By Will Atwater
A part of Alex Gregor’s childhood was spent growing up in Buncombe County, near Asheville, where he and his family enjoyed canoeing and hiking.
“I think that’s probably the origin of my environmental consciousness …those experiences with family and friends, outdoors,” he recalled recently.
After college, Gregor held several jobs before deciding to pursue a medical degree. One particular job was in the “social enterprise sector with a focus on global development issues.” He said his passion for the outdoors and his experience working on global issues carried from that career to his new one.
“Seeing the intersection of environmental challenges and human health, from that perspective, was a big part of what motivated me to go into medicine,” he said. “Specifically, to get involved in this movement of planetary health.”
Now Gregor is a fourth-year medical student at UNC Chapel Hill School of Medicine. But he noticed something missing from his medical training.
“What I saw in school was that we talked a lot about health, but not really about some of the big environmental elephants in the room, like climate change, and air pollution or other forms of pollution that really have a huge effect on health,” he said.
Public health and economic crisis
Researchers say that extreme weather events not only take a physical toll on the environment but also are responsible for causing a host of traumatic responses in people who experience the devastation, such as post-traumatic stress disorder, depression and suicide, among others.
A 2022 report published by the American Psychiatric Association, found that “67 percent of Americans agree that climate change is already impacting the population’s health.” While “55 percent of Americans are anxious about the impact of climate on their own mental health.”
What is more, in 2010, mental illness taxed the global economy by “at least $2.5 trillion in direct and indirect costs, including lost productivity and economic growth,” according to a briefing paper from The Lancet Global Health, published November 2020. The paper projects that by 2030, costs associated with mental illness will increase to $6 trillion.
Addressing the ‘elephants in the room’
In March 2020, Gregor and a group of his medical school colleagues decided it was time to act. They formed Climate Leadership & Action Network at the UNC School of Medicine (CLEAN UNC).
According to their website, the group has three primary goals: getting medical professionals up to speed on climate topics, working within the health system to reduce waste and greenhouse gasses to “do no harm” to the environment and getting the health care community involved in formulating policy solutions.
Kenan Penaskovic, associate vice-chair of clinical affairs and director of inpatient psychiatry services, was approached by CLEAN members, who had ideas about how to integrate the topic of climate and its impact on public health into a two-week elective course Penaskovic teaches titled Health and Human Behavior, he said.
“Over 200 medical and academic journals within the last year [are]simultaneously saying that the number one global public health threat is climate change,” said Penaskovic, who also said that more recently he was trying to incorporate the content into his formal teaching. “It is an acknowledgement of the fact that we’re all impacted by this and we’re all concerned.”
In a text message, Gregor said that since its founding in 2020, “more than 150 medical students and other graduate [and] undergraduate students have participated in CLEAN sponsored events (i.e. virtual lectures and discussions).” Currently, there are 778 students enrolled in the medical school, according to the registrar.
Gregor also said in the text that since the 2020-2021 academic year, “all first and second year medical students (M1s-M2s) have been taught about climate change impacts on public health in the foundation core curriculum, i.e. clinical science (including cardiovascular, pulmonary, renal and …psychiatry blocks) and social and health system courses.”
There are roughly 190 students per class.
One goal listed on CLEAN’s website focuses on “helping the health system” reduce its carbon footprint by identifying areas where reusable items can reduce waste, for instance. In order to facilitate change at the institutional level, however, students and leaders at the school must work together.
Assistant Professor Yee Lam teaches primary care at the medical school, is CLEAN’s faculty adviser and has acted as a liaison between the group and medical school leadership.
In addition to advocating for elective courses that address climate change, CLEAN offers an environmental impact evaluation.
“There is this planetary health report card that comes out and kind of gives an assessment of where your institution is at the moment on a variety of factors,” Lam said.
One of the issues CLEAN is exploring with the administration is whether sustainable practices can be enhanced in the clinical setting by partnering with vendors that use less of the “superfluous packaging” that comes along with the many medical supplies used daily in health care settings.
There are five medical schools in North Carolina, but it’s not clear whether any of the others offer any coursework on the impacts of climate change.
A spokeswoman from East Carolina University’s Brody School of Medicine said the school currently doesn’t offer any coursework on the impacts of climate change on public health. Campbell University School of Osteopathic Medicine, Wake Forest University School of Medicine and Duke University School of Medicine did not respond to requests for comment.
A national movement
The idea of addressing the impacts of climate change on public health in medical school curricula appears to be spreading across the country.
Last month, Lisa Doggett, co-founder and president of the board of directors of Texas Physicians for Social Responsibility (PSR), announced in a press release that three Texas Medical schools – Dell Medical School at the University of Texas at Austin, Baylor College of Medicine in Houston and University of Texas Southwestern in Dallas – are offering an elective course on “environmental threats, including climate change.”
“The elective courses were developed by Texas PSR, a nonprofit organization and a chapter of National PSR dedicated to addressing the gravest threats to human health, including climate change,” Doggett said in an email.
Doggett said what motivated her to collaborate with her colleagues to develop the course was inspired by the fact that when she attended medical school in the mid-1990s, environmental health training was not offered.
“I worked in community clinics, providing patient care, but I realized my ability to help my patients was limited in many ways,” she said. “We’ve learned that most of what determines someone’s health status comes from their environment and the conditions in which they live, not what a doctor can do for them in a clinic.”
When asked why it is important for medical students to take courses on the impacts of climate on public health, Doggett emphasized the role of medical doctors in educating patients.
“Physicians are well-positioned to help patients connect the dots between climate change and their own health and personal choices,” said Doggett. “We are also respected community leaders who can be impactful advocates for change at the policy level and with decision-makers and elected officials.”