This piece was previously published by In-Training: https://in-training.org/are-medical-schools-addressing-all-dimensions-of-health-perspective-from-philadelphia-medical-students-20810.
The past months have seen significant challenges in the United States, from upheaval around systemic racial inequities to post-reopening COVID-19 resurgences. However, last month also marked an optimistic event — the inaugural release of the Planetary Health Report Card (PHRC) project at thirteen leading medical schools across the country, including the Perelman School of Medicine (PSOM) at the University of Pennsylvania in Philadelphia, which we take here as a case study. This student-led project evaluates medical schools’ commitment to planetary health using a standardized scale; the aim is to galvanize action from the medical education community around the critical connections between patients’ health and current environmental crises.
So, what is planetary health? It refers to a burgeoning field focused on understanding the health impacts of human-caused disruptions of Earth’s natural systems, including climate change and environmental pollution. This also encompasses the immediate and downstream health threats from such disruptions, which have impacts on communities at the local level — Philadelphia is no exception.
As exemplified by the Philadelphia Energy Solutions oil refinery explosion last summer, Philly residents live in close proximity to hazardous industrial practices. South Philadelphians living downwind of the recently-bankrupt refinery, Philadelphia airport, Navy Yard and two major interstate highways experience higher rates of asthma than the general population; residents in Eastwick face increased contact with water-borne carcinogens from nearby landfills; and communities in northeastern and western Pennsylvania are exposed to the health risks associated with fracking. As climate change progresses, Philadelphia is projected to experience both more intense heat waves and increased flooding, which may lead to sewage-contaminated water. Environmental impacts like this, compounded by elevated ambient air pollution and urban heat islands in communities without sufficient green space, leads to worse cardiovascular, respiratory and neonatal health outcomes.
The PHRC encourages medical schools to directly address such planetary health risks in their surrounding communities and in broader populations. At each participating institution, medical students worked with key school administrators to comprehensively evaluate the school’s engagement across four domains: curriculum, research, community outreach and advocacy, and university support for student-led initiatives. Each school’s inclusion in the pilot report of the PHRC represents the culmination of a months-long process and an expanded commitment to public health.
PSOM’s results spotlight both strengths and opportunities for growth, many of which have parallels at peer medical schools across the U.S. For example, the university’s recently-announced Environmental Innovations Initiative to allocate funding for education, faculty recruitment and interdisciplinary collaboration around climate change, environmental equity and sustainability suggests new energy targeting planetary health issues within the university at large. In addition, longitudinal environmental health research and outreach continues at PSOM’s Center of Excellence in Environmental Toxicology. The school also addresses environmental impacts on health in its curriculum and provides funding opportunities for student-led planetary health pursuits.
Yet despite the vigor with which PSOM is spearheading environmental initiatives, no centralized planetary health institute or online database to consolidate relevant resources across Penn’s schools currently exists. In fact, much of the planetary health work at the university occurs unbeknownst to medical students. To increase engagement, the medical school should regularly augment and publicize existing opportunities and efforts, while also recruiting new faculty with planetary health expertise. By pinpointing these areas for improvement, the PHRC highlights a broader opportunity for Penn to bring planetary health to the forefront of holistic patient care and medical education. This call to action applies not only to PSOM but to all medical schools, which share accountability for the health of their surrounding communities.
To fully realize the Hippocratic obligation to protect patient welfare, medical schools must act against environmental injustice in their institutions and their communities, both locally and globally. Medical education should prioritize planetary health in the curriculum, pioneer environmental justice initiatives, and recruit leadership in planetary health research. The best way that medical schools can support planetary health education is to lead by example: embrace sustainable practices across campus; divest from fossil fuels; pressure local governments to protect public environmental health; and build advocacy training into the curriculum to empower students to do the same.
At this time of national flux, PSOM and other leading medical schools should take the opportunity presented by the PHRC to invest in and commit to the identified areas for change to improve public health. Proactive steps now can allow medical schools to better safeguard the wellbeing of all future patients.
Silva & Gotschall are second-year medical students at Perelman on the leadership board of PSOM’s Healthcare Sustainability Group, and they worked with the PSOM administration to develop the school’s 2020 Planetary Health Report Card results.
