The Daily Dose, July 22, 2019
by Carly Stern
First-year medical student Anna Goshua was interviewing an emergency room physician in March to learn more about the job when she heard about a patient who had come all the way from Puerto Rico to that ER in Massachusetts for health care. Hurricane Maria had wiped out all prospects of the patient seeking care at home.
A surprised Goshua pored over her Stanford University curriculum to learn more about climate migrants. She realized the school offered no coursework about mental or physical illnesses linked to climate change, nor about the ways in which climate change is changing health care access. While the physical health impacts of climate change crises are more obvious, a growing volume of research over the past five years has demonstrated how changing weather patterns are also leading to a ballooning global mental health burden. That’s both in the form of increasing depression and anxiety about the growing crisis, as well as mental health conditions that stem from climate change effects. The American Psychological Association in a March 2017 report said the “tolls on our mental health [from climate change] are far-reaching.” Yet universities have lagged behind in incorporating the subject into their programs. Until now.
A growing number of schools are beginning to introduce a curriculum that promises to help America produce its first set of professionals trained at school to identify and address this crisis. This summer, the Johns Hopkins Bloomberg School of Public Health introduced a course dedicated to climate change and mental health, while the Yale School of Public Health created a course looking at mental disorders associated with climate change. The University of California, San Francisco (UCSF) began holding faculty workshops in 2016 so that professors could transform their courses to examine adverse mental and physical health effects of climate change, as well as the environmental impacts of the health care industry. Beyond medical schools, University of Washington Bothell professor Jennifer Atkinson introduced a course on ecological grief last spring.
The new courses are cropping up amid pressure to keep pace with the research community. The U.N. accepted mental health as a key indicator of climate change impact in 2017, while academics increasingly use “ecological grief” in the vernacular to make the concept more easily understandable. And university administrators and professors are finding that students have a ready appetite for studies through a climate lens. After a UCSF medical school course in 2017 encouraged students to look at the intersection of climate change and mental health, a group of students set up a group called the Human Health and Climate Organization that now works closely with the university’s Academic Senate Sustainability Committee.
“There is an untapped demand for this among students,” says Sheri Weiser, a UCSF professor of medicine who helped co-lead the university’s initiative. “The students are already there.”
These courses start by familiarizing students with language to describe — and understand — the emotional challenges they’ll see in patients. “Ecological grief,” explored in 2018 research by environmental scientists Ashlee Cunsolo and Neville Ellis, refers to the sense of experienced or anticipated climate-related losses. This grief can arise both from creeping changes such as rising temperatures or acute events like natural disasters. “Solastalgia,” coined by Australian climate philosopher Glenn Abrecht in 2005, is an anxiety disorder referring to distress produced by environmental change to people’s home environment — for example, the feelings experienced by residents of Paradise, California, after the Camp Fire destroyed their town in 2018. Then there’s “eco-anxiety,” a sense of daily despair similar to feelings of powerlessness or exhaustion.
Meanwhile other coursework trains students in the direct health impacts and aftershocks of living with climate change. PTSD and trauma are commonly associated with living through wildfires, flooding and severe drought. But these impacts aren’t limited to extreme events. Projected temperature increases through 2050, for instance, could lead to an additional 21,000 suicides in the U.S. and Mexico, research from Stanford in 2018 found. Physical conditions — from asthma exacerbated by polluted air to chronic pain triggered by weather fluctuations — can also lead to psychological problems. Beyond existing illnesses, academic programs also aim to empower doctors with a “framework or habit of mind for problems that haven’t yet arisen,” says Peter Chin-Hong, a UCSF professor of medicine who has worked on climate change curriculum.
Additionally, doctors are being sensitized to the inequity woven into health impacts of climate change. Already vulnerable communities are more susceptible to climate disaster and also have poorer access to health care and infrastructure, says Chin-Hong. “Climate change is notable for exacerbating health disparities,” says Goshua. Wealthier countries have historically generated most greenhouse gas emissions but effects are felt more acutely in poorer nations, according to Jura L. Augustinavicius, a scientist at the Johns Hopkins Bloomberg School of Public Health who taught a course on climate change and mental health this year. The Stanford research in 2018, for example, showed that with a 1-degree increase in temperature, suicide rates in Mexico would spike three times faster than they would in the U.S. Augustinavicius notes that there’s less research focused on low- and middle-income countries so the impact on those populations isn’t fully known. Many professors are emphasizing these socioeconomic discrepancies in their teaching, integrating public health, medicine and psychology into their curriculum.
To be sure, the integration of climate change into mental health coursework is nascent — “probably in the fetal stage,” says Chin-Hong. These new programs are also optional at the moment and must be made mandatory to make a meaningful dent, argues Goshua. She says administrators often push back by pointing to the challenge of integrating climate classes at the expense of other courses in an already packed curriculum.
Still, the fact that some of the country’s top universities have taken the lead suggests more could soon follow. Before them, only a handful of isolated academics have been arguing for such a focus. The UC system, for instance, has asked selected faculty leads at various institutions to infuse themes of climate change and sustainability into existing courses. The statewide push is driven by the approach that “all health professionals should leave with a basic literacy of the most important health threat of our time,” says Weiser. The pressure to stay ahead in the innovation race with other competitive colleges might serve as motivation for top medical schools, says Goshua. Stanford, for example, will host representatives from 150 universities around the world in September for a meeting of the Planetary Health Alliance, where they’ll discuss how far different schools have integrated the effects of climate change into their curriculum.
While she feels energized by these small victories, Goshua still hears a ticking clock telling her community to move faster. The good news? Her generation of doctors will be better prepared than those before them to heed that call.
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