Doctors must be treated as a source for climate and health discipline

This article is authored by Soma Das, senior advisor, development space and Manash Kalita Neog, MD and co-founder, Chase India.

When the earth has been diagnosed with this toxic rising fever---global warming--can humanity really remain healthy? The climate crisis is a matter of concern for our health, an area where doctors always have a central role to play. The role of doctors in climate action, both in understanding the impact of the climate crisis on health, as well as in advocating the right prescriptions to patients and policies on the climate crisis are largely ill-defined today.

Doctors

With the climate crisis intensifying, the landscape of diseases as we knew it is changing. Shifting seasons are altering transmission patterns for infections, heat- and pollution-related illnesses and deaths are rising but research and databases have failed to keep pace with these changes. As these challenges become visible to doctors in their individual practice, they are realising at a collective level that their training has not equipped them with the wherewithal to deal with the onset of climate-related challenges on health.

It is partly because of this need-gap that there is an unprecedented groundswell among young medical students across the world including India to integrate climate issues and health into their curriculum for them to attend to their patients better. Probably for the first time in the history of medicine, already overburdened medical students—from Harvard Medical School to Stanford Medical School Association to the South Indian Medical Students Association---are demanding that they be taught more and better about how the climate crisis is affecting health. A 2022 study says that 90% of medical students in India wanted the climate crisis and health to be part of their curriculum, but 68.9% of medical schools do not have it as a part of their official medical curriculum. That will probably change as the National Centre for Disease Control (NCDC), an arm of the health ministry, has started working with various medical councils in 2023 to introduce the concepts of rising heat and air-pollution and their effects in medical education.

However, this complex and highly scattered subject of ‘climate and health’ will be a discipline in the making for a long time, looking at the nature of output of research—that has largely been supply driven, not demand driven to understand the phenomenon at an aggregate level that enables credible meta-analyses and generalisations for a discipline to emerge.

For one, the pathways between climate and health can be far from linear, often mediated by social, economic, and other determinants. These obtuse pathways usually marked by the slow onset of diseases, unlike Covid-19, which felt immediate and urgent, means it is easy for health professionals to miss the linkages—as in most cases climate remains an important contributing factor but not the only cause of such illnesses.

For instance, doctors explain that while they are now wired to look for smoking behaviour in lung cancer cases, they are still to count sustained exposure to air pollution as a risk factor. As a result, ground-breaking research such as the ones that show that children in highly polluted cities--from London to Delhi--have smaller lungs and lower lung capacity do not inform clinical practice in equally or more polluted smaller centres, where research lags because of resource constraints. Also, the limited evidence base mainly comes from rich countries, while the climate crisis impact will be borne disproportionately by the poorest people in the poorer countries with very thin research output to count on.

It comes as no surprise then, that in 2020, the Global Consortium on Climate and Health Education (GCCHE) found that 71% of global institutions keen to integrate climate and health struggled with the curriculum with 29% explicitly stating that they lack teaching materials. In smaller case studies published globally in recent times, medical faculties cite missing the meaningful ‘bigger picture’ in designing the curriculum map for climate and health, not sure of the ‘inventory’ for references and state that they would benefit immensely if they were connected to high-level policy stakeholders as a network of support.

Due to this unique context---where demand for a discipline has outpaced the supply and organisation of research in it---the health and climate professional communities must collaborate with policymakers and innovate to ensure that this discipline evolves almost real-time with a three-fold objective—equip our medical community better to diagnose and treat health conditions that are emerging from or exacerbating by the climate crisis, to prescribe preventive measures around diet and lifestyles to patients and communities so that they can reduce the risks of climate-sensitive diseases and ready our health systems better to cope with the health effects of climate-induced extreme events. These solutions will need paradigm shifts in the way medicine curriculums have been approached till now.

First, doctors practising in the field can become crucial evidence generators for climate and health discipline in a specially designed policy ecosystem. Doctors across specialties are noticing these changes in their practice in the field. Policymakers need to create and institutionalise pathways for them to report these observations in a centralised climate and health cell. This could start in specialties like paediatrics, primary care, psychology, emergency medicine, oncology, pulmonology, cardiology and infectious diseases, where climate-informed research is already beginning to flourish. This database of observations can then serve as a source for leads for research into climate and health discipline, that public health, climate scientists, policymakers can parse to distil ‘signals’ from noise, and then research those strands for enhancing our understanding of how climate is affecting health.

Second, in this era of super-specialisation in medicine, the discipline-making process for climate and health should allow for a transdisciplinary approach so that medicine curriculum can enrich itself from not only climate science but public health, public policy and even journalism. Both these approaches will make the pathways to understanding ‘climate and health’ issues shorter and learning faster for applied medicine in climate and health, till the discipline becomes more established and develops its own organic contours.

Third, there are many identified climate-sensitive disease which can be predicted with early warning systems. Unsurprisingly, some of the most successful early warning systems have been reactions to trauma. For instance, France’s heatwave warning system came after a deadly heatwave of 2003 but is estimated to have saved thousands of lives since. It’s wise to invest in early-warning systems in diseases that can be predicted.

Finally, parts of health databases crucial for research, planning, and policymaking must be redesigned with a climate lens to establish empirical evidence to better understand its impacts on health. The patchy vital registration system and health facility-based data not only in India, but across the developing world means it will be very long before continuous recorded data can yield insights which can be used as an evidence base to form a solid foundation for climate-health discipline.

This article is authored by Soma Das, senior advisor, development space and Manash Kalita Neog, MD and co-founder, Chase India.