How are doctors dealing with climate change? - The Climate Question podcast, BBC World Service

Key Concepts

• Global Health Issues: Tropical diseases are no longer confined to tropical regions due to climate change.
• Climate Change and Health Impacts: Climate change exacerbates health issues, disproportionately affecting vulnerable populations.
• Medical Education Gap: Climate change and its health implications are largely absent from medical curricula.
• Planetary Health: A holistic approach recognizing the interdependence of human health and the natural environment.
• Health System Resilience: Adapting healthcare infrastructure and practices to withstand climate-related disasters.
• Decarbonization of Healthcare: Reducing the health sector's carbon footprint.
• Community-Based Solutions: Empowering local communities to develop sustainable health and environmental strategies.
• Political Will: The necessity of strong leadership and policy changes to address the climate crisis.
• Narrative Shift: Moving from "climate doomism" to actionable solutions and human-centered stories.

Summary

Introduction: The Expanding Reach of Climate-Sensitive Diseases

The discussion begins by highlighting the alarming rise in deadly dengue virus infections, now appearing in temperate countries. This phenomenon underscores a critical gap in medical education, as healthcare professionals in these regions may lack sufficient training in tropical diseases. The core message is that global health issues are increasingly interconnected and no longer geographically confined, with tropical diseases spreading beyond their traditional boundaries.

Personal Journeys into Medicine and Climate Advocacy

Dr. Jemilah Mahmood shares her motivations for becoming a doctor, stemming from a childhood challenge, the loss of her father to cancer, and a genuine desire to care for people. Her entry into climate advocacy was later in her career, primarily through her extensive humanitarian work in Asia. Witnessing the severe impacts of climate change, such as floods and cyclones in countries like the Philippines and Bangladesh, and observing how these impacts are not gender-neutral, profoundly affected her. A particularly poignant moment was seeing a woman in Mozambique give birth during severe floods in 2000, highlighting the extreme challenges faced by women and the role of climate change as a "threat multiplier" linked to social equity. She emphasizes the responsibility of physicians to understand climate change's health impacts and become strong advocates.

Dr. Omnia El Omrani also entered medicine driven by a desire to help people. Her engagement with climate change began during her medical studies through a global student organization. Her realization intensified during an internship in the US when Hurricane Irma struck, exposing her to patients with direct injuries and those needing care whose treatment was hampered by hospital infrastructure failures, like non-functional generators. Returning to Egypt, she observed daily cases of children with asthma exacerbations and lung infections, directly linked to high levels of air pollution. This led her to understand that while treating symptoms, they were sending patients back into environments that worsened their health, impacting not only their lungs but also their neurological and mental well-being. She stresses that climate change is not just an environmental issue but a devastating factor in children's health, affecting the air they breathe, food access, and water availability.

The Climate Change Education Deficit in Medicine

Both doctors agree that climate change was largely absent from their medical education. Dr. El Omrani recounts that her only relevant module was occupational health, mentioning heat as a risk for construction workers. A global survey conducted by her medical student organization in 2020 revealed that over 85% of medical institutions worldwide had no mention of climate change in their curricula. Even where it was taught, it was often inconsistent, non-mandatory, and lacked formal assessment, creating a significant knowledge and preparedness gap for doctors expected to be on the front lines of climate-related health issues.

Progress and Curriculum Development

While acknowledging the past deficit, Dr. Mahmood notes that significant progress has been made since 2020. In the UK, medical school curricula have advanced, and in Malaysia, her university has introduced "Planetary Health" – a broader concept encompassing climate change, pollution, and other environmental factors – as a mandatory component for all undergraduates. This will be rolled out nationally for all disciplines from the following year.

What Doctors Need to Know: Integrating Climate into Practice

The curriculum should equip doctors with knowledge of specific health risks and approaches. Dr. Mahmood provides an example: a patient presenting with a heart attack or stroke might have their risk significantly increased by prolonged sun exposure or outdoor work, factors that might be missed if a comprehensive history isn't taken. While this might not alter immediate treatment, it enhances understanding of the patient's environment and the social determinants of health, which account for 85% of health outcomes outside the medical complex. This understanding aids in prevention and anticipation of complications.

Dr. El Omrani adds a UK-based anecdote where patients with mental health conditions experienced emergencies during heatwaves. Their psychiatric medications could impair the body's ability to regulate temperature, leading to heatstroke when doses weren't adjusted due to a lack of awareness among physicians. This highlights the critical need for climate change education to be integrated into medical training.

Building Resilient Health Systems

Beyond individual doctors, the entire health system needs to adapt. This includes:

• Early Warning Systems: Hospitals need to anticipate climate disasters like floods and infectious disease outbreaks.
• Infrastructure Adaptation: Hospitals must be resilient to extreme weather events.
• Government Policies and Funding: Prioritizing climate resilience in healthcare requires government support.
• Reducing Healthcare's Carbon Footprint: The global health sector contributes approximately 3.5% of global carbon emissions, similar to aviation. The NHS in the UK is a leader in this area.
• Cost Savings: Reducing carbon emissions can lead to significant cost savings within healthcare.

The Role of Nurses and Community Health Workers

Dr. Mahmood emphasizes the crucial role of nurses, community health workers, and allied health professionals. As highly trusted individuals, they serve as vital interfaces between patients and health systems, educating patients and promoting alternative measures. The concept of "social prescribing," integrating nature into prescriptions, is highlighted as beneficial for mental health and urban cooling.

Planetary Health: A Holistic Approach

Planetary Health is presented as a new, essential approach that recognizes the deep interdependence of human civilization's health and natural systems. It necessitates a rethink of economic development to be "pro-planet" and "pro-people," integrating finance, social justice, and environmental considerations. Malaysia's development of a national planetary health action plan exemplifies this systemic approach.

Visualizing a Climate-Resilient Hospital

Dr. El Omrani describes key features of a climate-resilient hospital:

• Solar Panel Installation: Reducing emissions and providing reliable energy, as seen in Egypt.
• Improved Equipment Maintenance: Extending the life cycle of medical equipment saves carbon and money.
• Sustainable Anesthetic Gases: Choosing carbon-friendly anesthetic agents without compromising patient outcomes.
• Energy and Waste Management: Implementing efficient energy use and waste disposal practices.
• Water Conservation: Even seemingly small measures, like water usage for handwashing before surgery, are being studied.

The fundamental shift required is from treatment to prevention, keeping people healthy and reducing the need for hospital visits. Decentralizing healthcare to community-based approaches is also vital.

Community-Led Solutions: Case Studies

Two powerful examples illustrate community-driven solutions:

• ASRI (Health in Harmony) in Kalimantan, Indonesia: Faced with deforestation driven by poverty and lack of healthcare access, ASRI offered healthcare in exchange for communities ceasing deforestation. They provided training in alternative livelihoods like organic farming, with payment in the form of seedlings or manure. This resulted in healthier communities, environmental restoration, and a win-win scenario.
• Thailand's Nam Mountains: An agricultural bank intervened to prevent deforestation in a critical watershed area. They encouraged communities to plant medicinal herbs, providing an alternative income source, improved healthcare access, and protecting the watershed.

These cases demonstrate that communities possess valuable knowledge and can adapt to find low-cost health solutions with economic and environmental benefits.

The Need for Political Will and a Shift in Narrative

While community action is crucial, Dr. Mahmood stresses the need for support from governments and global bodies. She advocates for working "at the speed of science, not the pace of politics," emphasizing the urgent need for political will. The "elephant in the room" is getting leadership to recognize the existential threat to humanity posed by climate change.

Dr. El Omrani attributes the lack of political will to the current geopolitical climate and a prevailing narrative of "climate doomism," which can lead to a loss of agency and burnout, particularly among young people. She highlights the complexity of climate science and the importance of translating it into human stories through media like the BBC to inspire action.

Conclusion

The discussion concludes with a call for a systemic shift in how health and the environment are viewed, emphasizing the interconnectedness of human well-being and planetary health. It underscores the urgent need for integrated medical education, resilient healthcare systems, community empowerment, and strong political leadership to address the climate crisis effectively. The overarching message is that while the challenges are immense, actionable solutions exist, and a collective effort is required to secure a healthy future for both people and the planet.