Climate Crisis & Structural Racism — Peas in a Pod: Urgent Need for Climate Competent Care as a Structural Competency to Advance Climate Medicine
It is critical to approach climate medicine with a structural lens rather than a narrowly focused approach of climate-health knowledge alone that does not connect this existential threat to the broader socio-political ecosystem in which we function.
Climate negotiations (COP26) in Glasgow, Scotland, this November were some of the most consequential in human history in determining our collective path forward towards a livable planet through aggressive climate action or a planetary collapse through underwhelming, incremental climate policy solutions. Unfortunately, the outcomes were more of the latter. Regardless, we must continue to look inward as well as outward to find entry points for climate actions within our fields, such as public health and clinical medicine — both of which are complementary to each other. This is critical since the climate crisis, an existential threat, is inextricably linked to human, animal, and planetary health. This is ubiquitously highlighted in many of the recent reports and calls to action ahead of COP26, such as the World Health Organization’s COP26 Special Report on Climate Change and Health, #HealthyClimate Prescription by the Global Climate & Health Alliance, and the 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future by the Lancet, among many others.
Like the climate and health connection, climate change and structural racism, too, are inextricably linked. Both trace their roots to colonization and capitalism, which results in climate change affecting different populations differently depending on a wide range of factors such as racism, class, social status, and so forth. The long history of systematic oppression and structural racism has resulted in inequities across the social determinants of health spectrum, leading to poor health outcomes for those at the margins of society. The confluence of current inequities, climate change, and structural racism will continue to exacerbate the existing social, racial, and health inequities among socially vulnerable populations. Historically marginalized and systematically disadvantaged communities will have limited adaptive capacity and resilience to the adverse health effects of climate change, further perpetuating climate injustices.
This complex sociopolitical phenomenon is directly relevant to public health and its allied field of clinical medicine. Climate exposures and resulting ailments will compel patients to seek medical care, thereby bringing climate change straight to the examination tables for physicians. Without understanding and factoring in the effects of climate change on health, physicians are providing a disservice to their patients, especially historically marginalized populations, who are among those most affected. Heat-related illnesses, vector-borne diseases, water-related illnesses, asthma, and mental health are some of the many health burdens that will continue to increase as temperatures keep rising and the climate changes around us, necessitating climate adaptation of clinical practice.
Fortunately, this has finally led to an increased interest in climate change from physicians’ perspectives, vibrant discourses on the emerging field of climate medicine, and an explosion of commentary to connect climate change with clinical practice. These developments are to be applauded as they provide us with a portal for equitable patient care. However, as the field of climate medicine emerges and coalesces, we must approach it with caution. Developing new frameworks and competencies for clinical care amid this constant and ever-increasing threat of climate change is critical for current and future physicians. This is necessary not only for clinical care but also because physicians serve as health educators for their patients. Beyond this, physicians are also in a unique position to advocate for their patients in the broader legislative capacity of climate advocacy. To that end, it is critical to approach climate medicine with a structural lens rather than a narrowly focused approach of climate-health knowledge alone that does not connect this existential threat to the broader socio-political ecosystem in which we function.
Climate medicine needs to be treated as a structural competency that cuts across narrow specialty silos. Our research team is working on proposing a simple, macro-level global climate medicine training framework that builds on exceptionally well-done and comprehensive existing literature and physician training frameworks. We believe physicians need to be trained as climate competent care providers by having skills in (a) climate-informed clinical practice; (b) climate advocacy at the interpersonal, institutional, and societal level (c) climate communications — with patients as well as the broader public given physicians are a trusted voice (d) climate equity and political economy — focusing on teaching physicians the intersection of structural racism and climate change as it relates to political economy; and (e) self-reflexive leadership — to ensure an equitable, non-white supremacist, decolonial approach towards climate competent care. An approach that allows physicians to lead with humility and help them lead by following those with a better understanding of social and structural determinants of health. Leading with humility when it comes to climate medicine is critical since clinical medicine is very limited in its scope of training yet physicians are rarely questioned for their leadership on issues they virtually know nothing about.
Climate medicine is a necessity that cannot be ignored within clinical medicine. Ignoring the undeniable intersection of climate change, structural racism, politics, and advocacy will only lead to clinical medicine repeating its arrogant mistakes of the past. Mistakes that range from a lack of advocacy for universal healthcare (a form of structural violence in itself) to reverence for murderous, violent racists such as Marion Sims to ‘proto-eugenics’, all while pretending to be apolitical. This is an opportunity for the field of medicine to lead with humility and train a future generation of climate medicine leaders to be better equipped to competently tackle this crisis and lead us towards a just society.
Ans Irfan, MD, EdD, DrPH, MPH is a faculty member, researcher, and critical public health scholar at Milken Institute School of Public Health, George Washington University. He is the Director of Climate & Health Equity Practice Fellowship, an international fellowship focused on training the next generation of climate medicine leaders in the Global South. He also is a Robert Wood Johnson Foundation’s Health Policy Research Scholar fellow. Currently, he is based at Harvard Divinity School, exploring the intersection of religion and public health policies, especially as those relate to climate change. He can be contacted at email@example.com; Twitter: @PHScientist
Kelly Maloney, PharmD is a retail pharmacist in Florida. She earned her Doctor of Pharmacy from the University of Wisconsin. Dr. Maloney is currently finishing a Master of Public Health, with an emphasis in epidemiology and climate change, at the Milken Institute of Public Health, George Washington University. She can be contacted at firstname.lastname@example.org. Twitter: @KellyCancelsCO2
Roger (Tanay) Pattani is a public health scientist currently pursuing advanced training through an MPH at the Milken Institute of Public Health, George Washington University. He can be contacted at email@example.com.
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