Education and the carbon footprint
Viewing climate change as a social determinant of health (SDH ) – and integrating it into medical training as such – is a topic of active discussion. At UCSF, Sarah J. Coates, MD, a fellow in pediatric dermatology, is working with colleagues to integrate climate change into formal resident education. “We know that climate change affects housing, food security, migration ... and certain populations are and will be especially vulnerable,” she said in an interview. “The effects of climate change fit squarely into the social determinant of health curriculum that we’re building here.”
Dr. Sarah J. Coates
Dr. Coates began to appreciate the link between climate and infectious diseases – a topic she now writes and speaks about – when she saw several patients with coccidioidomycosis as a dermatology resident at UCSF and learned that the cases represented an epidemic in the Central Valley “resulting from several years of drought.”
Her medical school and residency training were otherwise devoid of any discussion of climate change. At UCSF and nearby Stanford (Calif.) University, this is no longer the case, she and Dr. Williams said. “The medical students here have been quite active and are requesting education,” noted Dr. Williams. “The desire to know more is coming from the bottom.”
Mary E. Maloney, MD, professor of medicine and director of dermatologic surgery at the University of Massachusetts, Worcester, sees the same interest from physicians-in-training in the Boston area. They want education about climate science, the impact of climate changes on health and risk mitigation, and ways to reduce medicine’s carbon footprint. “We need to teach them and charge them to lead in their communities,” she said in an interview.
Dr. Mary E. Maloney
Dr. Maloney joined the AAD’s climate change resource group soon after its inception, having realized the urgency of climate change and feeling that she needed “to get passionate and not just do small things.” As a Mohs surgeon, she expects an “explosion” of skin cancer as temperatures and sun exposure continue to increase.
She urges dermatologists to work to decrease the carbon footprint of their practices and to advocate for local hospitals and other clinical institutions to do so. On the AAD website, members now have free access to tools provided by the nonprofit organization My Green Doctor for outpatient offices to lighten their carbon footprints in a cost-effective – or even cost-saving – manner.
Dr. Maloney’s institution has moved to automated lighting systems and the use of LED lights, she said, and has encouraged ride sharing (prior to the pandemic) and computer switch-offs at night. And in her practice, she and a colleague have been working to reduce the purchasing and use of disposable plastics.
Educating patients about the effects of climate change on the health of their skin is another of the missions listed in the AAD’s position statement, and it’s something that Dr. Coates is currently researching. “It seems similar to talking about other social determinants of health,” she said. “Saying to a patient, for instance, ‘we’ve had some really terrible wildfires lately. They’re getting worse as the seasons go on and we know that’s because of climate change. How do you think your current rash relates to the current air quality? How you think the air quality affects your skin?’ ”
Dr. Rosenbach emphasizes that physicians are a broadly trusted group. “I’d tell a patient, ‘you’re the fourth patient I’ve seen with Lyme – we think that’s because it’s been a warmer year due to climate change,’” he said. “I don’t think that bringing up climate change has ever been a source of friction.”