Raised by two psychologists, Madeleine Kline had wanted to become a doctor since she was little. And when she learned in high school how human activity was fueling climate change, she concluded “it felt fundamentally like a health problem.”
So it seemed the most natural thing for her to go into medicine. And once at Harvard Medical School, she combined her two interests to help produce a novel undertaking at the 350-year-old institution: embed teaching about the effects of climate change into all four years of the medical degree curriculum.
“I realized that the world then,” she said of her youth, “was not the world that I was going to inhabit as an adult or raise my children in. And, if I wanted to help take care of people, I needed to understand the challenges my patients were going to face.”
Now in her third year, Kline was among a small group of students and faculty who helped convince school leaders to adopt the new curriculum, which was approved earlier in January. It will include instruction on the effects of climate change on human health, the role health care systems play in contributing to climate change, and how physicians can work to be part of the solution.
Intense temperatures can cause hypothermia or heat stroke, particularly among elderly and homeless people, while survivors of extreme weather events such as a cataclysmic hurricane can experience high levels of anxiety and post-traumatic stress disorder, according to research from the CDC. And, the National Institutes of Health found that changes in air and water temperatures can increase bacteria, parasites, and chemical contaminants in food, according the National Institutes of Health..
One curricular change teaches Harvard medical students the effects of extreme weather on organs. The student group suggested that when instructors teach about the kidney, they briefly cover a chronic kidney disease called Mesoamerican Nephropathy that is prevalent among young, agricultural workers, primarily in Central America, which NIH research found may be linked to “recurrent dehydration” in hot climates.
“We thought it was an opportunity to really highlight a number of different ways that the climate crisis impacts communities,” Kline said. “There’s a clear link between extreme heat, agricultural practices, and this chronic kidney disease in these low- and middle-income countries.”
The changes, which begin this spring, are the culmination of more than a year’s worth of planning. Kline and her peers worked with course directors and faculty to find ways to integrate climate-related knowledge into existing lectures without adding too much new information to already-packed courses. The school is not adding new courses.
For example, all new students take a course called Introduction to the Profession, which teaches them the responsibilities and expectations of medical students and doctors. Last year, the course examined climate advocacy as a way for medical students and physicians to support their patients, said fourth-year student Julia Malits.
“We thought about [courses] individually and, one by one, worked on curricular content in close collaboration with both the faculty course directors who run the course and faculty experts,” said Malits, also a member of the student group.
Dr. Gaurab Basu, the new climate and health curriculum theme director at Harvard Medical School, said understanding how the climate crisis will have an impact on patients is crucial for the coming generations of physicians, especially as the threat to human health continues to grow.
As extreme heat becomes more common, for example, it can increase the risk of strokes and heart attacks and exacerbate underlying health conditions such as diabetes and asthma, according to the Centers for Disease Control and Prevention.
Massachusetts has already seen a 3.5 degree increase in average temperatures since the beginning of the 20th century and the summers will only get increasingly hotter, according to a study by the City of Boston. Researchers found that the number of days per year that reach over 90 degrees in Boston could increase from 22 in 2015 to up to 40 by 2030.
Harvard joins other medical schools that have incorporated climate education, largely inspired by student advocacy. A 2022 study by the Association of American Medical Colleges found the percentage of medical schools covering the health effects of climate change doubled over the past three years, to 55 percent in 2022 from 27 percent in 2019. Researchers credited student activism as one of the driving forces for this drastic change.
“I really commend students for leading the charge here and across the country,” said Basu, who is also co-director of the Cambridge Health Alliance’s Center for Health Equity Education.
As calls to include climate change in medical curriculums grow, so do the resources available to schools interested in making changes. Last year, trainees and faculty at several US universities launched the Climate Resources for Health Education, a free, digital resource bank to help guide the incorporation of climate change into medical curriculums.
“Many of the places that want to do this don’t have faculty with expertise in both climate and curricular development ,” said Karly Hampshire, a fourth-year medical student at the University of California, San Francisco. “And it’s hard as a student to build brand-new curricular resources when you’re still trying to learn the medicine part of it.”
Hampshire is the creator of the Planetary Health Report Card, where medical students from around the world collectively grade their schools on climate education. Now in its fourth year, the project includes students from more than 15 countries at more than 100 institutions.
None of the Massachusetts medical schools included in the gradings scored highly, with Harvard Medical School the highest at a B-.
But, changes are on the horizon. At Tufts University School of Medicine, course directors are working to integrate climate-related material into the curriculum, according to Laura Baecher-Lind, dean of education affairs for Tufts University School of Medicine.
“A team ... has completed an inventory of the entire curriculum to determine where climate change and health impacts are already presented, and where they may be able to be added fairly easily,” she said.
Climate change is also being woven into classes at the University of Massachusetts Chan Medical School in Worcester, which launched a new curriculum last August. Four topic areas will be integrated within all courses. One, called Societal Forces in Health and Disease, encompasses topics such as climate change, food equity, and social justice, according to Dr. Manas Das, the medical school’s assistant dean of the foundational curriculum.
“It’s an ever-expanding ... curriculum and we’re just learning so much,” he said.