Climate Change Forces Rethink of Medical Curricula in Europe

Dengue, malaria, heat waves, bacteria-infested shellfish, and pollution-related respiratory issues were once the realm of tropical medicine and faraway climes. Now these issues are becoming increasingly relevant and common in Europe owing to the impact of climate change.
But despite the link between climate and health being one of the most significant public health challenges of our time, most European medical curricula do not systematically cover the subject. Training often depends on the personal expertise of faculty members or student-driven initiatives, leaving many future doctors underprepared to confront these challenges.
The newly launched European Network on Climate and Health Education (ENCHE) seeks to address this gap by offering a comprehensive, evidence-based approach to teaching medical students about climate change and sustainability.
Changing Climate = Changing Medical Needs
“The north of Europe is becoming warmer and wetter, the south of Europe is becoming warmer and drier, and Europe is now the fastest-warming continent in the world,” said Ana Rakovac, MD, consultant chemical pathologist and general (internal) medicine physician at Tallaght University Hospital, Dublin. Rakovac is also the chair of the advisory group on climate action at the Royal College of Physicians of Ireland. 
Increasingly extreme temperatures and rising air pollution levels are exacerbating infectious and chronic diseases, respiratory illnesses, antimicrobial resistance, and mental health conditions, leading to thousands of deaths and intensifying pressure on already overstretched health systems across Europe, health and environmental agencies have warned. 
Rakovac told Medscape Medical News that doctors across the continent are not adequately aware of the health consequences of climate change for their patients and are not recognizing presentations of diseases not traditionally acquired within Europe.
“In a talk to [resident] nonconsultant hospital doctors in Tallaght recently, I told them if they are assessing someone who has been in southern Italy or southern France, they have to start thinking of dengue as a differential diagnosis. There were over 130 locally acquired cases of dengue reported in the EU/EEA last year. So we need to start thinking of these diseases in the differential diagnoses of people returning from travel within Europe, not just [areas like] Southeast Asia,” she said, adding that malaria also has the potential to increase within Europe owing to climate change.
A place to start improving this awareness is at medical school.
Final-year medical student Anthony Goodings said his experience in Ireland has been that curricula include “minimal” coverage of the impact of climate change on health and sustainability. He hopes to see all medical schools in Europe adopting a much more comprehensive approach to teaching these topics.
ENCHE was founded by 25 leading medical schools in Belgium, France, Germany, Ireland, Italy, Poland, Portugal, Slovenia, Sweden, Spain, Switzerland, and the United Kingdom. It is supported by the World Health Organization and major pharmaceutical and healthcare providers through the Sustainable Markets Initiative Health Systems Task Force.
In its first 3 years, ENCHE aims to train at least 10,000 medical students across participating undergraduate medical universities with the latest scientific and educational resources to enable them to recognize, prevent, and treat current and future health consequences of climate change. It also aims to foster sustainable practices within healthcare systems, encouraging doctors to contribute to decarbonization of the sector.
Goodings said he thinks ENCHE “is a great way” to have the topic of climate and health fully integrated into curricula so it has a much larger role, “which it definitely deserves.” Goodings is also a student officer for Irish Doctors for the Environment, a nongovernmental organization and registered charity of doctors, medical students, and allied healthcare professionals who create awareness and interest and implement action around environment health and its impact on health.
How It Will Work
ENCHE is chaired by the University of Glasgow and will become a regional hub of the Global Consortium on Climate and Health Education at Columbia University Mailman School of Public Health, New York. 
Camille Huser, PhD, deputy head of undergraduate medical school (biosciences) at the University of Glasgow and co-chair of ENCHE, told Medscape Medical News that it is crucial to train future doctors to be prepared to deal with the impacts of climate on health in their professional practice, and about how to practice more sustainably to reduce future health burdens. 
“The ENCHE initiative is timely as we see climate impacts on health accelerating and health institutions, such as the NHS in the UK, declaring net zero targets. Medical students need to be trained and prepared for both,” Huser said.
Although some medical schools have individually started to incorporate climate impacts on health into their curriculum, Huser said collaboration through ENCHE will allow member medical schools to share best practices, access expertise in different related fields, and develop teaching and assessment practices on climate and health faster and better together.
The network also aims to support member medical schools to campaign for the inclusion of climate and health in their respective national medical undergraduate curriculums, Huser said. “Our aim is that all future doctors are aware of the interconnection between climate and health and are equipped for their future professional practice.”
The health sector is a key contributor to the climate crisis, particularly in high-income countries, with approximately 5% of greenhouse gas emissions coming from healthcare. Dependence on single-use items; huge amounts of plastic packaging; high use of water, electricity, heating; and excessive waste are standard features of modern healthcare. “ So there is a need to teach medical students about how to practice more sustainably to reduce future health burdens, hopefully leading to a virtuous cycle of improving health,” Huser said. 
Goodings agrees. “This is one area where medical education is especially lacking. We learn all about different treatments and the potential side effects, but not about the difference in greenhouse impact between them,” he said, citing the “huge difference” in carbon emissions in certain anesthetic gases as an example, and his own research into how to make colonoscopies, which are a resource-intensive procedure, more sustainable.
More Than Lip Service 
Professor Colin Doherty, MB BCh BAO, head of the School of Medicine at Trinity College Dublin, one of the 25 medical schools involved in the initial rollout of the network, told Medscape Medical News that it will be key that ENCHE’s approach for teaching the impacts of climate change on health is comprehensive and embedded right across the medical curriculum, not just provided as a single module. 
He welcomed the opportunity to be involved in ENCHE, saying many of those in medical education in Europe had already been working in silos on this issue, but the network will allow valuable collaboration and access to much larger evidence bases and resources.
“It is not a tick-box exercise. If we are not teaching healthcare workers about the consequences of climate change, then what chance is there for citizens?” asked Doherty.
He said there is already a “huge appetite and engagement” with these issues among the younger generation, so he does not envisage student interest being an issue. “It is more about the trainers and how do we update them on these topics in order to be able to teach our students. It is not just about a quick update on a new drug or treatment. We are asking them to rethink the whole thing.”
This approach in medical education also needs collaboration and discussion with the general public about their thoughts on what future clinicians need to know regarding climate and health-related issues, Doherty added. “This should be citizen-led. Tell us what we should teach. That is the ethos we should be aiming for.”
Rakovac, Doherty, and Goodings have no relevant interests to declare. ENCHE, which Huser co-chairs, is supported by a grant from the Sustainable Markets Initiative Health Systems Task Force. 
Priscilla Lynch is a freelance writer for Medscape, with more than 20 years of experience covering medicine and healthcare. She has a master’s in journalism and recently completed a Health Innovation Journalism Fellowship with the International Center for Journalists. She can be found on X: @priscillalynch
 
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