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Is the health care system ready for climate change?

Stanford medical student Dan Bernstein challenges health care professionals to take steps to mitigate and respond to climate change.

I first learned about the most important graph in medicine about 20 years ago, an epiphany that guided my decision to pursue a career in green energy entrepreneurship and energy economics/policy rather than in medicine at that time.

The graph I refer to is the Keeling curve, a remarkable dataset that displays the accumulation of carbon dioxide in the atmosphere. CO2 levels were at 370 parts per million on the curve when I decided to delay my medical career to work on the climate problem. Today there are at over 410 PPM. If present trends continue, we will be at 450 ppm in 20 years. These numbers are frightening.

The insidious nature of the emissions problem dictates that the current 1 degree Celsius fever that the planet has today is from CO2 we emitted when most of my classmates were toddlers. Our best available science suggests we have maybe 10 years -- less than the time it will take some of my fellow second-year med students to become neurosurgeon attendings -- to cut our emissions by about 50% to avoid some very undesirable outcomes.

Most of us are living our lives of today and planning our lives of tomorrow as if the future climate will be a continuation of the past climate. This behavior is predictable yet completely wrong. The climate that enabled human civilization to flourish over the past 10,000 years is extinct. It is now incumbent on us -- because no one else is going do it -- to decide what our new climate will look like. It is not too late to try to make a difference.

What are some things we could do in the health care system to mitigate and respond to climate change? (An advance warning: I recognize that some of these may sound ridiculous in the present climate of inaction.)

First, our medical schools should be integrating climate science into the curriculum. In my first two years of medical training, climate change was mentioned exactly once: in an optional microbiology class. This is insufficient. I believe that all medical students should be learning about the Keeling curve and what it means for their future careers and lives.

Second, we ask our patients about tobacco use and vaccinations for both individual and societal public health reasons. Climate change will have a public health impact that is at least as significant. Why don't we start training medical students to begin asking their patients about their carbon footprints? Imagine how physicians could help to normalize the topic for our society -- and perhaps stimulate change -- if we asked them about what they're doing to help ensure our communal long-term health. If this sounds bizarre to you, just remember that decades ago physicians did not ask their patients about tobacco use.

Third, when I interviewed at medical schools, I emitted about five tons of carbon dioxide from my airline travel. For residency, I will likely emit another five to 10 tons as I travel for interviews.

Considering that medical education is a commodity that can be learned anywhere, do we really need to be crisscrossing the country to learn it? What would our system be like if it were more regional than national, a system where people trained near where they already lived? In a similar vein, how many emissions could be saved if we had fewer medical conferences that encouraged people to travel all over the world on a regular basis? I suspect that someday soon we will look back on some of these behaviors with significant regret.

Fourth, and perhaps most importantly, our health care system needs to start preparing strategically for change. For example, climate change exacerbated severe weather events have and will continue to disrupt global supply chains that provide our system with medicines and equipment that we need to care for patients.

Perhaps Stanford and other leading academic medical institutions should develop interdisciplinary climate and medicine institutes to help develop and transmit best practices for building a more resilient medical system in our new and changing climate. As the World Health Organization has already pointed out, climate change is the number one public health issue of the century.

We are at a point where heroic measures are necessary to ensure climatic stability. I think it's time that our health care system starts playing its role in the solution.

Dan Bernstein is a second-year medical student at Stanford. In his previous career he founded several green energy technology companies and nonprofits that continue to operate today to reduce global carbon dioxide emissions.

Photo by Trinity Moss

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