There are an infinite number of ways that the environment affects health, from endocrine-disrupting chemicals in our food supply to warming temperatures driving infectious diseases to new territories. It can feel overwhelming to consider a patient’s environmental exposures during a 20-minute visit, while still learning the basic anatomy of the human body. As medical students training in a time when climate change has been called the “biggest global health threat of the 21st century,” we must learn about the impact of environment’s impact on health. Pesticides, pollutants, and waste flood the environment, permeating the bodies of our patients, and wreaking havoc at the molecular level. It is critical that our education reflect the reality we encounter every day.
Current medical education does not train medical students to adequately understand how the environment affects patient health. A recent letter to UCSF School of Medicine deans, authored by medical student Zoe Kornberg and signed by over 50 medical students, residents, and physicians, highlights this gap in our education and calls for change.
In countless medical school lectures, speakers have posted a slide with a rectangle, with a diagonal line to form two nested triangles. One triangle is labeled “Genetics” and the other “Environment” as shown below.
This graphic is meant to explain that some diseases are genetic in origin, some entirely environmental, and others a mix. “Environment” is intended to encompass anything from toxic chemicals in the home, to the lived experience of racism or childhood trauma. Medical students need a more nuanced understanding of how environmental hazards cause disease and they need tools for talking to patients about the impacts their environment has on their health.
A small but passionate community of medical students has been pushing for UCSF to prioritize environmental health in medical education. For example, the medical school curriculum now includes a small section on toxic chemicals affecting fertility, information on toxic chemicals affecting reproduction and child development, and a lecture on climate change. In addition to changes in the required curriculum, there are student-organized lunchtime electives and expert panels to discuss topics including Earth-friendly nutrition, wildfires, and the intersections between climate change, migration, and health. While these are excellent first steps, there is much room for progress.
The letter sent to UCSF School of Medicine in August of 2019 is yet another example of student-led efforts to integrate environmental health into the curriculum. In response to the letter, Dean Lucey wrote a personal reply, thanking students for the letter and conveying a willingness to adapt the curriculum to reflect the environmental threats facing the world today. Dean Lucey has long been a powerful advocate of broadening the medical school curriculum to include education on the intersections between health and society, such as racism in medicine, gun violence, and harm reduction. We hope that environmental health and climate change will soon be added to that list.
We look forward to attending the upcoming Lancet Countdown on Health and Climate Change event on Thursday, November 21st from 4:30-6:30pm in Mission Hall, Room 1400. The UCSF Institute for Global Health Sciences is hosting the launch of the 2019 Lancet Countdown Report, an exciting opportunity to reflect on our progress and plan for the future.
Karly Hampshire is a second-year medical student interested in the intersections between climate change, health, and migration.
Zoe Kornberg, MPH is a fourth-year medical student applying into obstetrics and gynecology, who is interested in the role of environmental toxins in health disparities.