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Health care professionals are on the front lines of climate change, yet few have been trained to recognize and address the many ways climate change affects patients’ health.
Gaurab Basu is leading efforts at Harvard Medical School to change that. He is collaborating with students, clinicians, and leaders to bring climate change into medical curricula, continuing medical education, and public discourse in the Harvard community and across the country.
These efforts build on the pioneering work of many at HMS and the Harvard T.H. Chan School of Public Health, notably HMS alumnus and former HMS faculty member Eric Chivian, who founded and directed the HMS-based center now known as the Center for Climate, Health, and the Global Environment (C-CHANGE), based at the Harvard Chan School.
“Learning about climate change in medical school shouldn’t be an afterthought; it’s fundamental to the practice of being a good doctor,” said Basu, assistant professor of global health and social medicine in the Blavatnik Institute at HMS and HMS assistant professor of medicine at Cambridge Health Alliance.
Last year Basu helped integrate climate change into the School’s primary medical education curriculum. A new paper published May 29 in PLOS Climate describes the implementation and provides an initial evaluation of the results.
The work helps lead a national movement to develop, integrate, and assess climate-related competencies in medical education; implement such curricula at more medical schools; and collaborate with accreditation organizations to standardize them.
In addition, as director of education and policy at C-CHANGE, Basu has led the creation of an interdisciplinary climate change and planetary health concentration that will launch this fall.
He also runs a fellowship at Cambridge Health Alliance that teaches U.S. health professionals how to address climate change in their organizations and communities and was the subject of a study published in Academic Medicine in January 2024.
The Salata Institute for Climate and Sustainability at Harvard University recently spoke with Basu about why climate lessons must be embedded in health education. An excerpt from that conversation follows.
Salata Institute: Why is it important to train doctors and other health professionals on climate and planetary health?
Gaurab Basu: I had my climate awakening after the release of the Intergovernmental Panel on Climate Change 2018 report [on the impacts of 1.5 degrees Celsius of warming]. I’m a global health doctor and was working on issues of child nutrition and access to care around the world, delivering basic services like access to clean water and food.
And the 2018 report catalyzed me. It was like a thunderbolt. I recognized then that climate action was critical to addressing all those things I cared so deeply about. There’s something very special about health. When you talk about people's health, it’s about their humanity, it’s about their vulnerability, their hopes and dreams. And at the foundation of that is a special trust — people trust you to take care of them. And ultimately, I want to live in a society in which we are taking better care of each other.
After that report it became so fundamentally clear to me that all those values we have in medicine and public health are simply not possible without ambitious climate solutions. And then I realized we need to train doctors and public health professionals to be leaders and changemakers in this work.
Salata: Could you share an example from your own clinical practice?
Basu: There’s a patient I can describe to you, a healthy man of about 30, who was a sugarcane farmer in Central America before he came to the United States. He was having upper respiratory symptoms, acute shortness of breath; he thought he had a cold. He came to the emergency room thinking he would get some antibiotics and be on his way.
But he had a devastating, completely unexpected diagnosis. His kidneys were in failure, totally shutting down. He had to be hospitalized urgently and started on dialysis. Usually, with kidney disease, we expect to see long-term diabetes or high blood pressure; these are typically in older folks. But he was healthy and young.
Ultimately, we diagnosed him with a form of heat-triggered nephropathy. Back home he had been in the sugarcane fields day in and day out, attending to the crops in the heat. He was sweating so much that he was getting dehydrated every day. So the blood flow to his kidneys was significantly impaired, and his kidneys were slowly getting acute injuries. He didn’t know he was putting his body at risk every day. This was a dramatic diagnosis that completely upended his life.
I became his primary care doctor after his hospitalization. I always remember walking into the room and seeing him for the first time. He was so scared. That clinical experience taught me the broad impacts of climate change and how intersectional it was with so many issues of health equity and vulnerability. I realized it was my responsibility to be thinking about how climate change is impacting my patients.
Another patient was brought to our hospital very confused. We didn’t know what was causing his sudden mental decline. Then we found West Nile in his cerebrospinal fluid.
We don’t see much West Nile in Massachusetts. But we need to be developing a practice as medical students, residents, doctors, and health professionals to be analyzing the ways that climate change is changing disease patterns — by infectious diseases or extreme heat or air pollution — and be prepared to make those kinds of diagnoses and create appropriate treatment plans.
Salata: Is the type of climate education you’ve implemented at HMS gaining traction in other schools around the world?
Basu: It is still in a fairly nascent phase, but increasing. The Association of American Medical Colleges did a survey and found that 55 percent of medical schools reported that the health effects of climate change was a required topic in their courses in 2022. That doubled from 27 percent two years prior. So that’s good, but we’ve really got to do more.
That survey is simply saying that it was a topic at some point, but we’re trying to make the argument that we can have this kind of longitudinal, more coherently designed curriculum, so that students develop a practice of understanding the various ways in which climate change is affecting health. When students are learning about malaria [at HMS], we insert information about how land-use changes, flooding, and changing temperatures are changing the distribution of mosquito-borne illnesses. When they’re learning about asthma, we look at how air pollution can impact that.
In our survey of Harvard medical students, 94 percent said that understanding how climate change impacts human health should be part of all students’ medical education. Students are certainly one of the major drivers leading this work. And I believe that in the coming years you’re going to see the presence of climate change curriculum influence students’ decisions about where they want to go to medical school.
Read the full interview and read more about the PLOS Climate paper.
Adapted from Harvard Chan School and Salata Institute news materials.
