Simulation
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Our Diffusion of Responsibility Problem: The Climate Crisis

By: Mario Veen (@MarioVeen), Amy Booth (@DrAmyBooth), Sofie Jacobse (https://www.linkedin.com/in/sofie-jacobse-a0209811b/) and Lara Varpio (@LaraVarpio)

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Over 200 medical journals have called climate change the biggest threat to global health;1 however, medical education curricula have been slow to react to this emergency. Given overwhelming scientific evidence of the health impact of climate change,2,3 and healthcare’s contribution to global carbon emissions,3,4 we find our community’s limited action to address this issue troubling. We attribute this lack of action not to ill will, but to diffusion of responsibility.5 Our community may not see itself as actively contributing to or capable of addressing this problem: it isn’t our responsibility.

We want to overcome this bystander position. Using Darley and Latané’s five-step model,6 we argue that the medical education community must not only notice climate change as an important issue, but also recognize it as an emergency for which we are responsible to act. We discuss how medical education can own the climate crisis as a health emergency, and act on it with urgency.

Step 1: Notice the climate crisis as a core issue in medical education

The debate about the causes of the climate crisis has been long been resolved in scientific literature.7,8 Wynes and Nicholas state the basic facts of climate science as: “It’s warming. It’s us. We’re sure. It’s bad. We can fix it.”9 But the medical education community seems oblivious to the  impact of worsening climate change on healthcare. If we were aware, we’d be modifying our curricula so that future physicians would be prepared to meet the needs of tomorrow’s populations. But—we’re not.

Calls for redesigns of medical education curricula to address climate are increasing and, in fairness, are not being ignored.10-12 Medical students have acted as powerful catalysts for incorporation of climate content into pre-medical education.13-15 But changes are also needed at the graduate medical education and continuing professional development levels.16,17 We need medical education’s leadership to act because climate change harms health, necessitates adaptation in clinical practice, and undermines healthcare delivery.18

Step 2: Acknowledge the climate crisis as a medical education emergency

Unlike the Covid-19 pandemic which triggered immediate action, the climate crisis is not currently acknowledged as a medical education crisis.19 Terms such as sustainability and planetary health proliferate, however, the term climate crisis more aptly captures our situation.

What makes the climate crisis an emergency—and not merely important—for medical education is the risk of collapse of planetary systems that are essential for human well-being and the long response time needed to instigate change in medical education, running counter to the short time we have to mitigate the health effects of that collapse.20

Although there is growing consensus that we must do something about climate change, our current response cannot be described as urgent. We risk not doing enough because we are under the false impression that we are doing enough.

Part of our diffusion of responsibility problem is that we succumb to “the tragedy of the horizons”21 in that “the catastrophic impacts of climate change will be felt beyond the traditional horizons of most actors.”21 Consequently, members of the medical education community find it difficult to identify the climate crisis as an urgent problem because its impact is beyond the horizon of things we see as within our purview. COVID-19 was conceived of as within our experiential horizon; the climate crisis is not. Tragically, the pandemic’s impact pales in comparison to the potential impact of the climate crisis.19 Worse yet—if we wait until we experience the immediate effect of climate change, the window of opportunity for effecting change will be gone.22

Our assignment at this stage, therefore, is to trust science on whether we are in an emergency or not. This includes using crisis-appropriate language and educating ourselves on the impact and speed of climate change on health.

Step 3: See the climate crisis as our medical education responsibility

Why should we (as the medical education community) and I (as a medical education researcher, teacher, staff member etc.) feel responsible to act?

Information on the climate crisis is helpful in Steps 1 and 2; however, more information does not necessarily affect one’s sense of responsibility.5 As Wyatt et. Al.  warn: “As climate change continues to affect human health, Health Professions Education will need to think deeply about the relationship humans have to the environment and the ways that the two interrelate.”23

Presenting the climate crisis as a choice between global and individual health is a false dichotomy. What is good for the environment is usually also good for the patient. We ought to be aware of, and harness this double gain.24 By helping the planet, we help our patients.

The irony of modern-day healthcare is that we are both part of the solution, but also part of the problem. Currently, health systems contribute 4-5% of global greenhouse gas emissions; in America, this rises to 8.5-10% of national emissions, and in the Netherlands, to 7%.4,25-31 In addition to its carbon footprint, health systems produce huge amounts of waste.32 Surely, we can take responsibility for our own impacts on the planet, both personally and through our work.

Embracing our responsibility means acknowledging our negative impact on global health and our responsibility to prepare future healthcare professionals for the challenges they will face from this worsening health crisis.

Step 4: What do we need to do: adaptation, mitigation and transformation

The next diffusion of responsibility step asks us to adapt, mitigate, and transform. Adaptation involves teaching learners about the effects of climate change on human health and the responses they can harness to face these challenges. We suggest that, rather than teaching climate-related health effects in isolation, this topic should be incorporated into medical education as a cross-cutting theme. For example, when learning about kidney failure, students should be taught that climate change is a risk factor due to rising temperatures and dehydration.33 Infectious disease curricula should be updated to include the spread of diseases into new geographical contexts.34 Health inequalities education should incorporate ways in which climate change exacerbates these injustices.35  

Mitigation calls us to teach learners how their work contributes to the climate crisis and how to reduce this impact by adopting environmentally sustainable solutions in clinical practice. Core skills in sustainability should include behavior change, sustainable procurement, and efficient use of resources.36

The transformation level requires that we look beyond responding to immediate crises (as we did for the pandemic19) to instead work towards revising healthcare practices into systems that ease the health-related effects of climate change and that include planetary health as a framework for health care quality. This transformation would involve having medical schools and teaching hospitals revise their mission and vision statements to incorporate the climate crisis. It would involve training health professionals who are aware of climate change’s role in healthcare, who are equipped to respond to subsequent new patient care needs, who engage in sustainable practices, and who are climate change advocates. This transformation would have policy makers and governments incorporate environmental thinking into their decision-making.  Such foundational transformations would find the climate crisis being moved from a peripheral topic to one of medical education’s core concerns.

Step 5: Act now

Diffusion of responsibility can easily feed into a discourse of climate doomism: we are past the point of no return, our individual actions do not matter, so there is no sense in acting.37 But since all scientific, technical and political means to address climate change already exist, climate doomism is a subtle form of science denial.38 Another more subtle threat is a discourse of delay: we acknowledge the seriousness of the problem while avoiding responsibility to act or delay action in other ways.39 We can’t afford to accept these discourses. Acting now matters more than ever.

We can all do something, especially  considering that most medical education professionals globally are part of “the top 10% of income globally [who] are responsible for 40–60% of total GHG emissions”40 We can all analyze our professional roles and competencies to look for our “climate purpose”.38 As citizens, we can vote, lower our own carbon footprint, or engage in climate activism.41 As educational professionals, we can teach learners about the need to act in the climate crisis. As members of organizations, we can speak up and call for changes institutionally (e.g., changing room temperatures by one degree).

Conclusion

One thing that everyone can do right now is talk about our responsibility to address climate change. Talk with colleagues, management, students, and patients. We can fight against diffusion of responsibility tendencies. If our focus is the future of healthcare, being true to this mission may never have been as urgent as today.

About the authors:

Mario Veen, PhD, is an Associate Professor at the University of Applied Sciences Utrecht. He has a PhD in Discursive Psychology and Technology Assessment and an interdisciplinary background in philosophy, social science and the humanities. Mario has examined the role of reflection and philosophy in medical education. He is currently interested in social interaction around the climate crisis.”

Amy Booth, MD, is a South African medical doctor who is currently reading for a DPhil in Translational Health Sciences on a Rhodes Scholarship. During her time working as a clinician during the COVID pandemic, she became acutely aware of the impact the health system has on the environment. Her research will explore the environmental impact of health systems and how a sustainability lens can be embedded into healthcare practice and policy

Sofie Jacobse, PhD candidate studies Shared decision-making (SDM) in diagnostic decisions in general practice. SDM refers to an approach where the patient is actively involved in the decision-making process during consultations with their physicians. Although research has shown that this method can be beneficial to patient satisfaction and treatment outcome, little is known about how and when to apply SDM in the diagnostic process.

Lara Varpio, PhD, is a professor at the Children’s Hospital of Philadelphia and the University of Pennsylvania. She is internationally recognized for her expertise in qualitative research methods and methodologies, and in theories from the social sciences and humanities.

Reference

  1. Wise J. Climate crisis: Over 200 health journals urge world leaders to tackle “catastrophic harm”. BMJ. 2021;374:n2177.
  2. Smith KR, Chafe Z, Woodward A, et al. Human health: impacts, adaptation, and co-benefits. Climate Change 2014 Impacts, Adaptation and Vulnerability: Part A: Global and Sectoral Aspects 2015:709-754.
  3. Romanello M, Di Napoli C, Drummond P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet (London, England). 2022;400(10363):1619-1654.
  4. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health Care Pollution And Public Health Damage In The United States: An Update. Health Affairs. 2020;39(12):2071-2079.
  5. Frantz CM, Mayer FS. The Emergency of Climate Change: Why Are We Failing to Take Action? Analyses of Social Issues and Public Policy. 2009;9(1):205-222.
  6. Latané B, Darley JM. The unresponsive bystander: Why doesn’t he help? : Prentice Hall; 1970.
  7. Lynas M, Houlton BZ, Perry S. Greater than 99% consensus on human caused climate change in the peer-reviewed scientific literature. Environmental Research Letters. 2021;16 (11):114005.
  8. Powell J. Scientists Reach 100% Consensus on Anthropogenic Global Warming. Bulletin of Science, Technology & Society. 2017;37(4):183-184.
  9. Wynes S, Nicholas KA. Climate science curricula in Canadian secondary schools focus on human warming, not scientific consensus, impacts or solutions. PloS one. 2019;14(7):e0218305.
  10. Kligler B, Pinto Zipp G, Rocchetti C, Secic M, Ihde ES. The impact of integrating environmental health into medical school curricula: a survey-based study. BMC Medical Education. 2021;21(1):40.
  11. Maxwell J, Blashki G. Teaching About Climate Change in Medical Education: An Opportunity. J Public Health Res. 2016;5(1):673-673.
  12. Wellbery C, Sheffield P, Timmireddy K, Sarfaty M, Teherani A, Fallar R. It’s Time for Medical Schools to Introduce Climate Change Into Their Curricula. Acad Med. 2018;93(12):1774-1777.
  13. Hampshire K, Ndovu A, Bhambhvani H, Iverson N. Perspectives on climate change in medical school curricula—A survey of U.S. medical students. The Journal of Climate Change and Health. 2021;4:100033.
  14. Marill MC. Pressured By Students, Medical Schools Grapple With Climate Change: Medical students see gaps in the curriculum and work to fill them. 2020.
  15. Mercer C. Medical students call for more education on climate change. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne. 2019;191(10):E291-e292.
  16. Colbert CY, French JC, Brateanu A, et al. An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S. Teach Learn Med. 2021:1-12.
  17. Gandhi V, Al-Hadithy N, Göpfert A, Knight K, van Hove M, Hockey P. Integrating sustainability into postgraduate medical education. Future healthcare journal. 2020;7(2):102-104.
  18. Philipsborn RP, Sheffield P, White A, Osta A, Anderson MS, Bernstein A. Climate Change and the Practice of Medicine: Essentials for Resident Education. Acad Med. 2021;96(3):355-367.
  19. Hendlin YH, Visser R. Mobilizing COVID-19 level public health interventions for climate breakdown is necessary. J Clim Chang Health. 2022;8:100152.
  20. Lenton TM, Rockström J, Gaffney O, et al. Climate tipping points – too risky to bet against. Nature. 2019;575(7784):592-595.
  21. Carney M. Breaking the tragedy of the horizon – climate change and financial stability. Speech given at Lloyd’s of London; 29 September, 2015; London.
  22. Princiotta FT. We are losing the climate change mitigation challenge; Is it too late to recover? MRS Energy & Sustainability. 2017;4:E4.
  23. Wyatt TR, Ajjawi R, Veen M. “What Does It Mean to Be?”: Ontology and Responsibility in Health Professions Education. In: Brown MEL, Veen M, Finn GM, eds. Applied Philosophy for Health Professions Education: A Journey Towards Mutual Understanding. Singapore: Springer Nature Singapore; 2022:173-185.
  24. Pathak N, McKinney A. Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities. American journal of lifestyle medicine. 2021;15(5):541-552.
  25. Karliner J, Slotterback S, Boyd R, Ashby B, Steele K, Wang J. Health care’s climate footprint: the health sector contribution and opportunities for action. European Journal of Public Health. 2020;30(Supplement_5).
  26. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. The Lancet Planetary health. 2018;2(1):e27-e35.
  27. Nansai K, Fry J, Malik A, Takayanagi W, Kondo N. Carbon footprint of Japanese health care services from 2011 to 2015. Resources, Conservation and Recycling. 2020;152:104525.
  28. Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environmental Research Letters. 2019;14(6):064004.
  29. Strategists G. Een stuur voor de transitie naar duurzame gezondheidszorg [A control for the transition to sustainable healthcare]. Gupta Strategists;2019.
  30. Tennison I, Roschnik S, Ashby B, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. The Lancet Planetary health. 2021;5(2):e84-e92.
  31. Wu R. The carbon footprint of the Chinese health-care system: an environmentally extended input-output and structural path analysis study. The Lancet Planetary health. 2019;3(10):e413-e419.
  32. Booth A, Aga DS, Wester AL. Retrospective analysis of the global antibiotic residues that exceed the predicted no effect concentration for antimicrobial resistance in various environmental matrices. Environment international. 2020;141:105796.
  33. Johnson RJ, Stenvinkel P, Jensen T, et al. Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors. Journal of the American Society of Nephrology : JASN. 2016;27(8):2247-2256.
  34. Paz S. Climate change impacts on vector-borne diseases in Europe: Risks, predictions and actions. The Lancet regional health Europe. 2021;1:100017.
  35. Sunyer J, Grimalt J. Global climate change, widening health inequalities, and epidemiology. International Journal of Epidemiology. 2006;35(2):213-216.
  36. Walpole SC, Vyas A, Maxwell J, et al. Building an environmentally accountable medical curriculum through international collaboration. Med Teach. 2017;39(10):1040-1050.
  37. Russell M. Avoiding Climate Doomism. 2021.
  38. Nicholas K. Under the sky we make: How to be human in a warming world. GP Putnam’s Sons; 2021.
  39. Lamb WF, Mattioli G, Levi S, et al. Discourses of climate delay. Global Sustainability. 2020;3:e17.
  40. Nielsen KS, Nicholas KA, Creutzig F, Dietz T, Stern PC. The role of high-socioeconomic-status people in locking in or rapidly reducing energy-driven greenhouse gas emissions. Nature Energy. 2021;6(11):1011-1016.
  41. Gardner CJ, Thierry A, Rowlandson W, Steinberger JK. From Publications to Public Actions: The Role of Universities in Facilitating Academic Advocacy and Activism in the Climate and Ecological Emergency. Frontiers in Sustainability. 2021;2.

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