are the folks in the United States who are already most at risk for adverse health outcomes and climate change is the air conditioner on their back.
Ari Bernstein:
It is tipping them from a state of essentially stable to unstable. That can be through surprising pathways. It can be through financial stress when your home gets destroyed by flooding. It can be through how climate change flooding can affect communities, power outages, or it can be quite direct. It can be directly through the, what we know about heat effects on pregnancies, on the elderly etc. I think that’s one of the challenges we face is that I think the medical providers, it often seems that climate change is one step away from the bedside.
Ari Bernstein:
But the reality is, when you look at the data, it is at the bedside and we’re just not seeing it as much as we do, and so the educational piece here is key because in order … There’s so much more we could do to keep people out of harm’s way. The evidence tells us that, and we need to start doing that in our practice so that we can make that difference.
Kari Nadeau:
Absolutely. We need to ask questions. One thing, Toni, I’ve realized is to ask deeper questions when I see patients. For example, I’ll give you a story that exactly reflects what Ari was mentioning. We take care of people in Fresno, the Central Valley, and I have a family that lives just across the street from a toxic waste dump. There are a lot of gases admitted there, and so a lot of the families along that boundary have asthma and a lot of allergies, and that’s my field.
Kari Nadeau:
I take care of that family, but then on top of that, there’s a lot of pollution in the Central Valley. Unfortunately, because of environmental justice issues, the Central Valley has a lot of immigrants, and pollution is extensive there. It’s been that way for years. Now, put global climate change, and the extent of the drought and wildfires, and this same family that I take care of, this past August was dealing with smoky days of wildfire, so they have this asthma proclivity already because they live near a waste dump, there’s lots of gases, there’s lots of pollution.
Kari Nadeau:
Then add onto that, the wildfires that they have to suffer through. During the wildfires, they don’t have the means to go and evacuate. They didn’t have any clean rooms to go to. They didn’t have any air conditioning when it got over 120 degrees there, and they had no place to go with a filter. So, they opened up their windows and they get a waft of wildfire smoke and they have nowhere to go so they just had to put on masks, but there weren’t enough N95 masks to go around.
Kari Nadeau:
They literally had to get exposed to two weeks of high amounts of smoke because of the wildfires. The Central Valley has dealt with climate change extensively, as many other parts of the country have. But for example, in the Central Valley and the counties around the Central Valley, they have 140 days of smoky air due to wildfires a year now. This is just hopefully giving some examples of people that we’re treating, that we care about, as medical doctors, we need to ask, where are you living? How many days are you exposed to certain air pollution?
Kari Nadeau:
And how many days can you breathe or you don’t feel comfortable breathing? Do you have masks to use? Do you have air conditioners? Do you have filters nearby? Because if we ask these questions that are very operational, that are very logistics oriented, we get a better feeling for what capabilities these vulnerable populations have, what resources they have, and what resources they don’t have. For example, statewide, I think from a public health perspective, we also need to educate our public health officials and government.
Kari Nadeau:
When we had evacuations in California recently, there were no evacuation write-ups and guidelines in Spanish. So, much of the populations that needed to learn how to evacuate didn’t know how to do that because the guidelines weren’t written in the language that they understood. It’s these things that I think, as medical care professionals, we need to make sure they have the resources, and if they don’t, we need to understand them and try to help them.
Toni Gallo:
I think you’ve done a good job sort of explaining both of the work that you two have done. You talk about, not just teaching sort of the health effects, but also the science of climate change so that physicians can understand some of the underlying factors, what might be causing problems, and that’s why people are showing up at the hospital. It’s not just treating them when they get there, but really understanding the environment that they’re coming from.
Ari Bernstein:
Yeah. I think that’s critical, Toni. It would be sort of like teaching about HIV, but not understanding it’s a retrovirus. One of the things that’s important to underscore is we have a lot more to learn about how the greenhouse gases in the atmosphere are affecting health. We often talk about pathways from greenhouse gases to health outcomes, because we know that the greenhouse gases are affecting the wildfires that Kari is seeing in the patients in the Central Valley. We know that they’re affecting the heavy downpours we’re seeing in New England, not from hurricanes, from rainfall.
Ari Bernstein:
It may not be visible in every way that it … at least scientifically visible, in every way that will manifest in the future. We have to understand these pathways and how they evolve so that providers are mindful that it turns out that waterborne diseases can show up in places that are surprising. We’ve seen this already with vibrios moving into Alaskan waters, which was unprecedented because it was too cold for them, and they’ve been going up the coast of New England, the harmful algal blooms we see in the coast of Florida, which is another combination of runoff, which has been there for a long time and warming oceans.
Ari Bernstein:
Understanding the pathways, how greenhouse gases affect earth systems like the temperature or the precipitation cycle, and how those systems change wildfire risk in certain places and change rainfall patterns and others so that you can have some sense of what to expect because not every manifestation of climate change is here right now. If it is here now, it’s going to change as it continues to unfold. I think it’s critical that physicians have some underlying knowledge about how the climate works. I think it’s critical that they be able to trace from those emissions to what they’re doing in a clinic, whether that’s in terms of preparedness along the lines of what Kari’s saying.
Ari Bernstein:
It’s still, to today, that many families that are in direct harm’s way from air pollution and have no guidance about how to address it in a proactive fashion, which could prevent harm, yet there’s knowledge about how to prevent those harms. Not that they would have the resources as Kari pointed out, because often there are resource shortages, but often, there are plenty of resources that are simply not deployed because no one bothers to ask or understand the risks from climate that is directly affecting those patients. We’ve got to get that chain of knowledge in place because it … And just to put a fine point on this, we work so hard, and an example of asthmatic is good, to control asthma.
Ari Bernstein:
We ask about symptoms. We give controller medications. All of that is almost useless if you’re in the middle of a wildfire. Why would we invest all this time, energy and money and miss out on something that could thwart all of our efforts in the span of a day? It doesn’t make sense. It’s not the best patient care we can deliver and are capable of. I think, once these kinds of issues come to the fore, we’re going to see this more and more. And we are. We’re clearly seeing major advances. I’ve been teaching on climate and health now for over a decade and I’ve watched this trajectory, and there’s no question at the moment that this idea that climate change matters to clinical practice is really coming to the fore.
Kari Nadeau:
Couldn’t agree more, Ari. I think I’m very optimistic and positive that given the fact that the movement is there, that the AAMC, the WHO, the National Academy of Sciences, the AMA have now had this. I think more and more, the boards, the USMLE, we really need to make sure that people understand this is coming. This is here already. We’re developing curricula that can be put into all aspects of medical schools, Toni. Like you mentioned, there’s a lot of knowledge now on the science, on the molecular details of how one smoke particles can enter into the lungs, and that, that gets absorbed into the bloodstream, and how those particulates, which there are about 200 toxins in your average breath of wildfire smoke, for example.
Kari Nadeau:
When you think of the toxins brought in from water pollution during flooding, when you think of the other dust storms that are going on in the deserts in Africa, all of these things are bringing in items in our body that are foreign. Understanding how our body then responds to that is critical, and that’s typically in the first and second year of medical school. The fact that only a third of the medical schools right now, the AAMC did recently do a survey in 2018, in which out of the 147 medical schools around the country, only about a third have curricula for climate change.
Kari Nadeau:
We need to change that. Not only do we need to have it just in one year, maybe year one or two for the basic science aspects of how air pollution or other ill effects like vector-borne diseases are spreading across different zones now within our globe, like Ari mentioned in terms of now, because it’s getting warmer, we’re going to see a transmission increase across the world, but years, three and four too, we need to make sure this is part of clinical training at the bedside. How do we speak to patients about this?
Kari Nadeau:
What makes sense? How do we understand the needs of different communities? People in Jamaica and Puerto Rico are going to have different questions about climate change than patients necessarily in Utah. Making sure that as medical students, they’re trained in first, second, third, fourth, and then, as Ari’s article points out, during residency. So this is a critical piece of knowledge as we move forward as health care professionals, to make sure that it is woven into the fabric of our education and that we learn to use it in our vernacular, in our discussions professionally, and then also with patients.
Kari Nadeau:
I’m glad that the AAMC is doing something about it, and we need more articles like this, and then take it forward. Ari and I were just involved with a great discussion with the New England Journal with residents asking questions. It’s basically a 360 feedback mechanism, and things like this that are interacting with the media, with podcasts like you’re doing here, these are going to help us get this conversation going in many different levels.
Toni Gallo:
You mentioned in your paper, you looked at what different medical schools are doing. I wonder if you could just highlight a couple of examples or maybe what your institution is doing, just so our listeners can get a feel for what some of the existing curricula look like.
Kari Nadeau:
Yeah, I think it’s great. I think each medical school has a grassroots and again, thanks to medical students, residents, and fellows, I think that we, as faculty, as Ari and I were mentioning today, this also needs to envelop all of the wonderful groups of students that are moving forward and want to be taught this. There’s a captive audience, and thankfully, many medical students have tapped on the door of their administration and said, “We want this in our medical schools.” You see that coming forward.
Kari Nadeau:
In the article that we wrote, we have one table which discusses all of the great curricula that are moving for University of Minnesota, Emory, Harvard, where Ari is, Stanford. We have now started an elective with emergency medicine in which all undergrads, as well as medical students can take as part of their core curricula to help understand the effects of climate change in health. We’re also working with every core director for our year three and year four curricula to make sure that those advisors in those particular rotations talk about climate change.
Kari Nadeau:
So, we’re starting to develop curricula that can be used for licensure. Then finally, we also want to educate ourselves. I think there are many doctors in the community that don’t know about the importance of climate change in health. We’re also hoping that our medical students at all years, year one, two, three, and four, and residents, when they work with people that are older than them, and that might not have grown up in their medical education about climate change, that they will also have a ripple effect so that the students become the educators. The educators are the educators, but it’s important to know that it’s a two-way street. At Stanford, we’re hoping that this will have a multiplicative effect as we educate others and our patients too.
Kari Nadeau:
But Ari can talk about what’s going on at Harvard. I really am inspired by items that Ari has already put into place with his group there to help medical students and residents.
Ari Bernstein:
Oh, that’s kind of you to say, Kari. We’ve made great progress and we’ve got a lot of room to grow. I think one of the things we realized early on is that what is generally done in climate and health education, even at medical schools in many cases, is really public health education, which is critical but isn’t necessarily the best fit for medical schools. I think we need to really think clearly about what does matter in the climate and health curricula to medical students. We worked a lot with people in various specialties.
Ari Bernstein:
We worked with – certainly the students that have been instrumental. In fact, I would argue, in many, if not most cases, the students know far more about these issues than the faculty who are charged with teaching them, which makes for some awkward scenes. But I think the first point was that it makes a lot more sense to not only make it medically focused curriculum, but to make it focused within the structures of the curriculum that is present already.
Ari Bernstein:
Putting climate and health curriculum in as the fifth wheel is not as effective as has been done, and I think there are really good examples of this at Mount Sinai in Perry Sheffield’s work, and UCSF, and many other schools where the curriculum was sort of searched through, and people said, if we’re talking about asthma, but we’re not talking about air quality and the result of climate change, we should probably do that. If we’re talking about side effects of like anti-cholinergic medications, we should probably emphasize heat risks because the climate is already substantially warmer and the risk profile of many medications is changing in real time, but we’re not telling people about that and we could be causing harm sort of mindlessly.
Ari Bernstein:
I think focusing on integrating it into the curriculum in a systematic way in ways that are clearly linked to medical care is a foundation, and that’s very much what we’re trying to do here. We’re also trying to span across the spectrum, so undergraduate medical education, residency, we’re developing courses for continuing education. I think we’ve got some catch-up to do for sure, but as I alluded to before, I mean, Kari said there are maybe a third of medical schools. That’s one third more than there were when I started working at our center in 2001, 20 years ago. It’s growing, and I would say quite rapidly still.
Toni Gallo:
You’ve mentioned some of the science and then the clinical aspects. One of the other things you touch on is physicians as advocates for climate change policy. I wonder if you can talk a little bit about that and why you think physicians are well suited for this role.
Ari Bernstein:
I think at a core of being a health care provider, when one asks, what is our responsibilities, what are our core responsibilities as professionals, it’s to diagnose and treat in as humane, effective way as we can. There are many circumstances in which we get there, and there are circumstances in which we don’t, and there are also circumstances in which there are problems for which we cannot effectively diagnose or treat. When it comes to climate change, there’s absolute relevance to diagnosis and treatment that are very relevant, but there is a huge issue around what’s at stake, not just for our ability to do our jobs, but for the very welfare, the people we’re trying to diagnose and treat for any condition in general.
Ari Bernstein:
Oh, by the way, our trying to protect lives and livelihoods in our day job is causing a relatively large amount of harm in the process that we don’t quite see, and frankly, it’s kind of hard to look at because we like to think that everything we do is beneficent, but it turns out that in the United States, health care, and largely hospital-based care, largely procedural care, but also clinics is responsible for about 8% of the entire greenhouse gas emission profile of the country. With that burning of large, essentially all fossil fuels, is a lot of air pollution, and that air pollution is causing harm on par with the harm that led to the 100,000 Lives Campaign to prevent medical errors in hospitals.
Ari Bernstein:
We must advocate for change because if we’re not trying to get our own house in order, who’s going to … Do we want other people to tell us to get our house in order? I mean, I suppose we could wait that far, but I think it would be far better for us to get our house in order first. I’m the first to acknowledge that there are real challenges there for … Including for hospitals near and dear to my heart, that there are real systemic obstacles, but then we need to address those, because pretending we don’t have a climate problem and pretending it’s not because of us isn’t going to get us to where we need to go.
Ari Bernstein:
Then, of course, we need to be advocates for our patients. I mean, as we talked about, climate change is the air conditioner on the camel’s back. The folks who we worry most about whose health status is the most tenuous, their access to care the most at risk, who we’re trying every day to figure out how to protect that individual, we can do everything in our power, but if climate change is going unmitigated, it’s not going to matter much, and that’s the truth of the reality. Here’s a good example, and that kind of statement, I think, jars a lot of people to say, well, if it’s really that true, why aren’t we doing anything more about it if it’s really incredible?
Ari Bernstein:
Here’s what the science says. The Intergovernmental Panel on Climate Change, which is the group of scientists organized by the United Nations to get together – international scientists to assess the evidence for climate change, and to give a summary of that to policy makers so that they can make informed decisions. In one recent report, they said, what’s the difference between a world that warms one and a half degrees Celsius from the pre-industrial baseline and two degrees Celsius? And we’re well past one degrees already.
Ari Bernstein:
One and a half degrees is not so far off. In a one and a half degree world, there are about one in seven people living in the world today, including many in the United States who would be living in places that every five years it would be too hot to survive outside. In a two degree warming world, the science suggests that once every five years, it’ll be too hot for one in three people to survive. This is not inconvenient, uncomfortable, it is too hot for our bodies to physiologically adapt. When I say all these things we do to protect vulnerable people are critical, but if we ignore the climate problem, that’s what I’m talking about.
Ari Bernstein:
In my view, we can’t just sit back and say, “Well, it’s somebody else’s problem. It’s a public health problem. We need our policymakers to step up.” No, we need to step up. That’s not just because we’re the health people who are taking care of these folks, it’s because we have research that shows time and again, that in the United States, where climate change is politicized, which it isn’t everywhere, but there are a lot of places where it’s heavily politicized, that people see it, not as a scientific issue or how to fix-it issue. If you think it’s a problem, you’re of one stripe, and if you think it’s not a problem, it’s another stripe, that when health messages reached those places, it brings the issue down to size.
Ari Bernstein:
It makes it personal, it makes it actionable, it makes it urgent. You know who the best messengers are, the research also shows? Health care providers, especially primary care providers. We saw this. I mean, if you don’t believe me on the evidence, which I’m happy to share, there are many peer reviewed papers on this, we saw this in COVID in the research on who, in communities across the United States, did people trust for information on coronavirus? Was it someone at the CDC? Maybe a little bit. Someone in the state government? Maybe a little more.
Ari Bernstein:
It was their personal provider. It was the person they knew and had the direct link with most. There’s an obligation to get our own house in order to advocate for that. There’s an obligation to advocate to protect our patients. Frankly, as I see it, there’s an obligation for health care providers who are willing to stand up in their communities and talk about this for the sake of everybody in addressing the climate crisis at its root.
Kari Nadeau:
I think, Toni, for your listeners, it is now much easier to get involved on the policy level, that like Ari is saying, it is our obligation, it is our privilege as people that care for others as a trusted source, and we deserve that trust and we work very hard to deserve that trust, that it is our obligation and privilege to be able to help advocate for others that can’t speak for themselves, or that don’t necessarily have adequate representation. I think that in my, at least small amount of work, which I hope will be more, talking to the California state legislature, talking to the US Congress, talking to the US EPA, that our voices are heard and reverberate, and the more we have science behind us the better.
Kari Nadeau:
We have enough science now. We really do. That we have the science now to be able to say, let’s move forward with policy changes to help public health, as well as individual health. On the side of the AAMC and the fact that you’ve published these two articles in Academic Medicine, I mean, that alone is advocating for education, and that’s fantastic. I think that all of us can be advocates in the tools and the way, and that our expertise gives us, and we can’t stop there. We need to continue that message and advocating on the global level as well.
Toni Gallo:
Well, as we get to the end of our discussion here, I wanted to just give you each a chance, if you have anything else, any final thoughts for listeners, Kari, do you want to start?
Kari Nadeau:
Thank you. I think this is a great opportunity. I think education is key. We’ve all been through medical education and have valued that as well as have it inspire us as we move forward as health care professionals within that education. We need to make sure that in that fabric, every step of the way, there are teaching points about climate change and health, because this is here, this is a major issue for all people on the planet, as well as planetary health that we are really continuing to understand and be very humble about the fact that our species might not be here for a long time based on some of the diesel exhaust and some of the human specific items that we’ve done to this planet.
Kari Nadeau:
As health care providers, we need to intercede, we need to educate, we need to be part of that, and I think through the medical education process, we can intervene quite dramatically to help our patients and then to help others be educated about climate change and health and to stop it. Thank you.
Toni Gallo:
Thanks. Ari, any final thoughts?
Ari Bernstein:
Well, I think it’s important to acknowledge, Toni, that folks within medical education, those who are charged with teaching medical students, residents, fellows, continuing medical education would be the first to stay, and where are we going to put this? How does it matter? And many other legitimate questions. I think that those questions are answerable in any given context. I guess I would say that if something like HIV came along, and in the early days of HIV, there was no one who really knew much about the virus. It wasn’t exactly clear how it was transmitted.
Ari Bernstein:
There was a lot of uncertainty about it. And yet you saw medical education respond in powerful ways, that students were getting taught about it, residents were learning about it, and it made a huge difference. The attention the medical community gave made a huge difference in progress over time. Was it perfect? Of course not. Here we have climate change, which is widely considered to be one of the most significant concerns for health and the ability to deliver health care that we’ve ever faced. My question is not, how are we going to fit this in? My question is, how can’t we fit this in?
Ari Bernstein:
How is it possible to provide a medical education without educating about something that is, by every estimation, one of the biggest health challenges we face, and for which health care is so heavily responsible in the United States? Of course there are priorities, and I would be the first to say, we’ve got a lot of competition for things that deserve more time in medical education, issues around race, issues around LGBTQ, issues around nutrition.
Ari Bernstein:
I would argue we could go on about various issues that are struggling for a footing in a curriculum that was frankly emerged from the post-World War II era when a lot of concerns that matter to people’s health were simply not considered relevant, social determinants of health. So, it is a moment of real pressure cooker for what matters to medical education, what matters to training a good medical provider. I think we will see what comes out in the mix here is the things that really matter.
Ari Bernstein:
The truth is we know a lot more today than we did 50 years ago. So, having four years of medical school, it’s going to get tighter, and we’ve got to do a better job of figuring out how to use technology, how to be more efficient. I still hear medical students telling me time and again, they learn about things where they’re thinking, how does learning about a genetic disease for the third time that’s one in 5 million, and I must apologize to the geneticists here, I’m not trying to downplay the importance of genetics.
Ari Bernstein:
But I think, in any given environment, there’s students’ feedback who would say, I know this is important, but can we really justify point A over point B? And there’s always going to be contention. But you are going to look back to 2050 to today, and that I’m expecting that climate change is going to be more and more prominent in the curriculum, and we’ll still be training really, really great doctors and really great nurses and really great providers and we just have to focus on doing it well.
Toni Gallo:
I think that’s a good call to action for everyone to end on. I want to encourage our listeners to check out the March issue of Academic Medicine, which has the papers we talked about today and a few others on related topics. I want to thank you both for joining us and for talking about this really important topic.
Ari Bernstein:
Thanks so much for having us.
Kari Nadeau:
Thank you, Toni. Thank you, Ari. Have a great day.
Ari Bernstein:
Thank you, Kari.
Toni Gallo:
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