Transformative Education
for Health Professionals

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Role of physicians in helping patients to adapt and in developing public policy to mitigate climate change

As part of the preparations for the 2014 Prince Mahidol Award Conference Dr Julian Fisher (JF) spoke to Dr Margaret Mungherera (MM) President of the World Medical Association (WMA) about the role of physicians in helping patients to adapt and in developing public policy to mitigate climate change, as well as WMA's broader policy perspective around the social determinants of health.

JF:  The World Medical Association (WMA) participated in the recent Global Climate and Health Summit 2013, with the WMA press release noting that “climate change will worsen the impact of urban air pollution, which is already directly responsible for over 1.2 million deaths each year”.

- What role do health profesionals / physicians have in helping our patients adapt and in developing public policy to mitigate climate change ?

MM: Climate change is too big a problem to be addressed by one profession, but physicians do have a major role to play on multiple levels to mitigate its impact on people’s health: as medical professionals, as educators and community leaders, as advocates, and, finally, as citizens, setting example by adopting environmentally friendly behaviors at home and at work.

In our more traditional role as doctors delivering medical services to patients, we are the front-line responders to the climate’s effects on people’s health, from malnutrition to weather-related increased morbidity and mortality from cardiac and respiratory events. As a mental health professional, I am particularly concerned about the impact that climate change has on the health of vulnerable populations. For example, studies indicate that the incidence of post-traumatic stress disorders rises dramatically following extreme weather events, such as floods or hurricanes. It is physicians’ duty to alleviate the effects of such events and give patients the necessary tools to cope with them.

However, our role is not limited to the action in clinical settings. Physicians also work in academic institutions and hospitals, providing continuing medical education to students and residents. It is important that educational courses include training modules on climate change and health, so physicians, as trusted communicators, can make a difference at the community level.

Physicians’ roles as advocates could be even more prominent. The public health community has been very vocal about the issue over the past several years, while professionals in organized medicine have lagged somewhat behind. However, physicians can exert great influence on the development of public policies at national, regional and global levels through their affiliation in professional medical associations.

The World Medical Association, speaking on behalf of nine million physicians globally, has been very concerned about the harmful effects of climate change on health and have taken actions to address the issue by making statements at the World Health Assembly, participating in major global conferences, organizing side events on climate change and health, raising awareness of our membership, calling on governments to act and advocating for change.

Finally, on a personal level as citizens, physicians can do much to mitigate the impact of climate change. As respected leaders in their communities, physicians can set an example by adopting environmentally friendly behaviors at home and at work, such as, for example, using recycled products, avoiding the use of harsh disinfectants, thermometers and sphygmomanometers containing mercury, or switching to fluorescent lighting and using motion detector light switches to preserve energy. The important message is that climate change should be of everyone’s concern. Every single person’s action count, and physicians can leverage their influence in their communities to act as catalysts of change.

JF: The WHO global action plan for NCDs includes an objective “to reduce modifiable risk factors for non-communicable diseases (NCDs) and underlying social determinants through creation of health-promoting environments”.

- Recognising enironmental and health linkages and interactions in areas such as physical, chemical and biological hazards, how might a shared approach to modifiable risk factors enable health profesionals / physicians to use available technologies, policies and preventive and public health measures to lead to the creation of health-promoting environments ?

MM:  Addressing so-called modifiable risk factors of NCDs, such as tobacco use, excessive alcohol consumption, poor diets and lack of physical activity, requires a comprehensive “health in all policies” approach to make a significant impact on populations’ health. This means that a concerted multistakeholder effort will be needed to create health-promoting environments. This is not to say that physicians do not have an important role in this regard. Health promotion and disease prevention, along with the social determinants of health, such as poor housing, educational opportunities or employment, are areas that physicians, particularly at the Primary Health Care (PHC) level, can easily incorporate into their daily routines, and noticeable results can be achieved. The comprehensive approach at the PHC level should entail providing preventive, curative and rehabilitative services and the involvement of the patient, their families and communities.

However, physicians should be trained to provide such services. More importantly, they need to practice what they preach. It is well known that physicians serve as role models to their patients, and when physicians practice healthy behaviors, their patients are more likely to follow their lead.

I would stress again that physicians’ participation in global health can be significant through professional associations. The World Medical Association has been very active in its advocacy to adopt a comprehensive approach to tackling NCDs and consider not only the common modifiable risk factors of the four diseases (cancer, diabetes, cardio-vascular diseases and respiratory tract conditions), but also the determinants of health, or “the conditions in which people are born, grow, live, work and age.” We also advocate for expanding the focus and including mental health and other chronic diseases, as well as oral health, in the definition of NCDs for more comprehensive, person-centered care.

JF: The World Health Professions Alliance intervention at the 2013 WHO World Health Assembly noted that “WHPA members will encourage the inclusion of SDH in curricula guidelines ”. Key recommendations for health professionals’ education and training on SDH covering knowledge, skills, placements, CPD and access are included Sir Marmot Marmot’s Report, “working for health equity, the role of health professionals”.

- How can health professionals act as advocates and look beyond disease and broaden perspectives?

MM: Looking beyond disease and broadening perspectives of physicians in order to address SDHs will require greater attention to global health challenges in medical schools and greater integration of global health and primary care strategies into the curriculum for medical training. It is well known that the current healthcare model is very medical in most countries, and physicians are not well prepared to provide preventive services in clinical settings. Although education is important, the role of incentives should not be underestimated. Doctors should be rewarded for providing preventive services in addition to treatment. I would avoid overgeneralizations, since every country is different, and each one needs to address these challenges in a manner that suits its healthcare system best. However, I would add that it is important to think about health systems as a social determinant of health, which is influenced by and is influencing other social determinants.

In terms of advocacy, I would stress again the role of professional associations. WMA has been very active in this regard on a global level, but national medical associations also have a very important role to play on a country level, where policies should be translated into action.

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