Title:Bridging health care and the environment

Medical students lead efforts to integrate environmental health into curriculum

For Ruba Omeira (M’24), a single grain of rice illustrates the staggering consequences of climate change.

During a biology course Omeira took as a prerequisite for medical school, the professor discussed the impact of climate change on rice crops. The Earth’s rising levels of carbon dioxide are gradually altering the biochemical composition of rice, increasing its carbohydrate content and eliminating essential nutrients—particularly protein. With more than two billion people worldwide relying on rice as their main food source, this can cause a dramatic increase in nutrition-related diseases.

“Before that classroom session, I didn’t realize that a macro problem like climate change could be diluted down to one particular food that can affect so many people’s protein intake and ultimately result in medical problems,” Omeira says. “It was so interesting that I wanted to learn more about these issues. It was really eye opening for me to learn how the environment’s health trickles down to people’s nutrition and medical care.”

Climate change has the potential to affect every organ system within the human body, as well as mental health. That means health care providers increasingly encounter patients affected by environmental factors. And yet, this broad topic rarely is woven into preclinical curricula at medical schools.

Omeira and Vasalya Panchumarthi (M’24) wanted to change that at Georgetown. Their vision resulted in the School of Medicine’s new Environmental Health and Medicine longitudinal academic track, which allows medical students to receive additional training to address these issues. Those admitted to the track learn how to take patient histories that include environmental factors affecting health, educate patients about environmental risks, advocate for patients affected by climate change, and explore strategies for reducing the environmental impact of medical facilities.

“For the most part, medical students and professors understand that environmental health is an important topic, but we get so busy in training that it’s not active on our minds,” says Panchumarthi. “But as we recognize more and more health impacts of climate change, we see that it really needs to be integrated within the medical school curriculum.”

The biggest threat to humanity

Climate change is the “single biggest threat to humanity,” according to the World Health Organization (WHO). The global crisis affects every factor necessary for sustaining life: clean air, safe drinking water, food supply, and safe shelter. WHO estimates that between 2030 and 2050, climate change-related health problems—such as malnutrition, malaria, and heat stress will cause about 250,000 additional deaths per year.

Given these projections, training future health care providers to recognize the connections between health and climate change is essential. In June 2019, the American Medical Association (AMA) announced a new policy advocating for the integration of climate health topics into medical education curricula. Georgetown is a member of the Global Consortium on Climate and Health Education, launched at Columbia University in 2017 “to unite health professional training institutions, health societies, and regional health organizations to create a global climate-ready health sector.”

Despite the urging of numerous health care associations like the AMA and intergovernmental agencies such as the United Nations, “medical school curricula have not kept pace with this urgent need for targeted training,” according to an article co-authored by Caroline Wellbery, M.D., Ph.D., adjunct professor in the department of family medicine. The 2018 manuscript, “It’s Time for Medical Schools to Introduce Climate Change Into Their Curricula,” was published in Academic Medicine, the journal of the Association of American Medical Colleges.

“Taking the broad view, everything is health,” says Wellbery, whose interests include preparing future health professionals to advance climate change solutions through patient education and advocacy, as well as developing sustainable practices in the health care sector. “For a long time, there was little interest in or awareness of these issues. Now, there’s this momentum because it’s generally accepted that climate change is real, and that climate change is dangerous. People understand that it threatens the health of future generations and of the planet.”

Enriching the academic experience

With the addition of the Environmental Health and Medicine longitudinal academic track—which welcomed the inaugural cohort in Fall 2021—Georgetown School of Medicine now offers nine of these faculty-run, scholarly experiences. Other track topics are Diversity, Equity, and Inclusion in Medicine; Health Justice Scholar; Health Care Leadership; Literature and Medicine; Medical Education Research Scholar; Population Health Scholar; Primary Care Leadership; and Spirituality in Medicine.

The longitudinal academic tracks reinforce attitudes and skills for self-directed lifelong learning and career development. The programs strive to promote intellectual curiosity, appreciation of scholarly inquiry, interprofessional collaboration, and cura personalis.

The tracks are optional, and interested students may apply during their first year of medical school. Those who successfully complete all track requirements and maintain good academic standing graduate with distinction.

“The tracks introduce some individualization to the medical school experience,” says Mary Furlong, M.D. (G’91, M’95, R’00, Parent’21, ’25), senior associate dean of curriculum and director of the Office of Medical Education. “Students are choosing to dive deeply into topics they feel passionate about, meet people in the field, and potentially carry that knowledge and experience into their residencies, or into whatever specialties they end up choosing.”

From club to curriculum

Georgetown medical students are passionate about understanding the connections between environmental conditions and human health. Throughout their lives, this generation of students has been exposed to widespread media coverage and public debates about the causes and adverse impacts of climate change. Most take seriously their personal roles in mitigating environmental harms.

In 2019, Aditi Gadre (G’18, M’24) worked closely with Wellbery to establish the Georgetown Climate Health and Medical Sustainability Club (CHMS). This club helped lay the groundwork for the longitudinal track. The organization’s members had ambitious goals: they not only wanted to influence curriculum changes, but also were interested in forming community partnerships and building advocacy networks. Realizing that was a lot to take on at once, Gadre says the group decided to focus on integrating climate and health topics into the pre-clinical curriculum.

“As we become more knowledgeable about the impact of environmental changes on human health, we can not only communicate about them to our patients, but also advocate within our hospital systems, which contribute to carbon emissions,” says Gadre, the CHMS founding president. “These are things we can directly ameliorate. The growing body of research helps us understand the intricacies between climate change and human health. Educating students is such a big part of the process of chipping away at this problem that’s been so persistent.”

CHMS members developed around 30 slides that have been used by Georgetown School of Medicine professors. These materials cover a wide range of topics, including pharmaceuticals and the environment, the impact of wildfires on asthma and other respiratory conditions, and the role of rising temperatures on the cardiovascular system.

“We found that faculty members can be amazing climate champions,” says Gadre, who is completing the Health Justice Scholar longitudinal academic track. “They really care about these issues, but it’s not something that most of them were taught during their training. It’s been helpful to have that co-development and co-creation aspect within the curriculum. This has been a life-changing aspect of my education.”

The work of CHMS has expanded in recent months. Wellbery currently is working with the group on another project: creating patient-friendly brochures about environmental health to distribute to primary care offices.

These pieces will provide basic information on the potential harms of climate change and ways to improve one’s health. “We’ll study to what extent these brochures have an impact on a patient’s interest and awareness, to help create a link between the health care office and the public,” Wellbery explains. “That helps us determine whether or not the health care office is a good place to disseminate climate information to patients in a way that is accepted and relevant.”

To better serve patients

Before they envisioned and proposed the new longitudinal academic track, Omeira and Panchumarthi served in CHMS leadership positions, carrying the torch Gadre ignited. Both created slideshow presentations. Omeira, for example, was inspired by the rice grain lesson to develop slides on the dietary implications of rising CO2 levels.

Wanting to create something more permanent, Omeira and Panchumarthi wrote a proposal for the Environmental Health and Medicine track, recruited a faculty director, and presented the concept to four committees. Just weeks before the deadline for students to apply to join tracks, their idea was approved.

“We were really passionate about this track,” Panchumarthi says. “I don’t know how we did it within such an ambitious timeframe. Ruba and I made a really good team, and we kept each other going. Everyone we presented the proposal to was very supportive. They wanted this track as much as we did because they recognized the importance of climate health.”

The track has featured lectures and workshops on environmental history taking, the environment’s impact on rheumatoid arthritis, environmental injustices, pharmaceuticals and the environment, and the effects of wildfire on respiratory health. Advocacy and action are also key components of the track, with opportunities for students to learn how to write op-eds and how to lobby. During their fourth year, students in the track must complete a capstone project, such as a case study or a public awareness campaign.

The selection of speakers and topics are driven by student interest, allowing them to explore issues that may impact their future practices, says track director Shiloh Jones, Ph.D., associate professor and director of medical gross anatomy. In the long run, that will help them better serve their patients.

“It’s apparent that there are changes happening to the climate,” says Jones. “Temperatures are increasing, and that’s having impacts that weren’t even considered decades ago. It’s getting warm in places that weren’t warm before, and that’s bringing diseases to new areas. We’re finding new pathogens in places where they never existed. Droughts and bizarre weather patterns are impacting people’s health. Climate change in general is such a polarized topic, and there’s some data suggesting people are more likely to trust their physicians on the issue.”

Changing the practice of medicine

Today’s medical students not only will serve on the front lines of caring for patients affected by climate change—they also will be called upon to create solutions to medicine’s sustainability problems. The U.S. health care sector contributes an estimated 8.5 percent of carbon emissions through energy use, toxic chemicals, and waste. And according to a report by the nonprofit Health Care Without Harm, “The global health care climate footprint is equivalent to the annual greenhouse gas emissions from 514 coal-fired power plants.”

Future health care workers must be prepared to take action on decarbonization—from devising new methods to manage the health care supply chain to prescribing more environmentally friendly asthma inhalers. By exposing medical students to the full spectrum of climate change impacts, Georgetown is preparing them to mitigate climate change.

“The Environmental Health track, as well as CHMS, tries to strike a balance to make sure all medical students get a good dose of consistent information that’s up-to-date and relevant,” Omeira says. “We all will eventually become doctors and hopefully, we’ll integrate this knowledge into our clinical practices every time we see a patient. Climate and environmental health will change the way we practice medicine—it’s inevitable.”