Training Canadian doctors for the health challenges of climate change

Our planet is changing, and as with any drastic upheaval to patients' surroundings, global environmental changes affect individual health. Climate change is a major threat to ecosystems and the wellbeing of current and future generations of people. From wildfire-related evacuation of hospitals to the spread of Lyme disease and heat-related deaths and injuries, the health effects of climate change are becoming increasingly clear in Canada.1Howard C Buse C Rose C MacNeill A Parkes M The Lancet Countdown on health and climate change: policy brief for Canada. 2019https://storage.googleapis.com/lancet-countdown/2019/11/Lancet-Countdown_Policy-brief-for-Canada_FINAL.pdfDate accessed: December 16, 2019Google Scholar The environment is an important yet sorely neglected determinant of health. Despite increasing pressure to include environment-related topics in their curricula, medical schools have not adequately addressed the urgent need for training. Climate change is clearly relevant for medical education, which prepares students for future practice and promotes public health and eco-health literacy.2Maxwell J Blashki G Teaching about climate change in medical education: an opportunity.J Public Health Res. 2016; 5: 673Crossref PubMed Scopus (78) Google Scholar The International Federation of Medical Students' Associations has called upon medical schools to integrate teaching related to climate change into their curricula by 20203International Federation of Medical Students' AssociationsSixty-fifth session of the WHO Regional Committee for the Eastern Mediterranean. 2018https://ifmsa.org/statements/Date accessed: December 16, 2019Google Scholar and UK medical students also highlighted this point in the BMJ, in which they called for “urgent action to safeguard the health of our future patients”.4Legard C Green M Tucker Y van Daalen K Climate change is impacting population health and our future patients: remaining silent is not an option.The BMJ Opinion. 2019; (Sept 26)https://blogs.bmj.com/bmj/2019/09/26/climate-change-is-impacting-population-health-and-our-future-patients-remaining-silent-is-not-an-option/Date accessed: December 16, 2019Google Scholar First, we suggest that the core competencies that health professionals should have relating to climate change must be agreed upon by the medical community. Fortunately, resources already exist in the international health and environment community. For instance, the Centre for Sustainable Healthcare has a peer network supporting teaching on planetary health and sustainable health systems,5Centre for Sustainable Healthcare NetworksEducation for sustainable healthcare.https://networks.sustainablehealthcare.org.uk/network/education-sustainable-healthcareDate accessed: November 17, 2019Google Scholar and the Canadian Association of Physicians for the Environment published a climate change toolkit for health professionals, with concise modules for adapting to and mitigating the effects of climate change on patients and within communities.6Canadian Association of Physicians for the EnvironmentClimate change toolkit for health professionals.https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-for-health-professionals/Date accessed: November 17, 2019Google Scholar Second, a mechanism must be created to integrate these competencies into curricula that are already packed full. Topics can be presented through didactic lectures and incorporated into existing lectures, such as integrating teaching on the effects of air pollution with respiratory health teaching, discussing climate-related displacement within teaching on refugee and migrant health, and exploring the increasing burden of heat stress on health-care systems. Furthermore, case-based sessions can highlight the effects on specific individuals. Examples could include considering isolated older people at risk of heat stroke or of being in extreme weather events, or discussing the effects of flooding or poor water quality on Indigenous communities. Lastly, there must be a national movement to change, as well as a system to evaluate and compare planetary health education across the nation. Members of the Health and Environment Adaptive Response Taskforce (HEART), part of the Canadian Federation of Medical Students, have responded to this call by creating a set of core competencies on planetary health, including the effects of climate change and other environmental changes on health. These competencies promote advocacy and provide a framework for curricular development in medical education. In 2019, HEART conducted a national evaluation of planetary health teaching in undergraduate medical education with the participation of Canadian medical students and faculty. The survey was developed with international leaders in planetary health and distributed to students and faculty in environmental health and sustainability at each of the Canadian medical schools. Survey scores were based on the inclusion and quality of didactic and case-based teaching on climate change and environmental topics, and on opportunities for student engagement. By September, 2019, all 17 Canadian medical schools had participated in the evaluation. The results of the HEART evaluation7Canadian Federation of Medical StudentsHealth and environment adaptive response task force.https://www.cfms.org/what-we-do/global-health/heart.htmlDate accessed: November 17, 2019Google Scholar outline a clear opportunity to improve planetary health education in Canadian medical schools. Institutions can recognise and address this opportunity by tapping into the strong movement to change, with student interest groups and faculty already taking steps to integrate these competencies. Ultimately, physicians must be equipped with the knowledge and skills to serve as medical experts and health advocates in their communities. A rapid increase in curricular content related to planetary health, including climate change, is required to equip future physicians to manage the effects of ecological change on health and health systems. As can be seen from the dynamic energy surrounding the Fridays for Future movement,8Hope M Contagious youth.Lancet Planetary Health. 2019; 3: e376-e377Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar young people have the passion to drive a healthy response to ecological change. Physicians across Canada are beginning to advocate, standing in solidarity with youth at the Global Day of Action on Sept 27, 2019, and leading a recent call to action on climate change and health.9Canadian Association of Physicians for the EnvironmentCall to action on climate change and health. 2019https://cape.ca/wp-content/uploads/2019/07/Call-to-Action-Full-logos-updated-EN-June-25-2019.pdfDate accessed: November 17, 2019Google Scholar However, to address the growing challenges associated with climate change, young physicians must first understand those challenges and their responsibilities as health-care providers. Medical professionals are gaining the tools to become leaders in this area as we progress to a safer, more sustainable future. We declare no competing interests.

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