Our Policy Statement on the incorporation of content on Climate Change, Health and Sustainable Healthcare into UK Medical Education
This policy statement was drafted by Healthy Planet and adopted by Medsin-UK in October 2012; it also represents our position on medical education for climate, health and sustainable healthcare.
Summary
There is strong evidence that climate change has major potential to exacerbate health inequalities and harm human health. Therefore, since tomorrow's doctors will be dealing with these problems, concepts related to these and to sustainable healthcare should form an integral part of all medical curricula. We support the work of the SHE (Sustainable Healthcare Education) network(1) to promote teaching on these subjects within medical schools, and applaud the medical educators who have already implemented innovative and engaging teaching on the subject in a minority of UK medical schools. We call for the BMA to include explicit and substantial content on the subject in their next Tomorrow’s Doctors guidance; for the Deans of UK medical schools to recognise the importance of and actively support teaching in this area(2); and for students to work with their medical schools with the aim of securing more teaching on this.
Introduction and background
Margaret Chan, the current Director-General of the World Health Organisation, acknowledged in 2008 that climate change “will affect, in profoundly adverse ways, some of the most fundamental determinants of health”(3). As such, climate change threatens to undermine much of the work done to tackle poverty and malnutrition as well as presenting other multiple inter-related threats to global health. Tomorrow’s Doctors (2009 version) requires that students are able to “discuss from a global perspective the determinants of health and disease(4),” but currently includes very little on climate change or sustainability. At the same time as climate change may be ‘the biggest global health threat of the 21st Century’(5), the imperative to reduce greenhouse gas (GHG) emissions presents unparalled opportunities for public health gains - in terms of obesity reduction, respiratory diseases and other areas(6) – ‘co-benefits’ of which awareness is currently limited in the medical profession.
Moreover, our health system itself is contributing to climate change - the NHS also accounts for about 5% of the traffic on UK roads, makes up 25% of the public sector’s footprint(7), and its total is equivalent to Kenya, Botswana and Senegal’s entire carbon footprints combined(8). To meet the targets set by the NHS’ Carbon Reduction Strategy and the UK’s Climate Change Act we will need to reduce the NHS’ carbon footprint by 80% by 2050(9). Yet there is currently very little or no teaching on any of these areas in the majority of UK medical schools.
Main Statement
There is scope to include more content on the direct and indirect effects of climate change as part of a greater emphasis on global health in UK medical education generally, but in addition arguments for mitigation based on health co-benefits and content on healthcare sustainability should be incorporated into clinical parts of the course – for example, epidemiological studies into the effects of reducing red and processed meat consumption on health10, content on the health consequences of heatwaves, or teaching students about the environmental cost of producing pharmaceuticals as part of pharmacology.
If we are to succeed in making the ambitious reductions set out in the NHS Carbon Reduction Strategy, tomorrow’s doctors will need to be taught much more about sustainability and how it relates to the health service as well as helped to think more about alternative models of care and intelligent uses of technology. As the Centre for Sustainable Healthcare puts it, ‘less of the same is not the answer’(11) – we will need innovation, imagination and leadership: all characteristics which should be encouraged and helped to develop by high quality teaching on sustainable health systems. A more sustainable NHS will also be more resilient, by learning how to look after health in ways that engage patients more in their own care and are much less reliant on oil. Sustainable healthcare systems are likely to produce ‘triple bottom line’ benefits - ie. environmental, economic and social.
As one of the most trusted professions(12), doctors are opinion leaders, not to mention the fact that they come into contact with members of the public on a regular basis. This means that they are also well placed to influence change: in patients’ behaviour, in UK policy, and also internationally – making it all the more important that medical students are well informed about the science of climate change and health co-benefits of mitigation.
Lack of student interest in the topic should not be a problem: in an online survey of 143 Cambridge medical students, 30.8% said they were very interested in climate change and health, and another 48.7% described themselves as fairly interested. Moreover, students who have taken part in SSCs on the subject in Leeds, Bristol, Oxford and elsewhere have described it as intellectually challenging, and relished the opportunity to ‘think outside the box’(13) and to lead innovative change. Given that this is both a relatively new and a very multi-faceted subject, the challenge is to bring knowledge from many separate disciplines together, which will take collaboration and openness to change on the part of medical educators, but is by no means impossible.
With insufficient teaching, today’s medical students – as future doctors who will be dealing with the health effects – will be ill-equipped to respond effectively to the health consequences of this global challenge, and to advocate effectively for political action. Integrating both climate change and sustainability into medical school teaching, as well as through continuing medical education, has the potential to bring significant benefits for global health and for the future of the NHS. It can be fulfilling and stimulating for students and doctors, and is a key way to create a workforce ready for the challenges of the 21st century.
Recommendations
· Students and doctors should lobby the GMC to incorporate components of the CHC Pledge (14) into an updated version of the Hippocratic oath, and to incorporate the SHE Network’s Priority Learning Objectives into TD 2013.
· Work in conjunction with the SHE Network to support their efforts to this end
· Lobby Deans of Medical Schools to ensure that climate change and sustainability is not confined to a cursory mention in one or two lectures, but rather is integrated across the curriculum, so that instead of undermining core teaching, it complements it.
· Support and funding for research into and implementation of more sustainable models of healthcare - including research conducted with student involvement as part of SSCs, intercalated BSc projects and audits.
· Advocate for the NHS SDU and SHE Network to receive greater support and so that they are able to to increase their input into what is taught at medical schools, resource development and distribution, and to increase what is taught through continuing medical education.
References
1. SHE Network Priority Learning Outcomes http://greenerhealthcare.org/sustainable-healthcare-education/resources/2012/01/sustainable-healthcare-priority-learning-outcomes
2. BMA News feature: A green revolution? http://greenerhealthcare.org/sites/default/files/bma_news_oct22_2011.pdf 3. Margaret Chan, Message from WHO Director-General, World Health Day (2008) http://www.who.int/world-health-day/dg_message/en/index.html
4. Tomorrow’s Doctors (2009) http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp
5. Costello et al., ‘Managing the health effects of climate change’ The Lancet, Volume 373, Issue 9676, Pages 1693 – 1733doi:10.1016/S0140-6736(09)60935-1(2009) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960935-1/fulltext
6. WHO: Health co-benefits of active travel http://www.who.int/hia/green_economy/transport_sector_health_co-benefits_climate_change_mitigation/en/index.html
7. NHS Carbon Footprint Report http://www.sdu.nhs.uk/publications-resources/26/NHS-Carbon-Footprint-/
8. List of countries by carbon dioxide emissions http://en.wikipedia.org/wiki/List_of_countries_by_carbon_dioxide_emissions 9. NHS Carbon Reduction Strategy http://www.sdu.nhs.uk/publications-resources/3/NHS-Carbon-Reduction-Strategy/
10. Aston et al., Impact of a reduced red and processed meat dietary pattern on disease risks and greenhouse gas emissions in the UK: a modelling study BMJ Open Access (2012) http://bmjopen.bmj.com/content/2/5/e001072.full.pdf+html
11. Ipsos MORI poll: Trust in Professions 2011 ‘Doctors are most trusted profession – politicians least trusted’ http://www.ipsosmori.com/researchpublications/researcharchive/2818/Doctors-are-most-trusted-profession-politicians-least-trusted.aspx 12. Centre for Sustainable Healthcare: ‘Less of the same is not the answer’ http://greenerhealthcare.org/clinical-transformation
13. Oxford SSM in Sustainable Healthcare 2011-12 http://greenerhealthcare.org/sustainable-healthcare-education/resources/2012/05/oxford-ssm-sustainable-healthcare-2011-12 14. Climate and Health Council (CHC): http://www.climateandhealth.org/the_council.html (individuals can also sign their pledge online and sign up, for free, as a member: http://www.climateandhealth.org/sign_up.html).
Summary
There is strong evidence that climate change has major potential to exacerbate health inequalities and harm human health. Therefore, since tomorrow's doctors will be dealing with these problems, concepts related to these and to sustainable healthcare should form an integral part of all medical curricula. We support the work of the SHE (Sustainable Healthcare Education) network(1) to promote teaching on these subjects within medical schools, and applaud the medical educators who have already implemented innovative and engaging teaching on the subject in a minority of UK medical schools. We call for the BMA to include explicit and substantial content on the subject in their next Tomorrow’s Doctors guidance; for the Deans of UK medical schools to recognise the importance of and actively support teaching in this area(2); and for students to work with their medical schools with the aim of securing more teaching on this.
Introduction and background
Margaret Chan, the current Director-General of the World Health Organisation, acknowledged in 2008 that climate change “will affect, in profoundly adverse ways, some of the most fundamental determinants of health”(3). As such, climate change threatens to undermine much of the work done to tackle poverty and malnutrition as well as presenting other multiple inter-related threats to global health. Tomorrow’s Doctors (2009 version) requires that students are able to “discuss from a global perspective the determinants of health and disease(4),” but currently includes very little on climate change or sustainability. At the same time as climate change may be ‘the biggest global health threat of the 21st Century’(5), the imperative to reduce greenhouse gas (GHG) emissions presents unparalled opportunities for public health gains - in terms of obesity reduction, respiratory diseases and other areas(6) – ‘co-benefits’ of which awareness is currently limited in the medical profession.
Moreover, our health system itself is contributing to climate change - the NHS also accounts for about 5% of the traffic on UK roads, makes up 25% of the public sector’s footprint(7), and its total is equivalent to Kenya, Botswana and Senegal’s entire carbon footprints combined(8). To meet the targets set by the NHS’ Carbon Reduction Strategy and the UK’s Climate Change Act we will need to reduce the NHS’ carbon footprint by 80% by 2050(9). Yet there is currently very little or no teaching on any of these areas in the majority of UK medical schools.
Main Statement
There is scope to include more content on the direct and indirect effects of climate change as part of a greater emphasis on global health in UK medical education generally, but in addition arguments for mitigation based on health co-benefits and content on healthcare sustainability should be incorporated into clinical parts of the course – for example, epidemiological studies into the effects of reducing red and processed meat consumption on health10, content on the health consequences of heatwaves, or teaching students about the environmental cost of producing pharmaceuticals as part of pharmacology.
If we are to succeed in making the ambitious reductions set out in the NHS Carbon Reduction Strategy, tomorrow’s doctors will need to be taught much more about sustainability and how it relates to the health service as well as helped to think more about alternative models of care and intelligent uses of technology. As the Centre for Sustainable Healthcare puts it, ‘less of the same is not the answer’(11) – we will need innovation, imagination and leadership: all characteristics which should be encouraged and helped to develop by high quality teaching on sustainable health systems. A more sustainable NHS will also be more resilient, by learning how to look after health in ways that engage patients more in their own care and are much less reliant on oil. Sustainable healthcare systems are likely to produce ‘triple bottom line’ benefits - ie. environmental, economic and social.
As one of the most trusted professions(12), doctors are opinion leaders, not to mention the fact that they come into contact with members of the public on a regular basis. This means that they are also well placed to influence change: in patients’ behaviour, in UK policy, and also internationally – making it all the more important that medical students are well informed about the science of climate change and health co-benefits of mitigation.
Lack of student interest in the topic should not be a problem: in an online survey of 143 Cambridge medical students, 30.8% said they were very interested in climate change and health, and another 48.7% described themselves as fairly interested. Moreover, students who have taken part in SSCs on the subject in Leeds, Bristol, Oxford and elsewhere have described it as intellectually challenging, and relished the opportunity to ‘think outside the box’(13) and to lead innovative change. Given that this is both a relatively new and a very multi-faceted subject, the challenge is to bring knowledge from many separate disciplines together, which will take collaboration and openness to change on the part of medical educators, but is by no means impossible.
With insufficient teaching, today’s medical students – as future doctors who will be dealing with the health effects – will be ill-equipped to respond effectively to the health consequences of this global challenge, and to advocate effectively for political action. Integrating both climate change and sustainability into medical school teaching, as well as through continuing medical education, has the potential to bring significant benefits for global health and for the future of the NHS. It can be fulfilling and stimulating for students and doctors, and is a key way to create a workforce ready for the challenges of the 21st century.
Recommendations
· Students and doctors should lobby the GMC to incorporate components of the CHC Pledge (14) into an updated version of the Hippocratic oath, and to incorporate the SHE Network’s Priority Learning Objectives into TD 2013.
· Work in conjunction with the SHE Network to support their efforts to this end
· Lobby Deans of Medical Schools to ensure that climate change and sustainability is not confined to a cursory mention in one or two lectures, but rather is integrated across the curriculum, so that instead of undermining core teaching, it complements it.
· Support and funding for research into and implementation of more sustainable models of healthcare - including research conducted with student involvement as part of SSCs, intercalated BSc projects and audits.
· Advocate for the NHS SDU and SHE Network to receive greater support and so that they are able to to increase their input into what is taught at medical schools, resource development and distribution, and to increase what is taught through continuing medical education.
References
1. SHE Network Priority Learning Outcomes http://greenerhealthcare.org/sustainable-healthcare-education/resources/2012/01/sustainable-healthcare-priority-learning-outcomes
2. BMA News feature: A green revolution? http://greenerhealthcare.org/sites/default/files/bma_news_oct22_2011.pdf 3. Margaret Chan, Message from WHO Director-General, World Health Day (2008) http://www.who.int/world-health-day/dg_message/en/index.html
4. Tomorrow’s Doctors (2009) http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp
5. Costello et al., ‘Managing the health effects of climate change’ The Lancet, Volume 373, Issue 9676, Pages 1693 – 1733doi:10.1016/S0140-6736(09)60935-1(2009) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960935-1/fulltext
6. WHO: Health co-benefits of active travel http://www.who.int/hia/green_economy/transport_sector_health_co-benefits_climate_change_mitigation/en/index.html
7. NHS Carbon Footprint Report http://www.sdu.nhs.uk/publications-resources/26/NHS-Carbon-Footprint-/
8. List of countries by carbon dioxide emissions http://en.wikipedia.org/wiki/List_of_countries_by_carbon_dioxide_emissions 9. NHS Carbon Reduction Strategy http://www.sdu.nhs.uk/publications-resources/3/NHS-Carbon-Reduction-Strategy/
10. Aston et al., Impact of a reduced red and processed meat dietary pattern on disease risks and greenhouse gas emissions in the UK: a modelling study BMJ Open Access (2012) http://bmjopen.bmj.com/content/2/5/e001072.full.pdf+html
11. Ipsos MORI poll: Trust in Professions 2011 ‘Doctors are most trusted profession – politicians least trusted’ http://www.ipsosmori.com/researchpublications/researcharchive/2818/Doctors-are-most-trusted-profession-politicians-least-trusted.aspx 12. Centre for Sustainable Healthcare: ‘Less of the same is not the answer’ http://greenerhealthcare.org/clinical-transformation
13. Oxford SSM in Sustainable Healthcare 2011-12 http://greenerhealthcare.org/sustainable-healthcare-education/resources/2012/05/oxford-ssm-sustainable-healthcare-2011-12 14. Climate and Health Council (CHC): http://www.climateandhealth.org/the_council.html (individuals can also sign their pledge online and sign up, for free, as a member: http://www.climateandhealth.org/sign_up.html).
