If you haven’t heard it before, climate change is being described as the greatest public health threat of this century. It is the topic of large international meetings, like last year’s COP26, where country leaders discussed carbon goals and made numerous commitments for cameras and newsstands. The topic is increasingly featured in political debates and in media where national conversations about our priorities as a country are held. Locally, Ann Arbor is investing in the A2Zero campaign to achieve carbon neutrality in the city.
We are, however, doing an insufficient amount to address the threat adequately. Oil investments are still being made, carbon taxes are being stalled in legislation, and investment in sustainable energy and waste management is slow. The medical system itself is a major contributor to the problem with its massive energy costs and production of physical waste. For these reasons, individuals in the medical sphere have to push for practices that may help curb the inevitable changes in climate ahead of us.
Another reason it is important for medical professionals to care about climate change is that we have a lot to contribute by looking at the issue in the ways we contemplate issues in human health. The prevention framework from the world of public health, I believe, can be applied to climate change in an unfortunately tidy way; we’re past the point of primary prevention (preventing climate change entirely), we’re failing at methods of secondary prevention (making interventions to reduce the speed of climate change) and we’re not unified in how to perform tertiary prevention (managing climate change in the long-term and the harms it is already causing).
In primary care you work with patients on health concerns that rarely have a simple fix, where numerous small actions accumulate into poor outcomes, and where there is distance between the timing of the health insult and health outcome. These are the same kinds of barriers that get in the way of making meaningful changes in the way of climate change.
In the way that stopping smoking is a difficult but assured way to improve one’s future health, our emissions and waste production today make life easier even if the consequences in 20 years will be life altering (on a global scale). However, we don’t have to wait 20 more years to see effects, we’re already seeing the results of climate change here in Michigan in the ways of increased frequency of extreme weather events, threats to food security and the expansion of the geographic ranges of vector-borne diseases.
Like many issues in global public health, the negative effects of climate change are disproportionately being felt by more vulnerable populations. When taking the Homeless Healthcare elective, which is organized by the Wolverine Street Medicine student group, I had the unfortunate privilege of seeing the effects of climate change firsthand. Heavy rains made it impossible for people with lower extremity wounds to keep their legs dry on the street. High rates of COPD and asthma, partly attributable to city air quality, meant that needs for medicated inhalers were common (devices that have their own cost on the environment). Most life-threatening was the unseasonably cold weather during my rotation that caught many unhoused folks, even those with years of experience on the street, unprepared with sufficient supplies for staying warm. For these patients, worrying about the environment never stops; now coming into the warmer months they have to start thinking about how to stay cool and hydrated in humid summers. It is terribly difficult to live unhoused, and what we’re doing to the climate is not making it easier.
That humans are accelerating climate change is a fact that we’ve understood well for decades, and it’s something that I’ve known about since I was a kid. I remember that it was talked about in my 6th grade earth science class as global warming. I’m glad now that we recognize more is happening as a result of human activity than polar bears being stranded on melting ice flows. But the subject wasn’t anything I cared much about until it became a major part of my undergraduate education by accident; I wanted to study nutrition, and all of the food systems courses at my school were run through the department of environment.
My academic understanding of the issue was brought to reality when working in the urban agriculture scene in Detroit, where food sovereignty for communities was discussed as an assurance that they could provide for themselves knowing that their already-limited access to good food would be the first to go in the event of national food insecurity from climate change. Then it continued to be a theme in my graduate studies in public health, as I looked into understanding the interplay between our agricultural system, our nutrition and our climate. But when I started medical school, there was suddenly no talk about climate change. It was not a feature in the pre-clinical curriculum in areas where it clearly felt applicable. I learned of some more senior students who were engaged in individual projects that related to climate change and they had formed a little group that they used to vent about eco-anxiety and get feedback on their ideas.
Because of those students I was brought into a community of climate activists and have been able to make this a staple of my work today. I am a DOW Sustainability Fellow, the Co-Chair for Plant-Based Health with the Medical Students for a Sustainable Future and co-director of the White Coats for Planetary Health (WCPH), the organization born out of that small group of students that now organizes advocacy efforts for the elevation of climate change themes in all areas of UMMS’s functioning. Last summer, I was part of a group of students who presented to the academic cabinet about the need for more investment in climate change topics at our school, pointing to the report from the President’s Commission on Carbon Neutrality that was coming out with carbon production reduction mandates for the university.
In that presentation we discussed the need to comprehensively understand the school’s relationship with climate change and proposed that the school facilitate students completing the Planetary Health Report Card (PHRC). This is a tool developed for students to use to audit their medical school and how it engages with climate change in five different domains: Curriculum, Research, Community Engagement, Student Support and Operations. To date, 74 medical schools around the globe have participated in the international initiative.
Because of faculty support and passionate students, the WCPH were able to complete the PHRC for the first time this past year; UMMS scored a C+ with large areas to improve upon in how the school engages in climate teaching its core curriculum and how it engages on the topic with the local community and global academic movements. U-M is used to being the ‘Leaders and Best,’ and while a C+ is hardly a score to brag about, we now clearly know areas where our school can improve, and I feel the motivation to act from folks in all corners of University of Michigan Medical School.
I am immensely proud of WCPH and everything that we have been able to accomplish this past year.
- We’ve hosted events in the Global Health and Disparities Path to share local environmental issues and connect climate change to different areas of medical practice.
- We also improved upon the Planetary Health elective that our members put on in January to bring climate experts from around the country to run workshops with our students and outline actionable ways to get involved in climate advocacy.
- We spurred the creation of a committee of school administrators that makes decisions toward achieving carbon neutrality at the Medical School. That represents the first committee at an individual school at the University of Michigan to address the topic, and WCPH has guaranteed permanent representation on it.
I am most proud of my student peers and how dedicated they are to this mission. It is reassuring to see more people each year coming into UMMS wanting to be involved in this area and make it a focus of their work outside of patient care.
If you’re a student and interested in learning more about climate advocacy here at UMMS, please reach out to WCPH at firstname.lastname@example.org. We would love to get you involved, and if you have an idea for a project we would love to help in any way.
To learn more about virtual opportunities and movements around the country, please join MS4SF. And if you’re a professional, please use your influence in your department to do some introspection. Every field contributes to the climate change problem, which means every field can contribute to creating solutions.
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Christian Mackey, MPH, was born and raised in Michigan, attending the University of Michigan for his undergraduate, graduate public health, and medical school education. He will be applying into Family Medicine in the fall of 2022 and has professional interests outside of patient care in promoting environmental justice and sustainability.