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Impact of Climate Change on Health

Last updated.

This funding call is now closed and we will not be accepting any further applications.

Climate change is a severe and continually growing threat to human health globally. It's estimated that climate change will cause 250,000 additional deaths per year between 2030 and 2050 (World Health Organization). This is an area that urgently needs research investment, which is why we are committing £4 million towards new research aimed at tackling the impact of climate change on health in sub-Saharan Africa.

The Medical Research Foundation is inviting applications for collaborative research grants, from mid-career researchers working on the impact of climate change on health.

This scheme is open to pairs of mid-career researchers, in countries in sub-Saharan Africa and the UK, who are making the transition to research independence and seeking to progress in their field. Projects should aim to develop a new collaboration or solidify an existing partnership between two researchers, expanding their research networks and building their research profiles to develop emerging research leaders in both countries.

Research supported through these grants should aim to increase understanding of the mechanisms underpinning, and processes involved, in the impact of climate change on infectious diseases and other non-infectious health outcomes that disproportionately affect sub-Saharan Africa.

Research proposals in the broad area of the impact of climate change on health could include, but are not limited to:

• understanding the biological mechanisms underpinning the impact on human health of climate change
• the development and implementation of treatments for climate-change related illnesses
• understanding and reducing the impact of climate change on health and well-being.

Research into climate change itself, that does not consider impacts on health outcomes is not within the scope of this funding call.

The research supported in this funding call is possible thanks to the support of our generous donors.

Funding available

Applicants may apply for a research grant of up to £300,000 to support their collaborative project, over a maximum of a three year period. The Foundation has committed to making £4,000,000 available in this area.

Additional package of career-enhancing support

As well as funding innovative research projects, the Medical Research Foundation is committed to supporting its researchers’ career progression by providing access to a career-enhancing programme of support, including mentoring opportunities, training, networking events, and further funding only open to MRC and Foundation funded researchers.

Recipients of the Research Grants on the Impact of Climate Change on Health will also be given access to a bespoke programme of support that will aim to strengthen their skills and bring the climate change community together. Opportunities will include training in the establishment of equitable partnerships (delivered prior to the start of the research projects), grant-writing workshops and networking events.

Who can apply

Applications should represent a collaborative project between a mid-career researcher who is a national of and based in a sub-Saharan African country, from an organisation with an established legal entity in sub-Saharan Africa, and a mid-career UK-based researcher at an eligible institution (UK HEIs, Research Council research institutes, hospitals, and other independent research organisations). Nationality and country of residence/employment may be different.

UK-based applicants must hold a PhD, DPhil or MD, are expected to have postdoctoral experience and be in the process of, or be ready for, transition to research independence.

Sub-Saharan Africa-based applicants must hold a PhD, DPhil or MD, have active research experience and be in the process of, or be ready for, transition to research independence.

• Deadline for submission: 12:00 BST 28 September 2023
• Shortlisting notification (request for rebuttal): January 2024
• Deadline for rebuttal: February 2024
• Funding decision: March 2024
• Feedback on funding decision: March 2024

How to Apply

Applicants should apply online using our online grants management system.

Please see here for Guidance for Applicants.

Applicants must use our Résumé for Researchers template in their application.

The Medical Research Foundation is committed to making this application accessible to all by offering assistance where needed. Please do not hesitate to get in touch with the Research Team if you have any questions or concerns about the application process: [email protected] Tel: 0207 395 2314.

Terms and Conditions of Award

Awards funded through this competition will follow standard Medical Research Foundation terms and conditions. The terms and conditions spell out the responsibilities of the Principal Investigator and the Lead Research Organisation. The Principal Investigator and the Lead Research Organisation are required to indicate their formal acceptance of the proposal, their acceptance of the terms and conditions of an award, and the approval of the salaries and resources sought in the application.

The Medical Research Foundation may add additional conditions to a grant award to reflect the particular circumstances and requirements of the funding, or the nature of a particular award. Acceptance of an award constitutes acceptance of both the core conditions and any additional conditions. The Medical Research Foundation reserves the right to vary these terms and conditions.

Expert Review Panel

The Panel will be Chaired by Professor Nick Lemoine, Chair of the Medical Research Foundation’s Board of Trustees.

• Dr Cyril Caminade, University of Liverpool
• Professor Sinead Delany-Moretlwe, University of the Witwatersrand
• Professor Hazel Dockrell, London School of Hygiene & Tropical Medicine
• Professor Veronique Filippi, London School of Hygiene & Tropical Medicine
• Professor Andrew Morse, University of Liverpool
• Dr Kris Murray, MRC Unit The Gambia
• Dr Helen Nabwera, Aga Khan University
• Professor Refilwe Nancy Phaswana-Mafuya, University of Johannesburg
• Professor Paolo Vineis, Imperial College London
• Dr Caradee Wright, South African Medical Research Council
• Professor Dorothy Yeboah-Manu, University of Ghana

Expert Review

Applications will be reviewed by independent peer review

Independent Peer Review Guidance

Frequently Asked Questions

Can the Medical Research Foundation help me find a research partner? Unfortunately, the Foundation does not have the resources to help match researchers with appropriate partners. If your institute has a research development or research and innovation office, they may be able to assist you.

What is a mid-career researcher? The Foundation does not define a researcher as mid-career by their job title as this may vary between institutes and countries. Mid-career researchers are typically those with some or extensive postdoctoral experience and are in the process of, or ready for, transition to research independence. Mid-career researchers may have held or hold a Fellowship but have not secured multiple large grants as the Principal Investigator.

I am more than 10 years post-PhD, can I apply? Yes, the Foundation does not restrict applicants to a maximum number of years post-PhD.

I am a professor, can I apply? Usually no, the scheme is designed to support mid-career researchers who are making the transition to research independence. However, please do contact us if you think this does not apply.

What is the earliest start date? Applicants should be aware, that if successful the Medical Research Foundation will carry out institutional due diligence checks which can take some months. The earliest likely start date is therefore autumn 2024. Do I need to be a climate change expert? No, the scheme is designed to support health researchers. However, applicants are encouraged to include climate change expertise in their research team, as appropriate for their proposal. This could be a collaborator or mentor.

Are awards paid up-front or in arrears? Payments to UK research institutes will be made quarterly in arrears upon receipt of appropriate invoices. Payments to sub-Saharan African institutes will be made up-front according to a payment schedule, unless otherwise requested by the institute.

Medical Research Foundation: Climate change and health

  Tuesday, 13 Sep 2022 | Funding Deadline

The Medical Research Foundation is committing £4 million towards new research aimed at tackling the impact of climate change on health in sub-Saharan Africa. Applications are invited for collaborative research grants from mid-career researchers working on the impact of climate change on health. The scheme is open to pairs of mid-career researchers, in countries in sub-Saharan Africa and the UK, who are making the transition to research independence and seeking to progress in their field. Projects should aim to develop a new collaboration or solidify an existing partnership between two researchers, expanding their research networks and building their research profiles to develop emerging research leaders in both countries. Research supported through these grants should aim to increase understanding of the mechanisms underpinning, and processes involved, in the impact of climate change on infectious diseases and other non-infectious health outcomes that disproportionately affect tropical regions. Deadline for proposals: 13 September 2022 Find out more here

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• Volume 11, Issue 6
• Health effects of climate change: an overview of systematic reviews
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• http://orcid.org/0000-0003-4548-2229 Rhea J Rocque 1 ,
• Caroline Beaudoin 2 ,
• http://orcid.org/0000-0002-4716-6505 Ruth Ndjaboue 2 , 3 ,
• Laura Cameron 1 ,
• Louann Poirier-Bergeron 2 ,
• Rose-Alice Poulin-Rheault 2 ,
• Catherine Fallon 2 , 4 ,
• http://orcid.org/0000-0002-4114-8971 Andrea C Tricco 5 , 6 ,
• http://orcid.org/0000-0003-4192-0682 Holly O Witteman 2 , 3
• 1 Prairie Climate Centre , The University of Winnipeg , Winnipeg , Manitoba , Canada
• 2 Faculty of Medicine , Université Laval , Quebec , QC , Canada
• 3 VITAM Research Centre for Sustainable Health , Quebec , QC , Canada
• 4 CHUQ Research Centre , Quebec , QC , Canada
• 5 Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
• 6 Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada
• Correspondence to Dr Rhea J Rocque; rhea.rocque{at}gmail.com

Objectives We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies’ characteristics, climate impacts, health outcomes and key findings.

Design We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available.

Data sources On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science.

Eligibility criteria We included systematic reviews that explored at least one health impact of climate change.

Data extraction and synthesis We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors’ affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies.

Results We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research.

Conclusions Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.

• public health
• social medicine

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are not available.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2020-046333

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Strengths and limitations of this study

A strength of this study is that it provides the first broad overview of previous systematic reviews exploring the health impacts of climate change. By targeting systematic reviews, we achieve a higher order summary of findings than what would have been possible by consulting individual original studies.

By synthesising findings across all included studies and according to the combination of climate impact and health outcome, we offer a clear, detailed and unique summary of the current state of evidence and knowledge gaps about how climate change may influence human health.

A limitation of this study is that we were unable to access some full texts and therefore some studies were excluded, even though we deemed them potentially relevant after title and abstract inspection.

Another limitation is that we could not conduct meta-meta-analyses of findings across reviews, due to the heterogeneity of the included systematic reviews and the relatively small proportion of studies reporting meta-analytic findings.

Finally, the date of the systematic search is a limitation, as we conducted the search in June 2019.

Introduction

The environmental consequences of climate change such as sea-level rise, increasing temperatures, more extreme weather events, increased droughts, flooding and wildfires are impacting human health and lives. 1 2 Previous studies and reviews have documented the multiple health impacts of climate change, including an increase in infectious diseases, respiratory disorders, heat-related morbidity and mortality, undernutrition due to food insecurity, and adverse health outcomes ensuing from increased sociopolitical tension and conflicts. 2–5 Indeed, the most recent Lancet Countdown report, 2 which investigates 43 indicators of the relationship between climate change and human health, arrived at their most worrisome findings since the beginning of their on-going annual work. This report underlines that the health impacts of climate change continue to worsen and are being felt on every continent, although they are having a disproportionate and unequal impact on populations. 2 Authors caution that these health impacts will continue to worsen unless we see an immediate international response to limiting climate change.

To guide future research and action to mitigate and adapt to the health impacts of climate change and its environmental consequences, we need a complete and thorough overview of the research already conducted regarding the health impacts of climate change. Although the number of original studies researching the health impacts of climate change has greatly increased in the recent decade, 2 these do not allow for an in-depth overview of the current literature on the topic. Systematic reviews, on the other hand, allow a higher order overview of the literature. Although previous systematic reviews have been conducted on the health impacts of climate change, these tend to focus on specific climate effects (eg, impact of wildfires on health), 6 7 health impacts (eg, occupational health outcomes), 8 9 countries, 10–12 or are no longer up to date, 13 14 thus limiting our global understanding of what is currently known about the multiple health impacts of climate change across the world.

In this study, we aimed to develop such a complete overview by synthesising systematic reviews of health impacts of climate change. This higher order overview of the literature will allow us to better prepare for the worsening health impacts of climate change, by identifying and describing the diversity and range of health impacts studied, as well as by identifying gaps in previous research. Our research objectives were to synthesise studies’ characteristics such as geographical regions, years of publication, and authors’ affiliations, to map the climate impacts, health outcomes, and combinations of these that have been studied, and to synthesise key findings.

We applied the Cochrane method for overviews of reviews. 15 This method is designed to systematically map the themes of studies on a topic and synthesise findings to achieve a broader overview of the available literature on the topic.

Research questions

Our research questions were the following: (1) What is known about the relationship between climate change and health, as shown in previous systematic reviews? (2) What are the characteristics of these studies? We registered our plan (CRD42019145972 16 ) in PROSPERO, an international prospective register of systematic reviews and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 17 to report our findings, as a reporting guideline for overviews is still in development. 18

Search strategy and selection criteria

To identify relevant studies, we used a systematic search strategy. There were two inclusion criteria. We included studies in this review if they (1) were systematic reviews of original research and (2) reported at least one health impact as it related (directly or indirectly) to climate change.

We defined a systematic review, based on Cochrane’s definition, as a review of the literature in which one ‘attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a specific research question [by] us[ing] explicit, systematic methods that are selected with a view aimed at minimizing bias, to produce more reliable findings to inform decision making’. 19 We included systematic reviews of original research, with or without meta-analyses. We excluded narrative reviews, non-systematic literature reviews and systematic reviews of materials that were not original research (eg, systematic reviews of guidelines.)

We based our definition of health impacts on the WHO’s definition of health as, ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. 20 Therefore, health impacts included, among others, morbidity, mortality, new conditions, worsening/improving conditions, injuries and psychological well-being. Included studies could refer to climate change or global warming directly or indirectly, for instance, by synthesising the direct or indirect health effects of temperature rises or of natural conditions/disasters made more likely by climate change (eg, floods, wildfires, temperature variability, droughts.) Although climate change and global warming are not equivalent terms, in an effort to avoid missing relevant literature, we included studies using either term. We included systematic reviews whose main focus was not the health impacts of climate change, providing they reported at least one result regarding health effects related to climate change (or consequences of climate change.) We excluded studies if they did not report at least one health effect of climate change. For instance, we excluded studies which reported on existing measures of health impacts of climate change (and not the health impact itself) and studies which reported on certain health impacts without a mention of climate change, global warming or environmental consequences made more likely by climate change.

On 22 June 2019, we retrieved systematic reviews regarding the health effects of climate change by searching from inception the electronic databases Medline, CINAHL, Embase, Cochrane, Web of Science using a structured search (see online supplemental appendix 1 for final search strategy developed by a librarian.) We did not apply language restrictions. After removing duplicates, we imported references into Covidence. 21

Supplemental material

Screening process and data extraction.

To select studies, two trained analysts first screened independently titles and abstracts to eliminate articles that did not meet our inclusion criteria. Next, the two analysts independently screened the full text of each article. A senior analyst resolved any conflict or disagreement.

Next, we decided on key information that needed to be extracted from studies. We extracted the first author’s name, year of publication, number of studies included, time frame (in years) of the studies included in the article, first author’s institution’s country affiliation, whether the systematic review included a meta-analysis, geographical focus, population focus, the climate impact(s) and the health outcome(s) as well as the main findings and limitations of each systematic review.

Two or more trained analysts (RR, CB, RN, LC, LPB, RAPR) independently extracted data, using Covidence and spreadsheet software (Google Sheets). An additional trained analyst from the group or senior research team member resolved disagreements between individual judgments.

Coding and data mapping

To summarise findings from previous reviews, we first mapped articles according to climate impacts and health outcomes. To develop the categories of climate impacts and health outcomes, two researchers (RR and LC) consulted the titles and abstracts of each article. We started by identifying categories directly based on our data and finalised our categories by consulting previous conceptual frameworks of climate impacts and health outcomes. 1 22 23 The same two researchers independently coded each article according to their climate impact and health outcome. We then compared coding and resolved disagreements through discussion.

Next, using spreadsheet software, we created a matrix to map articles according to their combination of climate impacts and health outcomes. Each health outcome occupied one row, whereas climate impacts each occupied one column. We placed each article in the matrix according to the combination(s) of their climate impact(s) and health outcome(s). For instance, if we coded an article as ‘extreme weather’ for climate and ‘mental health’ for health impact, we noted the reference of this article in the cell at the intersection of these two codes. We calculated frequencies for each cell to identify frequent combinations and gaps in literature. Because one study could investigate more than one climate impact and health outcome, the frequency counts for each category could exceed the number of studies included in this review.

Finally, we re-read the Results and Discussion sections of each article to summarise findings of the studies. We first wrote an individual summary for each study, then we collated the summaries of all studies exploring the same combination of categories to develop an overall summary of findings for each combination of categories.

Quality assessment

We used a modified version of AMSTAR-2 to assess the quality of the included systematic reviews ( online supplemental appendix 2 ). The purpose of this assessment was to evaluate the quality of the included studies as a whole to get a sense of the overall quality of evidence in this field. Therefore, individual quality scores were not compiled for each article, but scores were aggregated according to items. Since AMSTAR-2 was developed for syntheses of systematic reviews of randomised controlled trials, working with a team member with expertise in knowledge synthesis (AT), we adapted it to suit a research context that is not amenable to randomised controlled trials. For instance, we changed assessing and accounting for risk of bias in studies’ included randomised controlled trials to assessing and accounting for limitations in studies’ included articles. Complete modifications are presented in online supplemental appendix 2 .

Patient and public involvement

Patients and members of the public were not involved in this study.

Articles identified

As shown in the PRISMA diagram in figure 1 , from an initial set of 2619 references, we retained 94 for inclusion. More precisely, following screening of titles and abstracts, 146 studies remained for full-text inspection. During full-text inspection, we excluded 52 studies, as they did not report a direct health effect of climate change (n=17), did not relate to climate change (n=15), were not systematic reviews (n=10), or we could not retrieve the full text (n=10).

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The flow chart for included articles in this review.

Study descriptions

A detailed table of all articles and their characteristics can be found in online supplemental appendix 3 . Publication years ranged from 2007 to 2019 (year of data extraction), with the great majority of included articles (n=69; 73%) published since 2015 ( figure 2 ). A median of 30 studies had been included in the systematic reviews (mean=60; SD=49; range 7–722). Approximately one-fifth of the systematic reviews included meta-analyses of their included studies (n=18; 19%). The majority of included systematic reviews’ first authors had affiliations in high-income countries, with the largest representations by continent in Europe (n=30) and Australia (n=24) ( figure 3 ). Countries of origin by continents include (from highest to lowest frequency, then by alphabetical order): Europe (30); UK (9), Germany (6), Italy (4), Sweden (4), Denmark (2), France (2), Georgia (1), Greece (1) and Finland (1); Australia (24); Asia (21); China (11), Iran (4), India (1), Jordan (1), Korea (1), Nepal (1), Philippines (1), Taiwan (1); North America (16); USA (15), Canada (1); Africa (2); Ethiopia (1), Ghana (1), and South America (1); Brazil (1).

Number of included systematic reviews by year of publication.

Number of publications according to geographical affiliation of the first author.

Regarding the geographical focus of systematic reviews, most of the included studies (n=68; 72%) had a global focus or no specified geographical limitations and therefore included studies published anywhere in the world. The remaining systematic reviews either targeted certain countries (n=12) (1 for each Australia, Germany, Iran, India, Ethiopia, Malaysia, Nepal, New Zealand and 2 reviews focused on China and the USA), continents (n=5) (3 focused on Europe and 2 on Asia), or regions according to geographical location (n=6) (1 focused on Sub-Saharan Africa, 1 on Eastern Mediterranean countries, 1 on Tropical countries, and 3 focused on the Arctic), or according to the country’s level of income (n=3) (2 on low to middle income countries, 1 on high income countries).

Regarding specific populations of interest, most of the systematic reviews did not define a specific population of interest (n=69; 73%). For the studies that specified a population of interest (n=25; 26.6%), the most frequent populations were children (n=7) and workers (n=6), followed by vulnerable or susceptible populations more generally (n=4), the elderly (n=3), pregnant people (n=2), people with disabilities or chronic illnesses (n=2) and rural populations (n=1).

We assessed studies for quality according to our revised AMSTAR-2. Complete scores for each article and each item are available in online supplemental appendix 4 . Out of 94 systematic reviews, the most commonly fully satisfied criterion was #1 (Population, Intervention, Comparator, Outcome (PICO) components) with 81/94 (86%) of included systematic reviews fully satisfying this criterion. The next most commonly satisfied criteria were #16 (potential sources of conflict of interest reported) (78/94=83% fully), #13 (account for limitations in individual studies) (70/94=75% fully and 2/94=2% partially), #7 (explain both inclusion and exclusion criteria) (64/94=68% fully and 19/94=20% partially), #8 (description of included studies in adequate detail) (36/94=38% fully and 41/94=44% partially), and #4 (use of a comprehensive literature search strategy) (0/94=0% fully and 80/94=85% partially). For criteria #11, #12, and #15, which only applied to reviews including meta-analyses, 17/18 (94%) fully satisfied criterion #11 (use of an appropriate methods for statistical combination of results), 12/18 (67%) fully satisfied criterion #12 (assessment of the potential impact of Risk of Bias (RoB) in individual studies) (1/18=6% partially), and 11/18 (61%) fully satisfied criterion #15 (an adequate investigation of publication bias, small study bias).

Climate impacts and health outcomes

Regarding climate impacts, we identified 5 mutually exclusive categories, with 13 publications targeting more than one category of climate impacts: (1) meteorological (n=71 papers) (eg, temperature, heat waves, humidity, precipitation, sunlight, wind, air pressure), (2) extreme weather (n=24) (eg, water-related, floods, cyclones, hurricanes, drought), (3) air quality (n=7) (eg, air pollution and wildfire smoke exposure), (4) general (n=5), and (5) other (n=3). Although heat waves could be considered an extreme weather event, papers investigating heat waves’ impact on health were classified in the meteorological impact category, since some of these studies treated them with high temperature. ‘General’ climate impacts included articles that did not specify climate change impacts but stated general climate change as their focus. ‘Other’ climate impacts included studies investigating other effects indirectly related to climate change (eg, impact of environmental contaminants) or general environmental risk factors (eg, environmental hazards, sanitation and access to clean water.)

We identified 10 categories to describe the health outcomes studied by the systematic reviews, and 29 publications targeted more than one category of health outcomes: (1) infectious diseases (n=41 papers) (vector borne, food borne and water borne), (2) mortality (n=32), (3) respiratory, cardiovascular and neurological (n=23), (4) healthcare systems (n=16), 5) mental health (n=13), (6) pregnancy and birth (n=11), 7) nutritional (n=9), (8) skin diseases and allergies (n=8), (9) occupational health and injuries (n=6) and (10) other health outcomes (n=17) (eg, sleep, arthritis, disability-adjusted life years, non-occupational injuries, etc)

Figure 4 depicts the combinations of climate impact and health outcome for each study, with online supplemental appendix 5 offering further details. The five most common combinations are studies investigating the (1) meteorological impacts on infectious diseases (n=35), (2) mortality (n=24) and (3) respiratory, cardiovascular and neurological outcomes (n=17), (4) extreme weather events’ impacts on infectious diseases (n=14), and (5) meteorological impacts on health systems (n=11).

Summary of the combination of climate impact and health outcome (frequencies). The total frequency for one category of health outcome could exceed the number of publications included in this health outcome, since one publication could explore the health impact according to more than one climate factor (eg, one publication could explore both the impact of extreme weather events and temperature on mental health).

For studies investigating meteorological impacts on health, the three most common health outcomes studied were impacts on (1) infectious diseases (n=35), (2) mortality (n=24) and (3) respiratory, cardiovascular and neurological outcomes (n=17). Extreme weather event studies most commonly reported health outcomes related to (1) infectious diseases (n=14), (2) mental health outcomes (n=9) and (3) nutritional outcomes (n=6) and other health outcomes (eg, injuries, sleep) (n=6). Studies focused on the impact of air quality were less frequent and explored mostly health outcomes linked to (1) respiratory, cardiovascular and neurological outcomes (n=6), (2) mortality (n=5) and (3) pregnancy and birth outcomes (n=3).

Summary of findings

Most reviews suggest a deleterious impact of climate change on multiple adverse health outcomes, with some associations being explored and/or supported with consistent findings more often than others. Some reviews also report conflicting findings or an absence of association between the climate impact and health outcome studied (see table 1 for a detailed summary of findings according to health outcomes).

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Summary of findings from systematic reviews according to health outcome and climate impact

Notable findings of health outcomes according to climate impact include the following. For meteorological factors (n=71), temperature and humidity are the variables most often studied and report the most consistent associations with infectious diseases and respiratory, cardiovascular, and neurological outcomes. Temperature is also consistently associated with mortality and healthcare service use. Some associations are less frequently studied, but remain consistent, including the association between some meteorological factors (eg, temperature and heat) and some adverse mental health outcomes (eg, hospital admissions for mental health reasons, suicide, exacerbation of previous mental health conditions), and the association between heat and adverse occupational outcomes and some adverse birth outcomes. Temperature is also associated with adverse nutritional outcomes (likely via crop production and food insecurity) and temperature and humidity are associated with some skin diseases and allergies. Some health outcomes are less frequently studied, but studies suggest an association between temperature and diabetes, impaired sleep, cataracts, heat stress, heat exhaustion and renal diseases.

Extreme weather events (n=24) are consistently associated with mortality, some mental health outcomes (eg, distress, anxiety, depression) and adverse nutritional outcomes (likely via crop production and food insecurity). Some associations are explored less frequently, but these studies suggest an association between drought and respiratory and cardiovascular outcomes (likely via air quality), between extreme weather events and an increased use of healthcare services and some adverse birth outcomes (likely due to indirect causes, such as experiencing stress). Some health outcomes are less frequently studied, but studies suggest an association between extreme weather events and injuries, impaired sleep, oesophageal cancer and exacerbation of chronic illnesses. There are limited and conflicting findings for the association between extreme weather events and infectious diseases, as well as for certain mental health outcomes (eg, suicide and substance abuse). At times, different types of extreme weather events (eg, drought vs flood) led to conflicting findings for some health outcomes (eg, mental health outcomes, infectious diseases), but for other health outcomes, the association was consistent independently of the extreme weather event studied (eg, mortality, healthcare service use and nutritional outcomes).

The impact of air quality on health (n=7) was less frequently studied, but the few studies exploring this association report consistent findings regarding an association with respiratory-specific mortality, adverse respiratory outcomes and an increase in healthcare service use. There is limited evidence regarding the association between air quality and cardiovascular outcomes, limited and inconsistent evidence between wildfire smoke exposure and adverse birth outcomes, and no association is found between exposure to wildfire smoke and increase in use of health services for mental health reasons. Only one review explored the impact of wildfire smoke exposure on ophthalmic outcomes, and it suggests that it may be associated with eye irritation and cataracts.

Reviews which stated climate change as their general focus and did not specify the climate impact(s) under study were less frequent (n=5), but they suggest an association between climate change and pollen allergies in Europe, increased use of healthcare services, obesity, skin diseases and allergies and an association with disability-adjusted life years. Reviews investigating the impact of other climate-related factors (n=3) show inconsistent findings concerning the association between environmental pollutant and adverse birth outcomes, and two reviews suggest an association between environmental risk factors and pollutants and childhood stunting and occupational diseases.

Most reviews concluded by calling for more research, noting the limitations observed among the studies included in their reviews, as well as limitations in their reviews themselves. These limitations included, among others, some systematic reviews having a small number of publications, 24 25 language restrictions such as including only papers in English, 26 27 arriving at conflicting evidence, 28 difficulty concluding a strong association due to the heterogeneity in methods and measurements or the limited equipment and access to quality data in certain contexts, 24 29–31 and most studies included were conducted in high-income countries. 32 33

Previous authors also discussed the important challenge related to exploring the relationship between climate change and health. Not only is it difficult to explore the potential causal relationship between climate change and health, mostly due to methodological challenges, but there are also a wide variety of complex causal factors that may interact to determine health outcomes. Therefore, the possible causal mechanisms underlying these associations were at times still unknown or uncertain and the impacts of some climate factors were different according to geographical location and specificities of the context. Nonetheless, some reviews offered potential explanations for the climate-health association, with the climate factor at times, having a direct impact on health (eg, flooding causing injuries, heat causing dehydration) and in other cases, having an indirect impact (eg, flooding causing stress which in turn may cause adverse birth outcomes, heat causing difficulty concentrating leading to occupational injuries.)

Principal results

In this overview of systematic reviews, we aimed to develop a synthesis of systematic reviews of health impacts of climate change by mapping the characteristics and findings of studies exploring the relationship between climate change and health. We identified four key findings.

First, meteorological impacts, mostly related to temperature and humidity, were the most common impacts studied by included publications, which aligns with findings from a previous scoping review on the health impacts of climate change in the Philippines. 10 Indeed, meteorological factors’ impact on all health outcomes identified in this review are explored, although some health outcomes are more rarely explored (eg, mental health and nutritional outcomes). Although this may not be surprising given that a key implication of climate change is the long-term meteorological impact of temperature rise, this finding suggests we also need to undertake research focused on other climate impacts on health, including potential direct and indirect effects of temperature rise, such as the impact of droughts and wildfire smoke. This will allow us to better prepare for the health crises that arise from these ever-increasing climate-related impacts. For instance, the impacts of extreme weather events and air quality on certain health outcomes are not explored (eg, skin diseases and allergies, occupational health) or only rarely explored (eg, pregnancy outcomes).

Second, systematic reviews primarily focus on physical health outcomes, such as infectious diseases, mortality, and respiratory, cardiovascular and neurological outcomes, which also aligns with the country-specific previous scoping review. 10 Regarding mortality, we support Campbell and colleagues’ 34 suggestion that we should expand our focus to include other types of health outcomes. This will provide better support for mitigation policies and allow us to adapt to the full range of threats of climate change.

Moreover, it is unclear whether the distribution of frequencies of health outcomes reflects the actual burden of health impacts of climate change. The most commonly studied health outcomes do not necessarily reflect the definition of health presented by the WHO as, ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. 20 This suggests that future studies should investigate in greater depth the impacts of climate change on mental and broader social well-being. Indeed, some reviews suggested that climate change impacts psychological and social well-being, via broader consequences, such as political instability, health system capacity, migration, and crime, 3 4 35 36 thus illustrating how our personal health is determined not only by biological and environmental factors but also by social and health systems. The importance of expanding our scope of health in this field is also recognised in the most recent Lancet report, which states that future reports will include a new mental health indicator. 2

Interestingly, the reviews that explored the mental health impacts of climate change were focused mostly on the direct and immediate impacts of experiencing extreme weather events. However, psychologists are also warning about the long-term indirect mental health impacts of climate change, which are becoming more prevalent for children and adults alike (eg, eco-anxiety, climate depression). 37 38 Even people who do not experience direct climate impacts, such as extreme weather events, report experiencing distressing emotions when thinking of the destruction of our environment or when worrying about one’s uncertain future and the lack of actions being taken. To foster emotional resilience in the face of climate change, these mental health impacts of climate change need to be further explored. Humanity’s ability to adapt to and mitigate climate change ultimately depends on our emotional capacity to face this threat.

Third, there is a notable geographical difference in the country affiliations of first authors, with three quarters of systematic reviews having been led by first authors affiliated to institutions in Europe, Australia, or North America, which aligns with the findings of the most recent Lancet report. 2 While perhaps unsurprising given the inequalities in research funding and institutions concentrated in Western countries, this is of critical importance given the significant health impacts that are currently faced (and will remain) in other parts of the world. Research funding organisations should seek to provide more resources to authors in low-income to middle-income countries to ensure their expertise and perspectives are better represented in the literature.

Fourth, overall, most reviews suggest an association between climate change and the deterioration of health in various ways, illustrating the interdependence of our health and well-being with the well-being of our environment. This interdependence may be direct (eg, heat’s impact on dehydration and exhaustion) or indirect (eg, via behaviour change due to heat.) The most frequently explored and consistently supported associations include an association between temperature and humidity with infectious diseases, mortality and adverse respiratory, cardiovascular and neurological outcomes. Other less frequently studied but consistent associations include associations between climate impacts and increased use of healthcare services, some adverse mental health outcomes, adverse nutritional outcomes and adverse occupational health outcomes. These associations support key findings of the most recent Lancet report, in which authors report, among others, increasing heat exposure being associated with increasing morbidities and mortality, climate change leading to food insecurity and undernutrition, and to an increase in infectious disease transmission. 2

That said, a number of reviews included in this study reported limited, conflicting and/or an absence of evidence regarding the association between the climate impact and health outcome. For instance, there was conflicting or limited evidence concerning the association between extreme weather events and infectious diseases, cardiorespiratory outcomes and some mental health outcomes and the association between air quality and cardiovascular-specific mortality and adverse birth outcomes. These conflicting and limited findings highlight the need for further research. These associations are complex and there exist important methodological challenges inherent to exploring the causal relationship between climate change and health outcomes. This relationship may at times be indirect and likely determined by multiple interacting factors.

The climate-health link has been the target of more research in recent years and it is also receiving increasing attention from the public and in both public health and climate communication literature. 2 39–41 However, the health framing of climate change information is still underused in climate communications, and researchers suggest we should be doing more to make the link between human health and climate change more explicit to increase engagement with the climate crisis. 2 41–43 The health framing of climate communication also has implications for healthcare professionals 44 and policy-makers, as these actors could play a key part in climate communication, adaptation and mitigation. 41 42 45 These key stakeholders’ perspectives on the climate-health link, as well as their perceived role in climate adaptation and mitigation could be explored, 46 since research suggests that health professionals are important voices in climate communications 44 and especially since, ultimately, these adverse health outcomes will engender pressure on and cost to our health systems and health workers.

Strengths and limitations

To the best of our knowledge, the current study provides the first broad overview of previous systematic reviews exploring the health impacts of climate change. Our review has three main strengths. First, by targeting systematic reviews, we achieve a higher order summary of findings than what would have been possible by consulting individual original studies. Second, by synthesising findings across all included studies and according to the combination of climate impact and health outcome, we offer a clear, detailed and unique summary of the current state of evidence and knowledge gaps about how climate change may influence human health. This summary may be of use to researchers, policy-makers and communities. Third, we included studies published in all languages about any climate impact and any health outcome. In doing so, we provide a comprehensive and robust overview.

Our work has four main limitations. First, we were unable to access some full texts and therefore some studies were excluded, even though we deemed them potentially relevant after title and abstract inspection. Other potentially relevant systematic reviews may be missing due to unseen flaws in our systematic search. Second, due to the heterogeneity of the included systematic reviews and the relatively small proportion of studies reporting meta-analytic findings, we could not conduct meta-meta-analyses of findings across reviews. Future research is needed to quantify the climate and health links described in this review, as well as to investigate the causal relationship and other interacting factors. Third, due to limited resources, we did not assess overlap between the included reviews concerning the studies they included. Frequencies and findings should be interpreted with potential overlap in mind. Fourth, we conducted the systematic search of the literature in June 2019, and it is therefore likely that some recent systematic reviews are not included in this study.

Conclusions

Overall, most systematic reviews of the health impacts of climate change suggest an association between climate change and the deterioration of health in multiple ways, generally in the direction that climate change is associated with adverse human health outcomes. This is worrisome since these outcomes are predicted to rise in the near future, due to the rise in temperature and increase in climate-change-related events such as extreme weather events and worsened air quality. Most studies included in this review focused on meteorological impacts of climate change on adverse physical health outcomes. Future studies could fill knowledge gaps by exploring other climate-related impacts and broader psychosocial health outcomes. Moreover, studies on health impacts of climate change have mostly been conducted by first authors affiliated with institutions in high-income countries. This inequity needs to be addressed, considering that the impacts of climate change are and will continue to predominantly impact lower income countries. Finally, although most reviews also recommend more research to better understand and quantify these associations, to adapt to and mitigate climate change’s impacts on health, it will also be important to unpack the ‘what, how, and where’ of these effects. Health effects of climate change are unlikely to be distributed equally or randomly through populations. It will be important to mitigate the changing climate’s potential to exacerbate health inequities.

Ethics statements

Patient consent for publication.

Not required.

Acknowledgments

The authors gratefully acknowledge the contributions of Selma Chipenda Dansokho, as research associate, and Thierry Provencher, as research assistant, to this project, and of Frederic Bergeron, for assistance with search strategy, screening and selection of articles for the systematic review.

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Supplementary materials

Supplementary data.

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• Data supplement 1
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Twitter @RutNdjab, @ATricco, @hwitteman

Contributors RN, CF, ACT, HOW contributed to the design of the study. CB, RN, LPB, RAPR and HOW contributed to the systematic search of the literature and selection of studies. RR, HOW, LC conducted data analysis and interpretation. RR and HOW drafted the first version of the article with early revision by CB, LC and RN. All authors critically revised the article and approved the final version for submission for publication. RR and HOW had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Funding This study was funded by the Canadian Institutes of Health Research (CIHR) FDN-148426. The CIHR had no role in determining the study design, the plans for data collection or analysis, the decision to publish, nor the preparation of this manuscript. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. HOW is funded by a Tier 2 Canada Research Chair in Human-Centred Digital Health.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Using Biomedical Research to Mitigate the Effects of Climate Change

Climate change is having many clear, detrimental effects: from more- intense hurricanes, widely rampaging wildfires, and record-breaking temperatures to drought, famine, and emerging infectious disease.

But, what effects do we not yet see? What are climate change’s longer term biological effects  and how will it affect overall human health in coming decades?

 “Huge segments of the world’s population will be at risk if global society cannot learn to anticipate and mitigate climate change’s multifaceted effects on human health,” says Whitehead Institute President and Director Ruth Lehmann. “Unfortunately science is currently hampered by limited knowledge about how increased temperature affects biology and by a lack of biotechnological tools to address detrimental effects. For that reason, Whitehead Institute is helping create the fundamental scientific knowledge and tools necessary to protect human health in the face of this swiftly emerging challenge.”

In 2021, Lehmann launched the Whitehead Initiative on Biology, Health, and Climate Change (WIBHC), a multidisciplinary program that explores the biological and health effects of climate change and that builds the foundations for biomedical and biotech interventions that could help prevent, mitigate, or treat detrimental impacts on human health.

“For more than 40 years, Whitehead Institute has been dedicated to making paradigm-shifting insights into the fundamental principles of life,” reflects Lehmann, who is also professor of biology at Massachusetts Institute of Technology (MIT). “Our climate change work is a natural and important extension of our mission to forge new frontiers in science, uncovering insights today that unlock the potential of tomorrow.”

The WIBHC is pursuing climate change-related investigations in three realms. Projects focusing on Cellular Processes in Extreme Conditions seek to better understand how mammalian cells and organisms adapt to dramatic shifts in temperature and the availability of food and water. Studies addressing Infectious Disease and Climate Change aim to help mitigate the risk to humans from emerging viruses and spreading parasitic infections, and work in Plant Biology aims to create the knowledge and tools necessary to grow climate change-resistant crops and plants capable of helping reduce atmospheric carbon.

“As traumatic as the SARS-Cov-2 pandemic experience has been, climate change presents an even more significant threat to human society,” Lehmann observes. “Yet the speed and effectiveness of the bioscience research enterprise’s response to COVID-19 is evidence of both the practical, long-term importance of discovery research and of biomedical science’s collective ability to quickly uncover, translate, and apply new knowledge. 

“Overcoming the threats presented by climate change will require a similar but vastly larger collaboration,” she says. “We are determined that Whitehead Institute will play a meaningful role in that collaborative effort as both a catalyst for pioneering projects and a partner in translating our discoveries. We will create and disseminate new knowledge and innovative tools, helping researchers across the globe to drive their work forward.”

Read more on Cellular Processes in Extreme Conditions

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To avoid widespread famine and malnutrition, the world must double current food production by 2050, and do so in the face of climate-driven pressures. That is why a key thrust of the Whitehead Initiative on Biology, Health, and Climate Change focuses on plant seeds, the source of more than two-thirds of calories currently consumed globally.

Climate change and economic development are increasing our risk of being infected by parasites and harmful viruses and bacteria. Whitehead Institute researchers are leveraging their expertise to better assess where pathogens will spread and evaluate their risk to humans.

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Climate change-associated health impacts: a way forward

Editorial article, explore article hub, read lead article.

• Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States

An Editorial on the Frontiers in Science Lead Article Immune-mediated disease caused by climate change-associated environmental hazards: mitigation and adaptation

• Climate change is inextricably linked with worsening planetary and human health, necessitating a global multidisciplinary effort to identify the cumulative human health risks to help predict, prevent, and manage future impacts.
• The development of climate change mitigation strategies with co-health benefits will require many technological and policy changes across multiple sectors, with the public health and healthcare delivery sectors playing a major role.
• Evidence-based climate mitigation strategies that are equitable, adoptable, sustainable, and economically feasible are urgently needed to reduce the impact of climate change on health.

Introduction: climate change threats to human health

Climate change is the greatest threat to human health and well-being that humanity has ever faced. Human activities are driving increases in the levels of atmospheric heat-trapping greenhouse gases (GHGs, i.e., carbon dioxide, methane, nitrous oxide, and chlorofluorocarbons), resulting in substantial increases in global temperatures. The rise of global temperatures is already causing widespread ecological changes, including increased frequency and severity of extreme weather events (heatwaves, wildfires, floods, and droughts), rising sea levels, and seasonal shifts in plant and animal geographic ranges and growing seasons that disrupt and endanger the health and lives of many ( 1 ). Left unchecked, climate change-related ecological impacts will worsen and threaten the very existence of humankind by affecting the air we breathe, the food we eat, and the water we drink. Thus, it is imperative that we take steps to prevent further loss of life associated with fossil fuel-related emissions.

In their lead article, Agache and colleagues ( 2 ) summarize the myriad of impacts of climate-related changes on physical health—including respiratory and allergic disorders, heat-related deaths, cancer, food- and waterborne infectious diseases, zoonotic diseases,and malnutrition—and mental health. As they point out, one of the strongest links between climate change and health is the direct effect of exposure to fossil fuel combustion products [e.g., particulate matter (PM 2.5 ), nitrogen oxides, and sulfur dioxide]. The World Health Organization (WHO) estimates that air pollution kills approximately 7 million people worldwide every year ( 3 ). Although major improvements in air quality have been made in the United States over recent decades, exposure to high levels of air pollution remains a threat to human health across much of the globe. Unfortunately, climate change-related extreme weather events (e.g., wildfires) are reversing some of the gains in air quality that have been achieved in some areas, while exacerbating already high levels in other parts of the world.

Exposure to ambient PM 2.5 is the leading risk factor for disease globally. PM 2.5 exposure is well documented to promote the development of cardiovascular risk factors such as hypertension and atherosclerosis, and as increasing the risk of cardiovascular diseases, including myocardial infarction, stroke, heart failure, and arrhythmias. It is also associated with lower respiratory tract infections, lung cancer, and diabetes. However, the best-documented link between exposure to fossil fuel emissions and disease morbidity and mortality is the exacerbation of respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). Global warming worsens respiratory diseases in several ways. For example, it increases ozone levels and the quantity and duration of airborne aeroallergens produced. It also increases the molecular allergenicity of pollens and changes their distribution. Strikingly, fossil fuel-driven increases in both temperatures and carbon dioxide levels have dramatically increased the quantity of allergy-inducing pollen produced and the length of the pollen season. Moreover, severe weather events such as thunderstorms increase the level of dispersion of respirable pollens—triggering acute asthma attacks and, in some cases, death. Cumulatively, these global warming effects will extend the suffering of individuals with hay fever and increase the frequency and severity of asthma attacks.

Synergistic pollutant and climate change-induced epithelial barrier function disruption

Agache et al. propose epithelial injury as the common mechanism linking climate-mediated ecological changes with the worsening of immune-mediated diseases. The epithelial lining of several organs, including the lungs, gastrointestinal tract, and skin, protects these organs against damage from external stimuli. This lining acts as a sentinel to alert the immune system to potential invaders or exposure to toxic substances through oxidative stress responses and the release of innate immune mediators that activate the adaptive immune system to mount a defense. For example, exposure to pollutants resulting from fossil fuel emissions and wildfires (e.g., PM 2.5 , smoke, and chemicals) triggers oxidative stress responses and the release of innate immune mediators such as complement factor 3 (C3), which recruits both inflammatory cells and cells of the adaptive immune response, e.g., CD4+ T cells ( 4 ). Saunders et al. ( 5 ) showed that exposure of mice to ambient levels of PM 2.5 alone induced allergic asthma symptoms through a CD4+ T cell-dependent mechanism. Similar scenarios are likely to occur at the gut and skin barriers.

The impact of climate-related increases in exposure to air pollutants on allergic airway disease is compounded by several factors. These include a concomitant increase in dust mites and molds, and the development of an increasingly chemical world, which is awash with pesticides, detergents, plastics, and endocrine disruptors—2000 new commercial chemicals are released annually in the United States alone. In parallel, climate-mediated disturbances in our microbial ecosystem will synergistically worsen our ability to respond. The cumulative health consequences associated with our changing exposome will be preferentially borne by those who are most vulnerable, including the elderly, pregnant women, children, those with pre-existing diseases, and those of low socioeconomic status. Allergic disorders and asthma are already the most common chronic disorders of childhood. Recent studies show that maternal exposure to even low levels of PM 2.5 is associated with intrauterine inflammation, which has been linked to several adverse birth outcomes ( 6 ), suggesting that exposure to these pollutants may have lifelong health effects. Exposure to fossil fuel emissions has also been linked to increased incidences of lung, breast, and colorectal cancers together with poorer survival rates. In common with its effects on respiratory diseases, PM 2.5 exposure is postulated to cause local tissue inflammation leading to oxidative stress and epigenetic changes that collectively create a permissive environment for cancer development. Similar processes may also promote autoimmune disorders, but more studies are required to firmly establish these links. Understanding the environmental underpinnings of various cancers, autoimmune conditions, and other immune-associated diseases would greatly enhance our understanding of disease susceptibility and may lead to the development of sorely needed prevention and treatment strategies for these debilitating disorders.

Identifying the full effect of climate change on health will require a global, multipronged, multidisciplinary approach in which scientists from all disciplines (including medicine, public health, biology, earth science, climate science, and data science) will need to lend their expertise to assess the individual and cumulative as well as past and current impacts of climate change on health—enabling the prediction of future consequences and the implementation of effective prevention and treatment strategies. Emerging capabilities in data science, artificial intelligence, and advanced biomedical monitoring and screening techniques must be leveraged to untangle the complex web of climate-induced health effects.

The need for effective and implementable mitigation and adaptation strategies

Given the multitude of climate change drivers, addressing the GHG mitigation challenge will require many technological and policy changes across multiple sectors. Agache et al. summarize the implementable and economically sound evidence- and equity-based strategies needed to reduce the impact of climate change on health, and they highlight the need for buy-in and cooperation among governments, industries, communities, individuals, and healthcare providers ( 2 ). They emphasize the need to reduce fossil fuel emissions and improve air quality, provide safe housing (e.g., improving weatherization) and green spaces, improve diets, adopt sustainable agricultural practices, and increase environmental biodiversity. Many mitigation and adaptation strategies that could potentially improve air quality and thus help reduce emissions are currently available. These include shifting to renewable energy alternatives, increasing green spaces, adopting strategies to reduce waste, and shifting to plant-based diets. However, these have not been adopted at the scale required to adequately reduce GHG emissions.

The lack of development of, investment in, and implementation of existing technologies/policies is due to the lack of political will; in turn, this is attributable to limited public support due to perceived uncertainties about climate change impacts and a lack of immediate benefit to those asked to undertake mitigation actions. As a greater emphasis on non-climate-related benefits can motivate greater support for climate-mitigation actions ( 7 ), there is a critical need to evaluate the effectiveness and co-health benefits of available and future interventions to identify those that offer the greatest societal benefits.

To date, few studies have evaluated the efficacy of existing climate mitigation strategies beyond air quality regulations in some parts of the world. Given the complex interactome of direct and indirect impacts of climate change on health, individual climate mitigation interventions/policies will need to be widely implementable, scalable, and effective in practice. Consideration of how local conditions may be affected and the impact of local/global economic impacts will be critical.

Policies that yield synergistic benefits across sectors are needed. For example, the adoption of a plant-based diet would have multiple intersectional benefits, including reductions in the amounts of land and water used for animal food production, GHG pollution (methane), and ammonia volatilization—not to mention the direct health benefits. Meanwhile, achieving sustainable food production and a healthier diet could bring environmental, economic, and health co-benefits that outweigh the costs of climate mitigation measures. However, these measures will need to be evaluated in specific localities as shifts to plant-based diets in some low-resource countries may not be possible and may increase malnutrition. Likewise, community planning that encourages walking and cycling and the use of clean-energy public transportation systems will both reduce GHG emissions and improve overall health.

The public health and healthcare sectors’ role in prevention of climate change health effects

Although the public health and healthcare sectors do not directly control government regulations or technology development, they will play an important role in the prevention and management of climate change-induced health risks through i) identification and communication of the health risks posed by climate change, ii) assessment of the co-health benefits of climate change mitigation strategies, iii) implementation of effective preventive measures, and iv) climate-proofing healthcare delivery.

As the climate crisis unfolds, the extent and severity of the health risks will depend upon the ability of public health and safety systems to respond to these challenges. Management of climate-related health risks will require intersectoral planning and coordination. Local public health departments will also need to be equipped to mobilize resources and issue warnings regarding severe weather/heat events to reduce their health impact. Healthcare delivery practices will need to adapt to adequately care for patients experiencing health-related consequences of climate change and to climate-proof the healthcare infrastructure itself. This will be particularly important in low-resource areas.

At the same time, healthcare systems will need to reduce their carbon footprint. In the United States alone, healthcare delivery is estimated to contribute 8.5% of all GHGs owing to the reliance on fossil fuels to run healthcare facilities and transport supplies, use of petrochemical-containing plastics, use of anesthetic gases in operating rooms, and the incineration of medical waste. The development of resilient healthcare systems globally will require methods for tracking their carbon footprint and interventions to decarbonize services and supply chains. Adoption of practices that reduce the carbon footprint of healthcare delivery could reduce the overall cost of healthcare, benefit the economy, and save lives.

Ensuring equitable climate-mitigation and adaptation strategies

It is widely acknowledged that poor and minority communities around the world, who generally bear little responsibility for driving climate change, will be most impacted by the associated health threats. Some climate adaptation strategies and policies may disproportionally benefit different groups, further exacerbating the vulnerability of disadvantaged individuals globally. Moreover, the implementation of some climate adaptation strategies may also amplify existing health disparities borne by these populations. For example, certain fossil fuel-reducing strategies (such as solar energy and electric vehicles) may only be available in affluent communities/countries and may therefore promote greater inequity. Building dams to manage floods in wealthy neighborhoods may exacerbate floods in areas with lower property values. Thus, it is imperative that all climate mitigation and adaptation strategies are designed to be deployed in an equitable manner to ensure the health and welfare of disadvantaged populations.

In conclusion, the scale of the impact of the climate crisis on human health and survival demands that we unite immediately to implement effective, equitable, and implementable strategies to protect the health of our planet and the people dependent upon it.

Author contributions

MW-K: Conceptualization, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. Intergovernmental Panel on Climate Change. Summary for Policymakers. In: Stocker TF, Qin D, Plattner G-K, Tignor M, Allen SK, Boschung J, editors. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change . Cambridge University Press, United Kingdom and New York, NY, USA (2013). Available at: https://www.ipcc.ch/report/ar5/wg1/summary-for-policymakers/ .

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Keywords: climate change, health, immune disease, environmental equity, mitigation strategies, asthma

Citation: Wills-Karp M. Climate change-associated health impacts: a way forward. Front Sci (2024) 2:1395850. doi: 10.3389/fsci.2024.1395850

Received: 04 March 2024; Accepted: 07 March 2024; Published: 04 April 2024.

Copyright © 2024 Wills-Karp. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Marsha Wills-Karp, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Child-focused climate change and health content in medical schools and pediatric residencies

• Anna Goshua 1   na1 ,
• Jason Gomez 1 , 2   na1 ,
• Barbara Erny 3 ,
• Michael Gisondi 4 ,
• Lisa Patel 5 ,
• Vanitha Sampath 6 ,
• Perry Sheffield 7 &
• Kari C. Nadeau 8  

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Anthropogenic climate change—driven primarily by the combustion of fossil fuels that form greenhouse gases—has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children’s health—with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children’s health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula.

Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels.

Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

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We thank the Sean N. Parker Center for Allergy and Asthma Research at Stanford University for their support. P.S. is supported in part by the Pediatric Environmental Health Specialty Unit (PEHSU) Program via a cooperative agreement award number 5 NU61TS000296-04 from the Agency for Toxic Substances and Disease Registry (ATSDR). The contents are the responsibility of the authors and do not necessarily represent the official views of the Agency for Toxic Substances and Disease Registry (ATSDR). The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing partial funding to ATSDR under Inter-Agency Agreement number DW-75-95877701. Neither EPA nor ATSDR endorses the purchase of any commercial products or services mentioned in PEHSU publications.

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These authors contributed equally: Anna Goshua, Jason Gomez.

Authors and Affiliations

Stanford School of Medicine, Stanford, CA, USA

Anna Goshua & Jason Gomez

Stanford Graduate School of Business, Stanford, CA, USA

Jason Gomez

Department of Internal Medicine, Division of Med/Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA, USA

Barbara Erny

Department of Emergency Medicine, Precision Education and Assessment Research Lab Stanford University, Palo Alto, CA, USA

Michael Gisondi

Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA

Vanitha Sampath

Departments of Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Perry Sheffield

Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

Kari C. Nadeau

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A.G. and J.G. made substantial contributions to conception and design, drafting the article or revising it critically for important intellectual content. B.E., M.G., L.P., V.S., P.G., and J.G. drafted the article and revised it critically for important intellectual content. K.C.N. approved the final version of the manuscript to be submitted.

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Goshua, A., Gomez, J., Erny, B. et al. Child-focused climate change and health content in medical schools and pediatric residencies. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02600-7

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Nih climate change and health initiative, 2022-2023 nih climate and health scholars program.

In early 2023, NIH selected eight established scientists with expertise in climate and health to work on the NIH Climate Change and Health Initiative. This inaugural class of NIH Climate and Health Scholars became part of the cross-cutting NIH effort to reduce health threats from climate change across the lifespan and build health resilience in individuals, communities, and nations around the world, especially among those at highest risk. The diverse group of scientists went through a competitive selection process and began working with NIH staff in February 2023. Each scholar is currently employed at a major university or with a research-based organization but is hosted by an NIH Institute or Center. They work with staff across NIH to share knowledge and help build capacity for conducting climate-related and health research. 

• NIEHS News Story:  NIH welcomes inaugural class of Climate and Health Scholars

Luis Fernando Chaves, Ph.D.

Department of Environmental and Occupational Health School of Public Health-Bloomington, Indiana University Host: National Institute of Allergy and Infectious Diseases

Luis Chaves, Ph.D., is an associate professor in the Department of Environmental and Occupational Health in the School of Public Health-Bloomington, Indiana University, and was previously an associate scientist at the Instituto Gorgas in Panama. His research agenda has been focused on understanding the impacts of environmental change on the ecology of insect vectors and the diseases they transmit. Over the last 20 years, he has combined field studies and modeling approaches, both statistical and mathematical, to address how insect vectors respond to changes in the environment and how these responses modify transmission patterns, to more generally quantitatively assess the factors that drive heterogeneities in disease transmission, and to measure the impact of interventions to control both vectors and infection levels. Recent research efforts have concentrated on malaria and dengue vectors as well as the development of statistical and mathematical tools to analyze serological data, with previous work including West Nile Virus among other infectious agents. Chaves holds his Ph.D. in ecology and evolutionary biology at the University of Michigan. His master’s and Ph.D. were focused on the ecological dynamics of vector-borne disease in changing environments with efforts spanning several zoonotic, vector-borne, and environmentally sensitive infectious diseases.

Lauren Clay, Ph.D., MPH

Associate Professor and Department Chair, Department of Emergency Health Services University of Maryland, Baltimore County Host: National Institute of Minority Health and Health Disparities

Lauren Clay, Ph.D., is a disaster scientist, public health researcher, and an associate professor and Chair of the Department of Emergency Health Services at the University of Maryland Baltimore County. Her research focuses on individual, household, and community health impacts of climate disasters. She has studied Hurricanes Katrina, Harvey, and Florence, the Deepwater Horizon Oil Spill, the 2013 Moore, OK tornadoes, and the Camp Fire among other disasters. Her expertise is in disaster disruption to the local food environment and food and nutrition insecurity. From 2018 – 2020, she was an Early Career Research Fellow with the National Academies of Science, Engineering, and Medicine Gulf Research Program to study the post-disaster food environment. In 2021, she was awarded National Science Foundation (NSF) CAREER and NSF Convergence Accelerator awards focused on bolstering food system resilience to disasters. She co-chairs the national COVID-19 Food and Nutrition Security Working Group supported by Healthy Eating Research, a program of the Robert Wood Johnson Foundation, and Nutrition and Obesity Prevention Research and Evaluation Network, a program of the Centers for Disease Control and Prevention. She holds a Ph.D. in disaster science and management from the University of Delaware and a Master of Public Health from Drexel University.

Ferdouz Cochran, Ph.D.

Climate-Health Science Lead |Health Innovation Center at MITRE Labs Host: National Institute of Environmental Health Sciences

Ferdouz Cochran, Ph.D., is a climate-health science lead at MITRE. She started working in climate change at the National Science Foundation (NSF) Science and Technology Center for Remote Sensing of Ice Sheets in 2006. She has since focused on climate change and environmental health through projects funded by federal agencies including an Oak Ridge Institute for Science and Education (ORISE) postdoc at the Environmental Protection Agency (EPA), a climate-health outreach position in the Carolinas funded by the National Oceanic and Atmospheric Administration (NOAA) Climate Program Office, and a brief time with the Centers for Disease Control and Prevention Building Resilience Against Climate Effects (BRACE) program for Michigan. She enjoys working with decision-makers across sectors, Indigenous experts, and local to national level research and implementation teams for a holistic approach to reduce adverse and disproportionate health impacts from climate change. Ferdouz holds her Ph.D. in geography from the University of Kansas, where she was an NSF Fellow in the Climate Change, Humans, and Nature in the Global Environment program.

Zhen Cong, Ph.D.

Professor, Environmental Health Science Host: National Institute on Aging

Zhen Cong, Ph.D., is a professor and director of Climate Change and Human Health in the Department of Environmental Health Sciences of the School of Public Health at the University of Alabama at Birmingham. She is a fellow of the Gerontological Society of America and serves as associate editor for several journals. Her career goal is to contribute to building a climate and aging resilient society. Her research examines intergenerational relationships and older adults’ health and mental health against the backdrop of social changes. Her current research focuses on vulnerability and resilience to disasters, especially social and health disparities concerning older adults and racial and ethnic minority groups in the disaster preparedness, mitigation, response, and recovery processes with a multilevel layered vulnerability perspective. She served on the faculty in the Department of Human Development of Family Studies at Texas Tech University. She later moved to the School of Social Work at the University of Texas at Arlington, where she served as associate dean for Research and Faculty Affairs and as the Ph.D. program director. She holds her Ph.D. in gerontology from the School of Gerontology at the University of Southern California.

Carina Gronlund, Ph.D., MPH

Research Assistant Professor, Survey Research Center, Institute for Social Research  School of Public Health | University of Michigan  Host: National Heart, Lung, and Blood Institute

Carina Gronlund, Ph.D., is a research assistant professor in the Social Environment and Health Program at the University of Michigan. She is an environmental epidemiologist with experience in clinical research, survey design and analysis, quantitative health impact assessment, and community-based participatory research. She. Prior to starting her graduate studies, she was a certified clinical research associate and worked on clinical trials at the Karmanos Cancer Institute in Detroit, MI. As a doctoral and postdoctoral trainee, she worked on heatwave preparedness, attitudes, and behaviors projects, and she has worked on predicting heat-health responses to power-grid failures in Phoenix, Atlanta, and Detroit. Gronlund also collaborates with the Michigan Department of Health and Human Services on studying weatherization health benefits among Medicaid beneficiaries. She is a founding member of the Climate Hazards, Housing, and Health Steering Committee, and has also co-led a community partner-initiated project performing a health impact assessment on energy justice. Finally, she is a principal investigator on an NIEHS-funded R01 that integrates climate change adaptation, mitigation, and health dimensions. Gronlund holds a BA in biology, with a specialization in ecology and evolution, a master’s in public health, and a Ph.D. in the University of Michigan Department of Environmental Health Sciences.

Praveen Kumar, Ph.D.

Assistant Professor, Boston College School of Social Work Host: Fogarty International Center

Praveen Kumar, Ph.D., is an assistant professor at the Boston College School of Social Work. His research lies at the intersections of climate change, environmental justice, and global health. His research is also framed by the theories of Implementation Science, which provides a solid grounding to examine sustained adoption of evidence-based health interventions in the face of climate and environmental risks. His overall research objective is to characterize interventions that address climate and environmental vulnerability to improve the health and well-being of marginalized communities. His research focuses on low and middle-income countries, particularly on climate-vulnerable populations. Kumar leverages large-scale data from field studies and secondary sources to inform his research questions. He primarily uses quantitative data analytics and the System Science approach of social network analysis (SNA) in his research. His studies have been funded by numerous reputed agencies, including the Fogarty International Center, the National Institute of Mental Health (NIMH), and the Government of India. Kumar holds a Ph.D. in social work from Washington University in St. Louis, a master’s from the Tata Institute of Social Sciences in India, and a Bachelor of Technology in Engineering from the Institute of Chemical Technology (ICT) at the University of Mumbai.

Patrice K. Nicholas, DNSc, DHL (Hon.), MPH, MS, RN, NP-C, FAAN

Distinguished Teaching Professor and Director, Center for Climate Change, Climate Justice, and Health MGH Institute of Health Professions Host: National Institute of Nursing Research

Patrice Nicholas, DNSc., is a teaching professor and director of the MGH Institute of Health Profession’s Center for Climate Change, Climate Justice, and Health and co-director for Policy and Advocacy at the MGH Center for the Environment and Health. Nicholas' scholarship and research efforts have focused on global health issues, HIV/AIDS care, research, and symptom management, quality of life in chronic illness, and climate change, climate justice, and health. She has published research and policy papers in these areas and has been funded as a Fulbright Senior Scholar in South Africa at the University of KwaZulu-Nata for a research and teaching award, focusing on adherence to HIV and TB medications. Nicholas has also received a Doctor of Humane Letters degree Honoris Causa from her alma mater, Fitchburg State University, and has been inducted as a fellow of the American Academy of Nursing. Nicholas has also served as director of Global Health and Academic Partnerships at the Brigham and Women’s Hospital, where she also co-led the efforts in their successful American Nurses Credentialing Center Magnet journey. She has received a Bachelor of Science degree in Nursing at Fitchburg State University, a Master of Science in Nursing degree, and a Doctor of Nursing Science degree at Boston University. 

Leticia Nogueira, Ph.D., MPH

Senior Principal Scientist at the American Cancer Society Host IC: National Cancer Institute

Leticia Nogueira, Ph.D., is a senior principal scientist at the American Cancer Society and an adjunct professor at the Emory Rollins School of Public Health. Nogueira’s research focuses on cancer disparities that can be addressed by policy changes, with a special focus on climate change and structural racism. She is a member of the American College of Surgeons’ Commission on Cancer, the Society of Behavioral Medicine Presidential Workgroup on Climate Change and Health, and the National Academies of Science Climate Collaborative. She received the Woman in Cancer Research Award, the Minority Scholar in Cancer Research Award, and the Fellows Award for Research Excellence from the National Institutes of Health. In 2018, Nogueira was inducted into the University of Texas College of Natural Sciences Hall of Honors and in 2020, she received the Outstanding Young Alumni Award from the University of Texas at Austin. Nogueira holds a Ph.D. from the University of Texas at Austin and a Master of Public Health from the Harvard School of Public Health.

This page last reviewed on October 24, 2023

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Climate and health education: A critical review at one medical school

Lucy greenwald.

1 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Olivia Blanchard

Colleen hayden.

2 The Leni and Peter W. May Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Perry Sheffield

3 Departments of Environmental Medicine, Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Associated Data

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

Introduction

As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy.

Objective and methods

In the present study, we assessed the “climate and health” content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign. We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign.

Results and discussion

Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school's new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.

1. Introduction

The overarching objective of undergraduate medical education curricula is to provide students with the scientific knowledge and practical skills to be accomplished and responsible physicians ( 1 ). Historically, medical school curricula undergo frequent content, format, and faculty changes as well as periodic large scale reorganization ( 2 ), which is currently happening across the country ( 3 ). Prominent trends throughout the present curricular developments include condensing the early coursework and introducing more content on social science and policy ( 4 ) and structural determinants of health ( 5 , 6 ). The driving forces for these changes include Association of American Medical Colleges (AAMC), Liaison Committee on Medical Education (LCME), and United States Medical Licensing Evaluation (USMLE) pressures and student demand ( 7 – 13 ).

Climate change is one of the large societal issues being integrated into some medical school curricula. Climate change has been on the radar of the general public for years but has only slowly gained traction as a political, social, and medical crisis. The effects of climate change on health come from both the indirect impacts of exacerbating inequities in SDOH, with the earliest and most prominent effects of climate change affecting those in low income and disadvantaged communities ( 14 ), and the direct impacts of heat, extreme weather events, pollution, wildfires, and other phenomena. Infants and young children, older adults, and people with disabilities are also among the most vulnerable to the effects of climate change. A breadth of research shows the direct clinical impacts of climate change in all medical disciplines [cardiac health, ( 15 ); pulmonary health, ( 16 ); renal health, ( 17 ); infectious disease, ( 18 , 19 ); psychiatry, ( 20 ); emergency medicine, ( 21 ); pediatrics, ( 22 , 23 ); gynecology, ( 24 )], but this research has not translated to inclusion into medical school curricula at the same rate. In a survey conducted by the International Federation of Medical Students associations, only 15% of the 2,817 medical schools included climate change in their curricula ( 25 ). In recent years, groups within medical schools have worked to build and adapt curricular initiatives that reflect the nature of climate change as a societal issue and a direct threat to health. Various methods for implementation have been adapted: Emory University and the Icahn School of Medicine at Mount Sinai (ISMMS) have adopted a disseminated design with climate change and health content spread throughout pre-clerkship courses and small group discussions ( 26 ), Queen's University Belfast, Stanford, and UC-Berkeley UCSF Joint Medical Program have an elective-based approach, and Georgetown School of Medicine and Harvard Medical School offer clinical scenario exercises to expose students to the practical applications of climate change ( 27 ). Because climate change results in pervasive, universal, and ever worsening health problems, it remains crucial to educate the students who will be responsible for human health on its impacts.

We are in a critical period for understanding curricular initiatives in climate change and health to ensure their sustainability. The ISMMS MD program is undergoing a curricular reform across all facets of the educational program. The climate change curriculum infusion project (CCCIP) is the initiative that has coordinated the introduction of climate change content at ISMMS since 2018. The student-led, faculty supported group responsible for the inception of the project designed stand-alone slides, each with a recognizable banner ( Figure 1 ), to be incorporated in 14 lectures across six courses in the first 2 years of the pre-clerkship curriculum ( 26 ). Two rounds of student feedback ( n = 74) of the CCCIP concluded that the content was appropriate in the courses (88%) and important to their medical education (83%). The feedback also indicated that students did not remember the content well (78%) and that the climate-related content at ISMMS did not match their expectations [62%; ( 26 )].

The CCCIP banner that appeared on each of the pre-prepared slides ( 26 ).

The goal of the present study is to explore a nationally relevant case study of the ISMMS' climate change content as it relates to a drastic curricular redesign. We aim to assess the CCCIP implementation from the perspective of the ISMMS faculty, understand the challenges to implementing the content as presented, and assess ways to improve the success and sustainability of the information in the new conceptual framework.

2.1. Retrospective review of CCCIP

2.1.1. study design and data collection.

The first component of this study was a retrospective review of CCCIP content continuity. We identified the lectures where CCCIP content was originally accepted by course directors and lecturers by following the CCCIP records ( 26 ) from the inception of the program. Medical administrators at ISMMS granted us access to the Blackboard course websites for all courses from the 2020–2021 and 2021–2022 academic years identified to have lectures with CCCIP material. With the timetabled lectures from 2018 as a guide, these courses were systematically reviewed to identify where CCCIP content was still being used.

2.1.2. Data analysis

Lectures where we found slides with the CCCIP banner were counted as lectures where the content was still present. The data for both years of content were recorded and helped to inform the second component of the study.

2.2. Assessment of faculty experience

2.2.1. study design and data collection.

The second component of the study aimed to gather faculty feedback on the CCCIP. To better understand faculty experience with CCCIP implementation, a mixed methods interview-based exploratory study was designed. The study was deemed exempt by the Mount Sinai Institutional Review Board (IRB). Inclusion criteria were based on participation in the original CCCIP. Eligible faculty members included lecturers who were tasked with delivering CCCIP content, course directors for courses where CCCIP content was included, and medical education leadership. Two separate semi-structured interview guides were created, one for lecturers and course directors directly involved in the CCCIP and one for medical education faculty who had knowledge of the aims of the content implementation and who are involved in the current curriculum redesign. The guides were designed by consulting studies with similar lenses of curriculum implementation ( 10 , 28 – 30 ) and by reviewing literature on qualitative research methods ( 31 ).

Eligible faculty members (nine lecturers, of whom five are also course directors, and six leaders in medical education) were emailed with information about the study, the research information sheet, and a request to schedule a 30-min interview. Once a time slot was selected, a calendar invitation was sent to the faculty member with a HIPAA-compliant videoconference Zoom link. Zoom sessions were run by one interview lead and notes were taken concurrently by another researcher. After obtaining consent, each session was recorded for note-taking purposes. Interview questions included three introductory questions related to the interviewee's field of practice, ten baseline questions regarding lecture content and delivery for lecturers and course directors, and seven baseline questions regarding curriculum design and sustainability for medical education faculty and those involved in the curricular redesign team ( Table 1 ). Following the conclusion of the interviews, the recordings were reviewed by the research lead to supplement the notes, as needed. Once the final data were organized, recordings were permanently discarded and data were stripped of all identifiers.

Closed and open interview questions for the semi-structured interviews for the climate content evaluation.

2.2.2. Data analysis

Interviews were reviewed and characterized throughout data collection. Qualitative interview data were coded by a single coder using an inductive approach ( 32 ). During analysis of individual interview transcripts, ideas in each interview were noted and subsequently added to a separate spreadsheet. The same spreadsheet was used to organize ideas from every interview and served as an initial code-book. Analyses were checked by a second, independent coder. The additional coder chose three interviews to code at random, after which the two coders reviewed the independently generated codes for consistency. Once all interviews were coded, results were refined and synthesized into broader thematic determinations. Quantitative, Likert-style questions were assessed using parametric summary statistics.

3.1. Retrospective review of CCCIP content

In the CCCIP, content was initially (2018) planned for a total of 14 lectures across 6 courses ( 26 ). In the retrospective review of these lectures from 2020 to 2022, we found that the content was present in nine lectures (64%) across five courses ( Table 2 ). The number and content of CCCIP lecture slides used in each lecture changed from year to year depending on lecturer preference. Interviews with course faculty revealed that CCCIP content was implemented in one lecture not originally included (Alzheimer's disease, Brain and Behavior Course ). Content that was originally planned for another lecture (asthma, Pulmonary Pathophysiology course ) was used initially, but was removed prior to the 2020–2021 academic year and therefore not included in this review.

Results of the retrospective (2020–2022) review of CCCIP inclusion, presented in chronological order of content delivery through the 2 years of the pre-clerkship curriculum.

3.2. Assessment of faculty experience

Interviews were conducted with seven of the nine recruited lecturers (including four of the five course directors) and with two of the six faculty members in medical education leadership. Faculty members were given unique identifiers A-I. The semi-structured interviews revealed several common ideas that were then organized into three major thematic umbrellas with regard to ensuring sustainable content development: ( 1 ) the necessity of centralization and a shared vision; ( 2 ) adequate professional development; and ( 3 ) assessment of student learning and of the content itself ( Table 3 ). Coding comparisons revealed high inter-rater reliability. Barriers to general curriculum development and re-design had a high degree of consistency with those felt by the faculty involved in the CCCIP.

Codebook from faculty interviews with lecturers and course directors.

3.2.1. Shared vision

The most commonly cited challenge was the lack of centralization in terms of the organization of the content arc and access of the contributors and participants to the full plan. When the CCCIP began, permission was granted from course directors to include the slides into their course. Slides were given to individual lecturers to integrate into their existing content, but participants noted a lack of knowledge of the “bigger picture.” Several faculty expressed the need for more visible leadership as well as an overt curricular map to provide context and to motivate them to present the material in a meaningful way. For example, one lecturer/course director (study participant C) noted that they “never heard if the content was implemented in other courses” and another lecturer (study participant E) thought that knowing what had been taught so far would make it easier to contextualize their piece of the curricular thread in relation to what had been taught about the topic in previous courses.

Themes discerned from conversations with faculty specifically involved in the upcoming curriculum redesign echoed similar themes to the lecturers and course directors. They further highlighted the need for comprehensive resources for proposed curriculum enhancements, with designs that involve a full educational arc:

“It's so critical that we have a curriculum map and an inventory of where [the content] is taught and where it is assessed. It needs to be big picture: What's the arc? Where do we start from? And Where are we going?…Do folks have learning objectives throughout? Do we have assessments? Are there questions on any exams related to this? This is a very important database of information to have as you think through the curriculum going forward… Where is it actually meaningful?... It really is figuring out how do we ensure the long term retention of it for the students.” - Medical education leadership (study participant I).

3.2.2. Faculty development

All but one of the interviewed faculty members agreed that climate change is important in their field, and in medicine in general (average = 3.75 on 5-point Likert scale; SD = 1.0206, median = 3.75). Reasons for this importance ranged from direct impacts on patient health, such as weather events impacting the ability of patients to receive care, to indirect impacts involving SDOH, with one lecturer/course director (study participant A) noting “people's social circumstances greatly affect whether they need intensive care.” Those that described lower degrees of importance of climate change in their field noted that, to their knowledge, the question of its impact had not yet been addressed. Lecturers had various reasons for agreeing to include information about climate change and health in their material. Lecturers with connections to climate change outside of the CCCIP generally felt more comfort in developing the material. Some faculty had a personal interest in climate change: one lecturer/course director (study participant F) cited family members who work directly in the field and act as climate change activists while another lecturer (study participant B) cited personal fears about the climate crisis outside of their occupation. Other faculty became invested in the health impacts of climate change through seeing it in their work. For example, one lecturer explained

“I think …in my education [climate change] didn't play any role, so I think it was really when I was working on the ground and I was seeing the effect…I was seeing malaria epidemics were happening where, according to the books, they shouldn't have happened…[Climate change became important] when I really had contact with it and really saw the consequences.” Lecturer (study participant D).

The role of students came up as an important topic throughout the interviews. One lecturer/course director (study participant C) noted that students in this generation “are more attuned to and more concerned with these issues,” making climate change a comfortable and important topic to bring into lectures. The idea of students as drivers of content development was consistent throughout almost every interview. Many faculty cited the CCCIP initiative as essential in reminding faculty that these topics are important. One lecturer (study participant D) stated that “what you are doing is like lobbying, you just have to continue lobbying” and another lecturer (study participant B) noted that being brought the material by the research group was the first time they had thought about climate change as it relates to their field. Interviewees also identified buy-in from medical education faculty as an essential driver for content development and reform. Some faculty participants explained that support from higher level administrators would make them feel that the new content is necessary, that there is a network of support, and that their labor involved in curricular development is valued.

Comfort and expertise with climate change and health was variable across the lecturers (average = 3.50 on 5-point Likert scale; SD = 1.643, median = 4.0). Limited faculty development and time were noted as a substantial challenge for those who were less comfortable with the topic itself, noting a lack of “bandwidth in the midst of the course to incorporate new material” and that there was “no support, no one in charge was giving a presentation” (lecturer, study participant E) during the CCCIP. Expansion of faculty development around climate change and SDOH through experiences such as an educational development session, written faculty guide, annual event with expert speakers, or a learning module for faculty were cited as ways to improve faculty comfort.

The challenge of faculty expertise on climate change was also identified as a factor in feedback on the efficacy of the pre-made CCCIP slides. While about half of faculty members felt that the CCCIP information fit “very well” into their existing course material, others noted that the slides felt “a little disjointed” or “like a post-script for the lecture rather than something that nicely tied it together” (lecturer/course director, study participant G). Positive attributes of the slides themselves included the recognizability of the banner ( Figure 1 ) and the clarity of having info-graphic style slides. Faculty members had differing opinions about whether having the pre-made slides was helpful in incorporating the new information, or if providing the slides was a barrier to feeling ownership and confidence in the material. One lecturer (study participant E) believed that the pre-made slides were helpful noting that if we “had not given [them] the slides, [they] probably would not have included it” but that the ease of having slides allowed them to avoid exploring the topic further and including the concept in their own words, making the slide more of a “shortsighted solution.” Overall, faculty motivation appears to be heterogeneous with lack of personal education as a substantial barrier to successful and motivated implementation.

3.2.3. Assessment

Assessment is a reflection of both student learning, in the form of summative assessment, and of the content implementation, in the form of institutional or accreditation requirements. Having these quantifiable assessments increases the pressure on institutions to include curricular topics and increases the pressure on students to internalize the content. The need for these outcomes in the success of any curriculum is clear when considering the frequently cited challenge of time and space constraints in medical education. One lecturer (study participant D) explained this challenge, saying “I think the problem is that medicine is always growing, but the time we have face to face with students never grows.” Faculty on the medical education leadership team (study participant H) echoed this idea with the notion that “there are many topics that people are passionate about, but [when something is added] something has to come out.” The upcoming curriculum reform plan for ISMMS includes changes to the mode of instruction, moving away from lecture-based learning toward more engaged learning modalities, which anticipates all courses having to confront the challenge of curricular space and prioritization:

“Everybody is going to have to pull out what's been most critical… we are going to have to figure out how we fit those into small group discussions and case-based discussions…[we have to figure out if there] is stuff with climate change that is …self-taught that we can still require [and] assess, but …in a way where the students are not going to gloss over it.” - Medical education leadership (study participant I).

Guidelines in the form of institutional requirements and summative assessment shape what continues to be included in medical education. None of the CCCIP information was included in course assessments to date. Several faculty members noted lack of assessment both at the school and the USMLE level as barriers to advocating for further development in this content area. Most faculty agreed that assessment is an important tool for learning. One lecturer/course director (study participant C) stated, “assessments should reflect what we think is most important for students to learn and to understand and I think that if we are not assessing that content that that's sending a message that it is maybe not that important.” In terms of a message of importance coming from governing bodies of medical education, faculty cited the student and educator fixation on the NBME boards to dictate was content is emphasized:

“There's so much major biomedical content that you have to have to get you ready for step 1 and the clinicals…a lot of this other [material]... the touchy-feely side of medicine…gets lost a bit.” - Medical education leadership (study participant I). “we're not going to get any points for it…for accreditation because we're not assessing it. We're just saying we did something, but we really didn't do it. We didn't go through it in a meaningful way.” - Medical education leadership (study participant I).

4. Discussion

The results of the retrospective review portion of this study show the longevity of the prior climate content integration at ISMMS, and the qualitative interview portion of this study serves to help cultivate an understanding of the reasons behind its mixed successes and failures. A majority of the CCCIP content that was created in 2018 was carried through to the 2021–2022 curriculum, but not all of it. This is consistent with the changing nature of curriculum and educational priorities ( 2 ). Two interesting changes to the pre-made CCCIP content noted in the interviews were 1) the removal from one lecture after having been in place the years prior, and 2) the addition of content to a lecture where it was not originally planned to be. First considerations of the removal of the content from a lecture may suggest that the content was deemed unimportant, but based on our conversations with lecturers, it may more likely reflect discomfort with the material and curricular time constraints. In a survey of 84 international health professional schools and programs, 71% of respondents indicated that they encountered challenges to instituting climate change content in their curriculum, with 24% indicating lack of teaching materials and expertise and 29% indicating no available space in the core curriculum, similar to challenges identified in our conversations ( 30 ). On the other hand, addition of climate related content into an unplanned lecture may point to a sustainable impact of the CCCIP initiative on the faculty themselves. Teaching and learning are often thought to be intertwined processes that happen simultaneously and symbiotically ( 33 ). Teaching the CCCIP material may in turn serve to make the lecturer more aware and interested in the topic. This is consistent with the idea that the CCCIP initiative and the student involvement in the curriculum helped to drive content implementation that was present across multiple interviews. The idea of student lead initiatives as drivers of change in medical education is present both in institutions initiating climate change education ( 34 – 36 ) and across additional domains of educational reform, outreach services, and advocacy groups as students engage in extracurricular activities and research throughout their medical education ( 8 , 37 , 38 ). Student-faculty partnerships are integral to the development and sustainability of curricular changes and accountability in the health sector ( 36 ). While students may be able to take on some of the required work in facilitating learning, including creating learning materials, teaching their peers, and leading faculty development, the investment of faculty support, clinical expertise, and status in the institution is continuously necessary for the longevity of the initiative ( 35 ). When medical education and faculty embrace students as partners, they are able to become more invested in shaping their own education.

Active collaborations to organize student and faculty advocacy efforts can aid in the creation and development of future curricula at ISMMS and other institutions. International organizations (International Medical Education Collaboration on Climate and Sustainability, IMECCS; and the Global Consortium on Climate and Health Education, GCCHE), international initiatives (Planetary Health Report Card, PHRC; and the Association of Medical Education in Europe's Consensus Statement, AMEE), and national student networks (Medical Students for a Sustainable Future, MS4SF) offer extensive and overlapping resources for guidance on advocating for inclusion of content, content development, and an in-depth content repository of content (summarized in Figure 2 ).

A guide for the various available resources for climate change content development and implementation [graphic created by Lucy Greenwald with information sourced from https://phreportcard.org/ , https://ms4sf.org/ , https://www.imeccs.org/ , https://climatehealthed.org/ , and ( 39 )].

Three key barriers to successful and sustainable content integration in the CCCIP arose from conversations with faculty: Lack of a shared vision for the content arc, inadequate faculty development, and failure to incorporate assessment. These essential elements of content design were echoed by the medical education faculty preparing to implement the new curriculum. The overall challenges faced by the ISMMS faculty in implementing the CCCIP curriculum match those seen in other institutions ( 30 ). When looking across institutions, it is clear that the efforts to improve an institution's climate literacy is never without its challenges. The PHRC provides an interesting look into the relative efficacy of climate curricula and additional aspects of sustainability and climate consciousness at different institutions. The results of the first year (2019–2020) of the PHRC indicated that zero out of the 13 participating institutions received an “A” grade (80% of possible points) and the results of the second year (2020–2021) indicated that only one institution, Emory University (Atlanta, GA, USA) out of 62 medical schools in five countries received an “A-” ( 40 ). These results indicate that significant improvement is still needed across all participating institutions ( 41 ).

Overall, we found that a transparent and intentional approach to implementation involving accessible content mapping, faculty education, and formal assessment of related content may help to improve the overall knowledge base of the institution and its students. These findings are consistent with the some of the important points in the six-step approach to curriculum development in medical education. The six-steps include “performing a needs assessment, determining and prioritizing content, writing goals and objectives, selecting teaching/educational strategies, implementation of the curriculum, and evaluation and application of lessons learned” ( 42 , 43 ). Without clear content mapping with a shared vision, faculty development, and formal assessment, these steps cannot be met.

Following the upcoming shift away from primarily lecture-based education, aspects of how content is best delivered at ISMMS, including climate change and health education, may need to be re-thought. As this research explores the CCCIP at ISMMS as it relates to the imminent curricular redesign, it can have national relevance as a case study for other medical schools. Institutions aiming to integrate climate and health education, and advocacy groups with hopes of empowering their institutions to do so, must be able to develop and promote these content initiatives in the context of wider curriculum development.

LCME guidelines create unique opportunities for climate change and other topics surrounding SDOH to provide enhancement of real-world applications of the scientific basis of medical education ( 13 ). With these guidelines, there has been a growing interest in teaching SDOH in medical education ( 44 ), a change that can both serve to highlight the importance of these issues in health and health inequity, and help to fulfill the accreditation requirements of the institution. While climate change impacts and exacerbates existing inequities of SDOH ( What is Climate Change? ), the reality of climate change as a present and imminent threat to the health and lives of the population may be better stressed by separating it from SDOH and focusing on ecologic determinants of health, such as air and ocean pollution, global warming, and declining biodiversity ( 45 ). This approach is also more holistic in examining the impact of the health of the planet on human and community wellbeing at a systems level, including more comprehensive factors, such as “ecological, social, cultural, and intergenerational determinants of health” and encouraging participation of community, policy, and indigenous programs outside of the health sector to inform perspectives ( 45 ). As the emphasis of medical curricula shifts to highlight the patient in context, individuals' social and physical environments play an even larger role in health ( 46 ).

At ISMMS, the LCME guided “societal problems” will be integrated in six threads throughout the curricular arc. These threads have already been chosen as an extension of the named priorities of the institution: Scholarly Discovery, Advocacy, Social Justice and Anti-Oppression, Healthcare Delivery Science, Medical Decision-Making, and Leadership and Professional Identity Formation. Climate change is included under the umbrella of “Advocacy, Social Justice, and Anti-Oppression.” Some possibilities for the future of the CCCIP include a pre-clerkship informal extra-curricular elective, a clerkship elective course, generating fully developed problem-based learning cases to be integrated in pre-curriculum courses, and continued advocacy for climate literacy of all faculty at the institution, integrating faculty development across subspecialties.

4.1. Limitations

The major limitation of this study was that we reviewed only one medical school's climate content. Additionally, we only reviewed the content from faculty involved in the first 2 years of the pre-clinical curriculum. Additional institutions and inclusion of faculty with greater diversity of educator experiences of climate content would be needed to make the conclusions generalizable to the public. Nevertheless, we were able to have meaningful conversations with faculty at each level of leadership in the curriculum that provided valuable information to consider.

5. Conclusions

From the retrospective review and qualitative interviews with faculty involved with delivering climate change content, we identified key steps that are needed to implement successful and sustainable curricula. It is necessary to stay active and continue to build fully realized curricula with the help of available resources, especially in the current period of reviewing and revitalizing medical education. Advocates must engage medical education deans and faculty to assure that there is higher-level understanding of the importance of this education. Further advocacy must extend beyond the institutional level to national networks of decision makers in medical education standards (USMLE, LCME, and AAMC). Climate and health literacy must be on the radar of all those with the power to make curricular decisions for the benefit of all current and future physicians and patients. Providers have direct access to communities, and therefore unique opportunities to recognize climate change and prepare patients for its effects. As respected members of society who are first-hand witnesses to the effects of the crisis, physicians must take active roles in preventing its worst effects by advocating for more robust climate action—specifically reducing healthcare sector carbon emissions and building climate resilient health systems. As a society we have begun to become numb to the devastating effects of catastrophes that we encounter every day ( 47 ). We must remember that climate change is here, it is impacting our health, and it is accelerating.

Data availability statement

Ethics statement.

Studies involving human participants are reviewed and approved by the Icahn School of Medicine at Mount Sinai IRB. This study was reviewed by the IRB and deemed exempt. The participants were provided the study information and gave verbal consent prior to the start of the interviews.

Author contributions

LG, OB, and PS conceived of the research idea and participated in data collection and analysis. LG wrote the manuscript with supervision from PS and editing from OB. CH provided expertise in LCME and accreditation requirements and reviewed and edited the manuscript. All authors discussed the results and helped shape the final product.

Acknowledgments

The authors wish to thank Dr. Sophie Balk, Children's Hospital at Montefiore and Professor of Pediatrics at Albert Einstein College of Medicine, for her review of earlier drafts of this manuscript. We would also like to thank all of the ISMMS faculty who participate in the CCCIP and are continuing to work with us to improve it.

Funding Statement

Support for medical students on this project (LG and OB) was provided by the Ramon Murphy Program for Global Health Education at the Icahn School of Medicine at Mount Sinai.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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