Climate change and health: Changes in student environmental knowledge and awareness due to the implementation of a mandatory elective at the Medical Faculty of Ulm? Translated title: Klimawandel und Gesundheit: Veränderungen in Umweltwissen und -bewusstsein von Studierenden durch die Implementierung eines Wahl-Pflichtfaches an der Medizinischen Fakultät Ulm?
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Abstract
Background and objectives:
According to the World Health Organization, climate change constitutes the single
greatest threat to human health. However, the health care system contributes to climate
change worldwide through its high CO
2 emissions. In order to make future physicians more aware of this issue and to expand
medical education to include climate-related aspects, the mandatory 28 academic hours
elective “Climate Change and Health” for students of human medicine in the preclinical
study stage was implemented at the Medical Faculty of Ulm in the 2020/21 winter semester.
Our accompanying study investigated
1. in what form the topic of climate change can be successfully integrated into the
study of human medicine in a manner that includes student opinions and
2. whether being required to take an elective on the topic led to changes in student
environmental knowledge and awareness.
Methodology:
Personal individual interviews were conducted with all
n=11 students after the course in a pilot that was carried out in the 2020/21 winter
semester to determine course feasibility and student acceptance. The students were
also able to evaluate the course using an evaluation form and were asked to complete
a questionnaire on their environmental knowledge and awareness before and after the
course. The course was revised on the basis of the results and offered again in the
2021 summer semester with an intervention group (
n=16, participation in the mandatory elective) and a comparison group (
n=25, no participation in the mandatory elective). The intervention group was asked
to evaluate the course on the evaluation form. Both groups completed the environmental
questionnaire at the same time.
Results:
The positive feedback from students for both semesters indicates a good feasibility
and acceptance of the course. Student environmental knowledge was increased in both
semesters. However, there were only few observable changes in student environmental
awareness.
Conclusion:
This paper illustrates how the topic of climate change and health can be embedded
into medical studies. The students considered climate change an important topic and
drew added value from the course for their future work in healthcare. The study shows
that knowledge transfer at the university level is an effective way to educate the
young generation on climate change and its impacts.
Zusammenfassung
Hintergrund und Zielsetzung:
Laut Weltgesundheitsorganisation stellt der Klimawandel die größte gesundheitliche
Bedrohung der Menschheit dar. Sogleich trägt das Gesundheitssystem über seine hohen
CO
2-Emissionen weltweit zum Klimawandel bei. Um zukünftige Medizinerinnen und Mediziner
hierfür zu sensibilisieren und die medizinische Ausbildung um klimabezogene Aspekte
zu erweitern, wurde an der Medizinischen Fakultät Ulm im Wintersemester (WS) 2020/21
das Wahl-Pflichtfach „Klimawandel und Gesundheit“ mit einem Umfang von 28 akademischen
Stunden für Studierende der Humanmedizin im vorklinischen Studienabschnitt implementiert.
Unsere begleitende Studie untersuchte,
1. in welcher Form das Thema erfolgreich in das Studium der Humanmedizin unter Einbezug
der Studierendenmeinung integriert werden kann und
2. ob es durch Teilnahme an einem Wahl-Pflichtfach zum Thema zu Veränderungen in Umweltwissen
und -bewusstsein bei den Studierenden kommt.
Methodik:
Zur Durchführbarkeit und Akzeptanz des Kurses wurden in einer Pilotrunde im WS 2020/21
mit allen
n=11 Studierenden nach dem Kurs persönliche Einzelinterviews durchgeführt. Auch konnten
die Studierenden den Kurs über einen Evaluationsfragebogen bewerten und wurden gebeten
vor und nach Besuch des Kurses einen Umweltfragebogen zu Umweltwissen und -bewusstsein
zu bearbeiten. Auf Basis dieser Erkenntnisse wurde der Kurs optimiert und im Sommersemester
(SS) 2021 mit einer Interventions- (
n=16, Teilnahme am Wahl-Pflichtfach) und einer Vergleichsgruppe (
n=25, keine Teilnahme am Wahl-Pflichtfach) erneut durchgeführt. Die Interventionsgruppe
bewertete den Kurs über den Evaluationsfragebogen. Beide Gruppen bearbeiteten zeitgleich
den Umweltfragebogen.
Ergebnisse:
Die positiven Bewertungen in beiden Umläufen lassen auf eine gute Durchführbarkeit
und Akzeptanz des Kurses schließen. Das Umweltwissen der Studierenden konnte in beiden
Umläufen gesteigert werden. Veränderungen im Umweltbewusstsein waren hingegen nur
wenig zu beobachten.
Schlussfolgerung:
Die vorliegende Arbeit veranschaulicht, wie das Thema Klimawandel und Gesundheit
in das Medizinstudium eingebettet werden kann. Die Studierenden erachten die Thematisierung
des Klimawandels als wichtig und ziehen aus dem Kurs einen Mehrwert für ihre künftige
Arbeit im Gesundheitswesen. Die Studie zeigt, dass die Wissensvermittlung auf universitärer
Ebene eine effektive Möglichkeit darstellt, die junge Generation zum Klimawandel und
dessen Auswirkungen aufzuklären.
Executive summary The Lancet Countdown is an international collaboration established to provide an independent, global monitoring system dedicated to tracking the emerging health profile of the changing climate. The 2020 report presents 43 indicators across five sections: climate change impacts, exposures, and vulnerabilities; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. This report represents the findings and consensus of the 35 leading academic institutions and UN agencies that make up the Lancet Countdown, and draws on the expertise of climate scientists, geographers, engineers, experts in energy, food, and transport, economists, social, and political scientists, data scientists, public health professionals, and doctors. The emerging health profile of the changing climate 5 years ago, countries committed to limit global warming to “well below 2°C” as part of the landmark Paris Agreement. 5 years on, global carbon dioxide (CO2) emissions continue to rise steadily, with no convincing or sustained abatement, resulting in a rise in the global average temperature of 1·2°C. Indeed, the five hottest years on record have occurred since 2015. The changing climate has already produced considerable shifts in the underlying social and environmental determinants of health at the global level. Indicators in all domains of section 1 (climate change impacts, exposures, and vulnerabilities) are worsening. Concerning, and often accelerating, trends were seen for each of the human symptoms of climate change monitored, with the 2020 indicators presenting the most worrying outlook reported since the Lancet Countdown was first established. These effects are often unequal, disproportionately impacting populations who have contributed the least to the problem. This fact reveals a deeper question of justice, whereby climate change interacts with existing social and economic inequalities and exacerbates longstanding trends within and between countries. An examination of the causes of climate change revealed similar issues, and many carbon-intensive practices and policies lead to poor air quality, poor food quality, and poor housing quality, which disproportionately harm the health of disadvantaged populations. Vulnerable populations were exposed to an additional 475 million heatwave events globally in 2019, which was, in turn, reflected in excess morbidity and mortality (indicator 1.1.2). During the past 20 years, there has been a 53·7% increase in heat-related mortality in people older than 65 years, reaching a total of 296 000 deaths in 2018 (indicator 1.1.3). The high cost in terms of human lives and suffering is associated with effects on economic output, with 302 billion h of potential labour capacity lost in 2019 (indicator 1.1.4). India and Indonesia were among the worst affected countries, seeing losses of potential labour capacity equivalent to 4–6% of their annual gross domestic product (indicator 4.1.3). In Europe in 2018, the monetised cost of heat-related mortality was equivalent to 1·2% of regional gross national income, or the average income of 11 million European citizens (indicator 4.1.2). Turning to extremes of weather, advancements in climate science allow for greater accuracy and certainty in attribution; studies from 2015 to 2020 have shown the fingerprints of climate change in 76 floods, droughts, storms, and temperature anomalies (indicator 1.2.3). Furthermore, there was an increase in the number of days people were exposed to a very high or extremely high risk of wildfire between 2001–04 and 2016–19 in 114 countries (indicator 1.2.1). Correspondingly, 67% of global cities surveyed expected climate change to seriously compromise their public health assets and infrastructure (indicator 2.1.3). The changing climate has downstream effects, impacting broader environmental systems, which in turn harm human health. Global food security is threatened by rising temperatures and increases in the frequency of extreme events; global yield potential for major crops declined by 1·8–5·6% between 1981 and 2019 (indicator 1.4.1). The climate suitability for infectious disease transmission has been growing rapidly since the 1950s, with a 15·0% increase for dengue caused by Aedes albopictus in 2018, and regional increases for malaria and Vibrio bacteria (indicator 1.3.1). Projecting forward, based on current populations, between 145 million people and 565 million people face potential inundation from rising sea levels (indicator 1.5). Despite these clear and escalating signs, the global response to climate change has been muted and national efforts continue to fall short of the commitments made in the Paris Agreement. The carbon intensity of the global energy system has remained almost flat for 30 years, with global coal use increasing by 74% during this time (indicators 3.1.1 and 3.1.2). The reduction in global coal use that had been observed since 2013 has now reversed for the past 2 consecutive years: coal use rose by 1·7% from 2016 to 2018. The health burden is substantial—more than 1 million deaths occur every year as a result of air pollution from coal-fired power, and some 390 000 of these deaths were a result of particulate pollution in 2018 (indicator 3.3). The response in the food and agricultural sector has been similarly concerning. Emissions from livestock grew by 16% from 2000 to 2017, with 93% of emissions coming from ruminant animals (indicator 3.5.1). Likewise, increasingly unhealthy diets are becoming more common worldwide, with excess red meat consumption contributing to some 990 000 deaths in 2017 (indicator 3.5.2). 5 years on from when countries reached an agreement in Paris, a concerning number of indicators are showing an early, but sustained, reversal of previously positive trends identified in past reports (indicators 1.3.2, 3.1.2, and 4.2.3). A growing response from health professionals Despite little economy-wide improvement, relative gains have been made in several key sectors: from 2010 to 2017, the average annual growth rate in renewable energy capacity was 21%, and low-carbon electricity was responsible for 28% of capacity in China in 2017 (indicator 3.1.3). However, the indicators presented in the 2020 report of the Lancet Countdown suggest that some of the most considerable progress was seen in the growing momentum of the health profession’s engagement with climate change globally. Doctors, nurses, and the broader profession have a central role in health system adaptation and mitigation, in understanding and maximising the health benefits of any intervention, and in communicating the need for an accelerated response. In the case of adaptation in national health systems, this change is underway. Impressively, health services in 86 countries are now connected with their equivalent meteorological services to assist in health adaptation planning (indicator 2.2). At least 51 countries have developed plans for national health adaptation, and global spending in health adaptation rose to 5·3% of all adaptation spending in 2018–19, reaching US$18·4 billion in 2019 (indicators 2.1.1 and 2.4). The health-care sector, which was responsible for 4·6% of global greenhouse gas emissions in 2017, is taking early but important steps to reduce its own emissions (indicator 3.6). In the UK, the National Health Service has declared an ambition to deliver a net-zero health service as soon as possible, building on a decade of impressive progress in reducing delivery of care emissions by 57% since 1990, and by 22% when considering the service’s supply chain and broader responsibilities. Elsewhere, the Western Australian Department of Health used its 2016 Public Health Act to conduct Australia’s first climate and health inquiry, and the German Federal Ministry of Health has established a dedicated department on health protection and sustainability responsible for climate-related matters. This progress is becoming more evenly distributed around the world, with 73% of countries making explicit references to health and wellbeing in their Nationally Determined Contributions under the Paris Agreement, and 100% of countries in the South-East Asia and Eastern Mediterranean regions doing so (indicator 5.4). Similarly, least-developed countries and small island developing states are providing increasing global leadership within the UN General Debate on the connections between health and climate change (indicator 5.4). Individual health professionals and their associations are also responding well, with health institutions committing to divest more than $42 billion worth of assets from fossil fuels (indicator 4.2.4). In academia, the publication of original research on health and climate changed has increased by a factor of eight from 2007 to 2019 (indicator 5.3). These shifts are being translated into the broader public discourse. From 2018 to 2019, the coverage of health and climate change in the media increased by 96% world-wide, outpacing the increased coverage of climate change overall, and reaching the highest observed point to date (indicator 5.1). Just as it did with advancements in sanitation and hygiene and with tobacco control, growing and sustained engagement from the health profession during the past 5 years is now beginning to fill a crucial gap in the global response to climate change. The next 5 years: a joint response to two public health crises Dec 12, 2020, will mark the anniversary of the 2015 Paris Agreement, with countries set to update their national commitments and review these commitments every 5 years. These next 5 years will be pivotal. To reach the 1·5°C target and limit temperature rise to “well below 2°C”, the 56 gigatonnes of CO2 equivalent (GtCO2e) currently emitted annually will need to drop to 25 GtCO2e within only 10 years (by 2030). In effect, this decrease will require a 7·6% reduction every year, representing an increase in current levels of national government ambition of a factor of five. Without further intervention during the next 5 years, the reductions required to achieve this target increase to 15·4% every year, moving the 1·5°C target out of reach. The need for accelerated efforts to tackle climate change during the next 5 years will be contextualised by the impacts of, and the global response to, the COVID-19 pandemic. With the loss of life from the pandemic and from climate change measured in the hundreds of thousands, the potential economic costs measured in the trillions, and the broader consequences expected to continue for years to come, the measures taken to address both of these public health crises must be carefully examined and closely linked. Health professionals are well placed to act as a bridge between the two issues, and analogically considering the clinical approach to managing a patient with COVID-19 might be useful in understanding the ways in which these two public health crises should be jointly addressed. First, in an acute setting, a high priority is placed on rapidly diagnosing and comprehensively assessing the situation. Likewise, further work is required to understand the problem, including: which populations are vulnerable to both the pandemic and to climate change; how global and national economies have reacted and adapted, and the health and environmental consequences of these actions; and which aspects of these shifts should be retained to support longer term, sustainable development. Second, appropriate resuscitation and treatment options are reviewed and administered, with careful consideration of any potential side-effects, the goals of care, and the life-long health of the patient. Economic recovery packages that prioritise outdated forms of energy and transport that are fossil fuel intensive will have unintended side-effects, unnecessarily adding to the 7 million people that die every year from air pollution. Instead, investments in health imperatives, such as renewable energy and clean air, active travel infrastructure and physical activity, and resilient and climate-smart health care, will ultimately be more effective than these outdated methods. Finally, attention turns to secondary prevention and long-term recovery, seeking to minimise the permanent effects of the disease and prevent recurrence. Many of the steps taken to prepare for unexpected shocks, such as a pandemic, are similar to those required to adapt to the extremes of weather and new threats expected from climate change. These steps include the need to identify vulnerable populations, assess the capacity of public health systems, develop and invest in preparedness measures, and emphasise community resilience and equity. Indeed, without considering the current and future impacts of climate change, efforts to prepare for future pandemics are likely to be undermined. At every step and in both cases, acting with a level of urgency proportionate to the scale of the threat, adhering to the best available science, and practising clear and consistent communications, are paramount. The consequences of the pandemic will contextualise the economic, social, and environmental policies of governments during the next 5 years, a period that is crucial in determining whether temperatures will remain “well below 2°C”. Unless the global COVID-19 recovery is aligned with the response to climate change, the world will fail to meet the target laid out in the Paris Agreement, damaging public health in the short term and long term.
Publisher:
German Medical Science GMS Publishing House
ISSN
(Electronic):
2366-5017
Publication date
(Electronic):
15
May
2023
Publication date Collection: 2023
Volume: 40
Issue: 3
,
Planetary Health and Climate Medicine/Planetare Gesundheit und Klimamedizin
Electronic Location Identifier: Doc32
Affiliations
[1
]University of Ulm, Medical Faculty, Institute of Biochemistry and Molecular Biology,
Ulm, Germany
Author notes
*To whom correspondence should be addressed: Susanne J. Kühl, University of Ulm, Medical
Faculty, Institute of Biochemistry and Molecular Biology, Albert-Einstein-Allee 11,
D-89081 Ulm, Germany, E-mail:
susanne.kuehl@
123456uni-ulm.de
Article
Publisher ID:
zma001614
Publisher ID:
Doc32
Other ID: urn:nbn:de:0183-zma0016148
This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 License. See license information at
http://creativecommons.org/licenses/by/4.0/.
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