Not really, say Dutch medical students. They therefore argue in favor of including climate science in their curriculum.

Gone are the days when only climate researchers were concerned about the climate. Ominous messages are now also being heard from other fields, such as the medical world. Last month, for example, more than 200 medical journals sounded the alarm by collectively warning of ‘catastrophic health damage’ as a result of climate change and closely related problems such as environmental and air pollution and biodiversity loss.

From gynecology to immunology

They may be very abstract problems, but they are already expressed very concretely in the doctor’s office, says Amber Ten Buuren, a fourth-year medical student at Utrecht University (UU) and a member of the CO2 assistant, an organization under others advocate implementing sustainability and climate change in medical education. “In fact, the consequences of climate change, pollution and biodiversity loss are already visible in every medical field. For example, due to air pollution in gynecology we see more premature births and the same problem in geriatrics leads to an increase in dementia.” Pulmonologists meanwhile have their hands full with patients with air pollution-induced lung diseases, such as asthma and COPD. “And immunologists, for example, see more patients with longer lasting hay fever symptoms due to higher temperatures.”

The faces behind the CO2 assistant: medical students from Groningen, Amsterdam and Utrecht.

Viruses

And the biodiversity crisis is not a far-fetched show for doctors, says Jopke Janmaat, sixth-year medical student at the UU and founder of the CO2 assistant. Because where ecosystems are destroyed, water and food security are at stake and the interaction between wildlife and humans can introduce new pathogens. “Biodiversity loss can lead to more disease (for example through malnutrition, ed.), other forms of disease or the emergence of new viruses.” We all witnessed the latter a year and a half ago. “It is not a future problem,” Janmaat underlines. “It’s a problem now and it’s only going to get worse.”

Causative agent

And doctors are not only confronted with the consequences of biodiversity loss, climate change and pollution, they also contribute to it. “In the Netherlands, for example, about 7 percent of CO2 emissions come from medical care,” says Janmaat. It can be traced back to the energy consumption of hospitals, practices and care homes. “But also, for example, to the transport of patients and employees.” Meanwhile, the use of medicines and protective equipment contributes to environmental pollution. “The intensive care unit of Erasmus MC recently made an inventory that about 108 pairs of gloves and 8 incontinence pads are used per patient every day. This results in an enormous amount of plastic waste, and those incontinence pads are also very difficult to recycle. Although high-quality care is provided, it comes with a (polluting) price. It’s a toxic cycle. We want to ensure that the quality of care is guaranteed and at the same time that it is not harmful to the environment.”

Change

Enough reason to ensure that future doctors become aware of that cycle and commit to breaking it. But that doesn’t happen. “There is alarmingly little systematic attention for the climate and environmental problem within medicine education. And that does not only apply to the Netherlands, but that is actually the case worldwide.” And that has to change, according to the medical students who have gathered within the CO2 assistant. “Students must become aware as soon as possible of the role they play as doctors in the climate problem,” says Ten Buuren.

Prevention

But what should concretely change in medicine training? “More attention should be paid to diseases caused by climate change,” says Ten Buuren. “But also for more sustainable care, for example.” Because it is clear that it can be done more sustainably. “Now it is usually the case that you go to a doctor when you are sick, but the focus should be much more on prevention.” Because if diseases or health problems can be prevented, they do not need to be treated. In this way, the impact that medical care has on the climate and the environment can be reduced, resulting in health benefits for everyone. In addition, a healthy diet is often more sustainable and more exercise by, for example, taking the bicycle instead of the car also yields double benefits. Moreover, prevention is also cheaper than cure. So win-win-win-win.

Sustainable choices

Of course, not all conditions can be prevented, but even where treatment is necessary, more sustainable choices can be made. “For example, by opting for an e-consultation more often or by scheduling multiple appointments that one patient has with different doctors in one day as much as possible.” But there is still room to be made in the choice of medicines and protective equipment. “Think of the difference it would make if we started using biodegradable gloves or incontinence pads that are easy to recycle. Or if, when considering two puffers that are both just as effective, we opt for the puffer that has the least impact on the environment?”

But such considerations can only be made if you are aware of the climate and environmental problems and the role that the medical sector plays in this. And that is why medical students should be taught this, according to the CO2 assistant. And their plea is heard. “There is momentum,” says Janmaat. “Utrecht University, for example, is very sympathetic and awarded ‘The CO2 Assistant’ last month with a student prize for ‘Special Administrative and Social Merits’.” But it remains to be seen whether the curriculum will also be opened up. “We are very optimistic,” says Ten Buuren. “During the corona crisis, we saw that a lot of money can be released for an urgent problem in a short time and mountains can also be moved.” Now it’s time to do the same for those other pressing issues. “The climate crisis is a health crisis.” Janmaat agrees. “According to the World Health Organization, this is the biggest problem of the coming century and threatens to negate the health gains made in recent decades.” That would be a waste. And so the students remain committed to change. “And not only us; there are many more working groups that deal with this, such as Care for Climate, Med-Zer0, the Sustainable Nursing and Green Care Alliance. And of course it is difficult to bring about change.” But the students are not deterred by this. “If you start thinking in impossibilities, you fall into passivity, while this should be the generation that will make the difference.”