Professional bodies, from the Royal Colleges to the World Health Organisation (WHO), urge educators to prepare tomorrow’s doctors for the medical consequences of an increasingly unstable climate. In reality, however, few medical schools do so.

In 2008, Norwich Medical School joined with the Centre for Sustainable Healthcare and the NHS Sustainable Development Unit to build a network of medical academics to trial various approaches to integrating teaching on the links between health, sustainability and healthcare into an already-overstuffed medical curriculum.

The results have been surprising. The Sustainable Healthcare Education Network now has over a hundred and thirty members, nationally and internationally. Members have developed teaching in about half of the medical schools in the UK, in public health, global health, general practice and leadership and management modules. Norwich Medical School contributes to dozens of publications and presentations on the health effects of climate change, the health benefits of a low-carbon society, and the new professional responsibilities awaiting doctors in a ‘lo-carb’ NHS.

Teaching materials and lesson plans are available for free download at: The Campaign For Sustainable Healthcare  
 

Learning Objectives for Medical Students

1. Describe the benefits and challenges of sustainable healthcare

a) Explain the concept of sustainable development in relation to human health.
b) Describe, with examples, how an understanding of living systems can help in the design of more sustainable systems in healthcare.
c) Explore the ways in which the links between environment and health might affect the duty of the doctor to 'protect and promote the health of patients and the public'.

2. Recognise the role of climate change (as an environmental hazard) in ill-health and discuss ways to mitigate its effects

a) Describe the impact of climate change on health inequalities.
b) Understand the difference between adaptation and mitigation in climate change responses.
c) Explain the health co-benefits of policies to address climate change in a variety of sectors, including transport, food production, energy generation & use, population control, distribution of resources.
d) Explain how ‘Contraction and Convergence’ relates to ethical issues of distributive justice in health.
e) Critically appraise scientific evidence on the mechanisms by which climate change affects health (directly and indirectly)

3. Explain the role of doctors as both managers and clinicians in the provision of sustainable healthcare

a) Describe ways in which a sustainable healthcare system may differ from the NHS as it is today, giving examples of how doctors can help to bring about these changes in their role as managers of healthcare resources. (Academy of Medical Royal Colleges’ Medical Leadership Competency Framework competency areas: setting direction, improving services [inclusion of sustainability as an aspect of care quality], managing services [stewardship]).
b) Discuss the relationship between sustainability and quality of care in one medical speciality.
c) Demonstrate clinical skills applicable to sustainable healthcare, including:

•  use of evidence-based lifestyle interventions in disease prevention
•  describing ways in which patients may be supported to care for themselves •  conduct of a remote consultation with a patient
  d) Identify an opportunity to improve sustainability in your medical school or in a clinical setting and the channels by which change can be brought about.

4. Demonstrate advocacy and leadership skills for sustainable healthcare

a) Discuss social and psychological aspects of environmental behaviour change (e.g. why and how people change or don’t change).
b) Informal advocacy: be able to discuss with colleagues whether or why individuals in the NHS should support sustainable healthcare.
c) Formal advocacy: Give a 10 minute presentation or write a letter to senior colleagues about NHS responsibilities and opportunities for sustainable healthcare.
d) Be aware of existing networks, and how to build a local network to support professional action to increase sustainability.