The following article was presented by Eric Chivian M.D. (Assistant Clinical Professor of Psychiatry, Harvard Medical School; Staff Psychiatrist, MIT; Director, Project on Global Environmental Change and Health, Physicians for Social Responsibility) at the Conference on Human Health and Global Climate Change (September 11, 1995 ) in Washington, D.C.. It is published here with the permission of the author.
I would like to congratulate the National Science and Technology Council and the Institute of Medicine for holding this conference, which I hope will be a watershed both for physician and other health professional involvement in the issues of climate change and ozone depletion, and for a wider understanding of the potential human health consequences of global environmental change.
In the early l980's, it was stated U.S. government policy that if necessary we would fight and win a nuclear war with the Soviet Union, protecting our people by relocating them to the countryside where they would make shelters to defend themselves against a nuclear attack.
In retrospect, looking back l3 years or so, these policies may seem incredible, but at the time, though they were challenged overwhelmingly by consensus scientific opinion, including by the government's own scientists, they were largely unquestioned by policy-makers and the public.
How could this have occurred? How could people have gone along, knowing intuitively, as I believe they did, that these policies made little sense?
Of course, our fear of the Soviet Union and its own nuclear capability was the underlying reason, but the public's general acceptance then of the nuclear arms race and of the possibility of using these weapons was made possible by four features that characterized how people dealt with the threat of nuclear war.
#l. that the subject was highly technical and complex and therefore hard for people to understand,
#2. that it was beyond the scope of anyone's experience or imagination, an abstraction that made it hard to consider as a potential reality,
#3. that it was terrifying to contemplate death and destruction on such a massive scale, and therefore easy for people to avoid thinking about and to deny as a threat,
and #4. that there were people, including some scientists, who were very vocal in their efforts to question the warnings about nuclear war, and who attempted to undermine the credibility of those issuing such warnings--so it was not surprising for the public at times to be confused.
The role of physicians and other health professionals--in Physicians for Social Responsibility, International Physicians for the Prevention of Nuclear War, and other groups--during this period in helping to promote a change in public opinion about nuclear war was crucial. By talking about what a nuclear war would really mean to the health and lives of people and their children, they were able to translate the abstract, technical science of nuclear weapons into concrete, personal terms that people could relate to and understand. In this way, they were able to help people overcome some of their avoidance, denial, and confusion and to motivate them to work for the prevention of nuclear war.
Now why am I talking about the l980's and nuclear war?
Because as you have heard today we are now facing what may be a similar threat to human health and life with climate change, ozone depletion, and other forms of global environmental degradation, because there is a profound and fundamental lack of understanding of what scientists are saying about these issues, and an enormous amount of avoidance and denial about the nature and magnitude of this threat for human beings, and because, once again, there is a critically important role to play for physicians and public health professionals.
Over the last several years, we have been deluged with reports from scientists worldwide, detailing the accumulation of greenhouse gases in the atmosphere, and warning us that unless we are able to reduce our emissions of these gases, we are likely to experience major changes in the world's climate, with consequences that could prove disastrous for human beings.
And in the last decade, we have witnessed some of the most variable and extreme weather on record, consistent with greenhouse warming predictions, from cyclones in Bangladesh, to tornadoes across the U.S., to record heat and flooding in Europe, to the Mississippi River valley disaster, and to this summer's 5 day heat wave across the plain states, which killed l000's of cattle and hundreds of people, 568 in Chicago alone.
But despite all these studies; all the warnings by the world's scientific community; despite even the concrete evidence before us that we have changed the composition of the atmosphere and that this change already may be resulting in a warming of the land and the oceans and in unprecedented violent weather patterns, and may be causing harm to plants and animals and to ourselves; we seem oblivious to the dangers we face, we seem not to understand the urgent need to reduce our production of greenhouse gases and at least slow down this runaway global experiment with life on this planet, the outcome of which no-one can really predict.
We seem to be turning away from mass transit, energy conservation, and renewable energy resources, buying more and more gas guzzling 4 wheel drive jeeps and Land Rovers as if we were about to cross the Serengeti rather than negotiate our way in and out of suburban shopping mall parking lots, burning fossil fuels as if there no tommorrow, acting, as George Kennan said in l98l in reference to the nuclear arms race, "like victims of some sort of hypnotism, like men in a dream, like lemmings heading to the sea."
How can one explain this?
I believe the reasons are similar to those which greeted the prospect of nuclear war. The science of global environmental change is too abstract, technical, and complex for people to comprehend. The possible scenarios involving heat, flooding, drought, and disease are too frightening, biblical in their proportions, for people to want to think about. Political leaders, by and large, lack the scientific, and in particular the medical and public health, knowledge that would help them understand the implications of global environmental change for human beings, and therefore many tend not to take the issue terribly seriously.
And there are strong voices, including a few scientists, who dismiss concerns about climate change and even ozone depletion, some clearly motivated by reasonable scientific uncertainties, but many of whom represent vested interests and have tried to undermine the credibility of those in the IPCC, the National Academy of Sciences, and other respected scientists, calling them doomsayers or "chicken littles", and who are often given equal time by the media, as if they represented widely held, equally valid, opposing scientific viewpoints, making it hard for the public to know what or whom to believe.
But perhaps the most important factor in our failure to grasp the potential dangers we face is the fact that most of us see ourselves as separate from, rather than an integral part of, the environment, that it is something to be conquered or exploited, that we can change the atmosphere and oceans and alter biodiversity in the process without these changes affecting us.
For all these reasons, ultimately because of this fundamental disconnection between ourselves and the physical and biological worlds in which we live, it is essential that health be at the center of the global environmental debate, and that physicians and other health professionals take the lead in educating the public and informing policy-makers about the human dimensions of global environmental change.
But until recently human health has not figured prominently in discussions about the global environment, and the medical and public health communities have not been involved. As this conference so well illustrates, along with one held last spring by the NIH on Biodiversity and Human Health, and the soon to be released report by the IPCC, this is starting to change.
In large part, this lack of involvement has resulted from the fact that most physicians and public health professionals have little knowledge of these issues. With few exceptions, global environmental health is not a part of medical or public health education in the United States.
Although there have been no formal studies about how the relationship of human health to the global environment is addressed in medical schools and schools of public health, there has been much attention paid to the more general topics of environmental and occupational medicine in medical school curricula. A brief review of how these subjects have been handled may provide some insights into global environmental health issues, and illustrate how great a task it will be to introduce them into curricula.
The IOM, the Association of American Medical Colleges, the ATSDR, the American College of Physicians, and the American College of Occupational and Environmental Medicine have all called attention to the fact that practicing physicians in the United States do not have the training or experience to identify possible occupationally or environmentally induced illnesses, as they have been inadequately exposed to information about these conditions at every level of their education. A l99l/92 survey by Jay Burstein and Barry Levy found that while 2/3 or so of U.S. medical schools included occupational medicine in their curricula, the average number of hours devoted to this subject during the entire 4 years of medical school was only 6. The situation was even worse for internal medicine and family medicine residency programs.
If this is the state of affairs for occupational and environmental medicine, with their emphases on the direct effects of toxic exposures, a subject that has a long history in traditional medicine, what can we expect for global environmental medicine, which involves such disciplines as atmospheric chemistry and physics, oceanography, entomology, botany, and ecology, all of which are very foreign to medical education.
An informal brief interview survey, which I conducted during early August of this year with faculty from 9 U.S. medical schools and 7 schools of public health revealed that the issues of climate change, ozone depletion, and other aspects of global environmental change, if they were mentioned at all, were simply listed among other environmental causes of disease in introductory core courses, usually without significant content, or were covered in electives that were held because of a specific interest by a key faculty member. Schools of public health were more likely to devote attention to climate change, ozone depletion, and other aspects of global environmental change in their required courses.
The main source of information and education for health professionals about the global environment has come from the medical and scientific literature and from the efforts of various governmental and non-profit groups. In the last several years there have been numerous papers, monographs, and books summarizing the potential medical consequences of global environmental change and calling on physicians and public health professionals to become more involved.
These include this excellent series in the Lancet, edited by Paul Epstein and David Sharp, our MIT Press book Critical Condition: Human Health and the Environment, which includes chapters on climate change, ozone depletion, world population growth, and biodiversity loss, edited by Mike McCally, Howard Hu, Andy Haines and myself, (there is a copy on the display table and some order blanks and I must admit that a small fraction of the proceeds of go to the Judah Benjamin Chivian at the University of Colorado education fund. Others who have published seminal work in this field include Alex Leaf, John Last, Tony McMichael, Jonathan Patz, Chris Cassel, Bob Shope, Larry Kalkstein, Steve Morse, Margaret Kripke, Mary Wilson, Aminikutty Jeevan, Raymond Hayes, Tassir Hussain, Warren Piver, Jay Fouts, Tee Guidotti, Bernie Goldstein, Tony Cortese, Jennifer Leaning, and many others.
Several non-profit organizations have also played an active role in health professional education, including Physicians for Social Responsibility and its Project on Global Environmental Change and Health, which I direct, which has been in the forefront of educating physicians, public health professionals, environmentalists, and policy-makers on global environmental health issues through conferences such as this one at MIT in l992 and numerous publications, presentations, and briefings; the National Association of Physicians for the Environment, NAPE, organized by John Grupenhoff, which has been highly successful in bringing organized medicine and medical specialty societies into environmental health efforts and has been particularly active in air pollution and biodiversity issues and in promoting the UV index with the National Weather Service, and the Consortium for Environmental Education in Medicine, CEEM under the leadership of Tony Cortese and Kathy Rest, which has begun to enlist students, faculty and deans at New England medical schools, and ultimately across the country, in the task of integrating environmental health studies, including global environmental health, into medical school curricula.
The IPCC, WHO, UNEP, the EPA, and in Canada, the Canadian Global Change Program of the Royal Society, have all made major contributions to public understanding about health and global environmental change.
The IOM, with the support of the ATSDR, NIOSH, and the EPA just published this superb text, edited by Andrew Pope and David Rall. Although its focus is almost exclusively on occupational and environmental medicine, it provides an excellent framework for our discussions on how to train physicians and public health professionals about global environmental issues.
It recommends that all graduating medical students should understand the influence of the environment on human health,
It discusses the many barriers to introducing environmental medicine into medical school curricula, and most importantly, it presents a comprehensive strategy for integrating environmental health issues into existing courses and clinical rotations, using 56 largely self-instructional case studies.
Integrating global environmental medicine into medical and public health education will, however, be far, far more difficult. But I believe there is no task more important.
Physicians and other health professionals helped change public opinion about nuclear weapons, a change we see evidence of so clearly today with the massive protests against French nuclear testing.
They now need in addition to help people understand how climate change, ozone depletion, and other global environmental degradation may threaten their health and lives and those of their children, for it is only then that people will be willing to change their personal behaviors and be motivated to support policies necessary to protect the global environment.
It is our responsibility--as physicians and public health professionals, as educators, as government leaders and officials, as concerned citizens to find ways to educate the medical and public health communities about global environmental change so they can accomplish this critically important task.
Thank you.