Girl Planting seeds

Training New Doctors in Environmental Health

Doctors_shutterstock_168767105By Benjamin Kligler, MD
Since the COVID 19 pandemic hit earlier this year, understandably the focus for all of us—and for our health care system-- has been the fight against the virus. And this will continue to be the case probably through much of next year. But even while we focus on COVID, the other urgent issues that impact our health are still in play—and not least of these is the challenge of the threat to our health from undealt-with environmental issues including untested and hazardous chemicals at home, work, and school, pollution of our air and water, and the growing impact of climate change. According to Dr. Karen Mulloy, an Associate Professor at Case Western School of Medicine, “In the broadest sense, the environment is probably the major contributor to the determinants of health.”[1] And yet, how many of us have ever talked about environmental issues with your family’s doctor?

Over twenty years ago, a major report from the Institute of Medicine recommended that environmental health become a standard part of medical education, laying out six specific areas for learning including the role of doctors in bringing these issues into the discussion about public health [2] And yet very few physicians graduate from training with a strong knowledge base and sense of competence on environmental health issues. Doctors have played a key role in many important public health campaigns—from smoking awareness to seat belts and bicycle helmets. They can only play that role if they themselves are educated and aware.


But this trend may be starting to change. A recent WNPR report focused on a curriculum to teach residents at a Boston area hospital about how climate change can affect the health of their individual patients.[3] The American Medical Association—not always the most progressive organization—has recommended that every school include climate change in its curriculum.[4] And at Hackensack Meridian School of Medicine in New Jersey, we are taking this issue beyond climate change to make learning about the whole range of environmental health issues a required part of medical school. The program starts with a workshop on environmental issues, from toxins in our food supply, to lead in our water to ozone in our air—all of which we could be addressing much more effectively as a society if the medical community was speaking out more. Then we ask the students to use the Healthy Living app produced by the Environmental Working Group to identify something in their own diet, and something they use at home for cleaning or personal care that pose a potential health risk. And then we ask them to consider actually making a change—so they can see what that might be like for their patients. Experiencing this issue in their own lives is more powerful than just a lecture or a workshop.

In an evaluation of this new program earlier this year, we found that on a survey of students feeling of preparedness to discuss environmental issues with their patients, they made significant progress as a result of this program.  We hope that more schools will take a look at this success and choose to take a similar approach to bringing this subject to their own students.
So please don’t be afraid to bring up the issue of environmental health with your own family physician. It’s part of their job! And knowledgeable and informed patients are one of the best ways to move physicians to learn about important new areas they might have missed in school.
Dr._KliglerDr. Kligler is the Medical Advisor for The Deirdre Imus Environmental Health Center®. He is also the National Director of the Integrative Health Coordinating Center for the Veterans Health Administration and Research Director for the Office of Patient Centered Care & Cultural Transformation. He was the founding  Director  of the Beth Israel Fellowship Program in Integrative Medicine, and teaches in the Beth Israel Residency Program in Urban Family Practice. Dr. Kligler is the author of Curriculum in Complementary Therapies: A Guide for the Medical Educator, and co-editor of Integrative Medicine: Principles for Practice, a textbook published by McGraw-Hill. He is also Co-Editor-in-Chief of the peer-reviewed journal Explore: The Journal of Science and Healing.
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