Time for Action

Posted by Holly Fletcher on Monday, May 16, 2022 in Features, Spring 2022 .

“Either we’re all going to rise, or we’re all going to sink together.” When she says that, Carol Ziegler, DNP, NP-C, RD, is getting real about how the intensifying changes in climate are going to intersect with health — for each and every one of us, but especially for her low-income patients who often live in apartments without air conditioning and in areas where asthma is rampant.

It’s not just heat strokes and sun exposure from increased temperatures. It’s also the effects of flooding and more severe storms. Changes to the earth’s environment will bring more vector-borne diseases such as malaria and dengue fever, more cardiovascular disease, depression and anxiety, and the list goes on. Those will inevitably spur people to seek medical treatment.

Ziegler, a member of the Vanderbilt Institute for Global Health and a professor at Vanderbilt University School of Nursing, is in the vanguard of those at Vanderbilt raising awareness of the complex intersection of climate and health.

“Climate care is health care”

All those imaging machines that lead to diagnosis? Electricity guzzlers.

Reed Omary, MD, MS, Carol D. and Henry P. Pendergrass Professor and chair of the Department of Radiology, is taking the radiology world by storm this year. He’s on a mission to put his specialty at the forefront of reducing the carbon footprint in health care. His mantra is “climate care is health care.”

Guided by his maxim and the words of architect and futurist Buckminster Fuller, “We are called to be architects of the future,” he is encouraging people at all levels within health care — and especially physicians — to think critically about how they can be agents of change and proponents of health equity.

“I think it’s beyond our opportunity as physicians. It’s actually a responsibility. We need to care about the health of the public. We need to care about equity. We need to care about the planet. And it’s not just for us right now; it’s for every subsequent generation, our children, our grandchildren, 100 generations from now. It’s who we are. It comes to our values,” Omary said on the “Climate is Us: Why climate change is health care’s lane” episode of the “Vanderbilt Health DNA: Discoveries in Action” podcast, which also featured Ziegler and Louise Rollins-Smith, PhD, professor of Pathology, Microbiology and Immunology, who studies the immune defense mechanisms of amphibians.

Omary is taking that message on a road show. He’s given eight grand rounds lectures so far this year to departments around the country ranging from Washington to Illinois to California. He challenged health care leaders — really, the leader in all of us — to infuse climate leadership into their professional resolutions in an op-ed, ‘As a medical doctor, this is how I’m making climate action my 2022 resolution,’ that ran in The Tennessean this year.

‘Well, that doesn’t work anymore’

Medicine is in a watershed moment to adjust to and account for the social determinants of health that hinder well-being. While not every patient is limited by tight purse strings or lives in a food desert or goes up against discriminatory structures while just trying to carve out a niche in this life — each person will be impacted by climate change. From one lens, climate change is the ultimate social determinant of health.

Physicians alone cannot fix the climate crisis, of course. Engineers or farmers or scientists or devoted recyclers cannot fix it. It requires a nimble, committed laser-focus from not just a cross section of society, but advocates and action-takers in all neighborhoods, agencies, board rooms — and yes, clinics, according to experts at Vanderbilt’s Center for Biomedical Ethics and Society.

“It is important to order the right test and perform surgery with technical competence and prescribe the right medication, but that’s not all there is. There’s the question of how do we as medical providers ethically engage in the interdependent nurture of health? That’s the paradigm we need to be nurturing — this ecology-health vision,” said Keith Meador, MD, ThM, MPH, professor of Psychiatry and Behavioral Sciences and director of the center.

The fusion of ideas and collaboration across professions is at the core of Vanderbilt University School of Medicine’s first climate course, Ecology and Health: Climate, Food, and Justice, taught by Meador and John Compton, M.Div., program manager of Rooted Community Health within the Center.

Rooted Community Health works across the VUMC campus and regional communities on projects promoting sustainability and well-being through the paradigm that ecological communities and people flourish through interdependency.

“We’re delving into the ethical obligations around social determinants of health and aspects of human flourishing, and there is more research coming out that links ecology to the social determinants,” said Compton. “It’s a gift to me to hear the interdisciplinary conversation as students, medical trainees and other fields translate their knowledge for each other. The exchange becomes really rich. We clearly see we’re on each other’s team.”

The course is co-taught by faculty who are already infusing climate into their medical practices.

• Eva Parker, MD, assistant professor of Dermatology, sits on the Executive Committee for the American Academy of Dermatology’s Expert Resource Group on Climate and Environmental Affairs and presents about how rising skin cancer rates can be attributed to the effects of climate.
• Beth Malow, MD, Burry Professor of Cognitive Childhood Development, and professor of Neurology and Pediatrics in the Sleep Disorders Division, and Ciaran Considine, PhD, assistant professor of Neurology, explain links between the warming planet and brain health.
• Curtis Basinger, MD, professor of Anesthesiology, talks about polarization and policy.
• Omary and others from his department are frequent guest lecturers.

The mindset and perception of how physicians fit into the ecosystem of communities is swiftly changing, hastened in large part by the assault on evidence-based public health measures during the heart of the pandemic. The students matriculating into medical school now are influenced by the social injustices that surround them and are motivated to be holistic advocates of health.

“Any notion that we sit in the dyad of the clinical encounter and dispense a medicine with the outlook that ‘health care has occurred’ — well, that doesn’t work anymore,” said Meador. “I understand it, and I know the argument, but I think it lacks the fullness of the cultural moment right now. If we’re going to address the larger questions of how to prevent illness, cost effectively give care, and nurture the health of the community in which we can all share, then we need an ecological lens and commitment to health equity.”

Who is practicing medicine for the next 40 years?

Kelsey Barter, a third-year VUSM student, grew up in Arizona in a family of hydrologists and geologists. She was surprised in college to find that other regions of the United States were not focused on water conservation when it came to things like watering yards or taking showers.

“Why isn’t sustainability on everyone’s mind? There are going to be wars about water someday,” she recalls thinking and realizing her childhood gave her a broader perspective on the relationship between humans and the environment.

Climate change is a lightning rod topic that conflates science and politics and personal observations, fear and feelings of helplessness. But there’s also resolve and dedication, and a rapidly growing movement in various sectors to lean into a circular economy, sustainable farming and dining, eco-friendly urban planning and more.

Given the deluge and cultural divisiveness on the topic, talking about climate with strangers can spark anxiety — what is the reaction going to be, and is it going to immediately illicit a negative response? Couple that with the realities of caring for people who are already in the vulnerable position of needing medical treatment, and the weight of those discussions loom large for Barter and other medical students.

Yet, the imperative outweighs her nervousness. There’s an obligation even though it is incurable by a single person; timing, delivery and tone are key. What is a parent of an asthmatic child supposed to do about living in a polluted neighborhood if that’s what their budget affords, Barter ponders.

“First of all, we as physicians need to recognize these issues, then bring them into conversations with patients. Right now, the language of how to talk about climate and the risk factors are not present in our curriculum — and that’s a skill we need to be practicing,” said Barter, who worked with Meador and Compton to create the class.

Medical education is doing a better job of equipping physicians with the soft skills to talk about amorphous issues. Yet climate is still largely off the radar even as headlines splash across news feeds and eco-anxiety is common in neighborhoods around the world. From mental health issues to strokes and poor sleep, people will be wrestling, even if subconsciously, with changes that have a direct impact on their long-term well-being.

“If I’m going to practice medicine for 40 years, then this is going to increase over the course of my career. Knowledge of climate change’s impact on health is essential to the practice of medicine in the 21st century,” said Barter, who plans to go into pediatric neurology. “Medical education isn’t forcing everyone to be aware of the impact of climate on health, but once you are, you see it everywhere.”

Just as Ziegler told “Discoveries in Action” podcast listeners to “double click” on the social justice issues, recent generations of medical students see that as part and parcel of their future lives as physicians. Meador and Compton said it’s music to their ears to hear medical students talk about their responsibility as stewards of evidence-based care extending beyond clinic walls.

The community and equity threads are interwoven through medical education to equip future doctors with the understanding that good health is often a luxury, and that Vanderbilt’s vision as a regional health system includes communities that thrive.

“We’re hoping to model ways to have this conversation as a community. It’s important for VUMC that we as physicians be ethically responsible members of our communities. Be willing to listen, then not be afraid, but willing to give voice to evidence-based, quality care. We have a responsibility to do that. That’s not political advocacy,” said Meador. “The world is opening doors that really we can’t turn away from. Social determinants of health and health equity are embedded in training and research, and the ecological-climate mandate? That’s a lens that we as a VUMC community can embrace.”