The vision
“Medicine is a practice. And it is not difficult for people trained as clinicians to see that there is another practice they can learn, namely community organizing.”
Pedja Stojicic, instructor at Harvard’s School of Public Health
The spotlight
As climate impacts increase, healthcare workers increasingly find themselves on the front lines. From the dangers of extreme heat to the spread of infectious diseases, climate change is a health crisis. Doctors, nurses and other practitioners take this into account in their daily work – and increasingly find themselves in the broader fight for climate mitigation and justice. Because of this, they are also a good test group for understanding what it takes to move someone from resignation to empowerment. It seems there is a blueprint anyone can follow. And one recent effort with health professionals is leading the way.
In 2022, the Center for Health Equity Education and Advocacy launched at Cambridge Health Alliance, a Harvard teaching hospital. a community to equip health workers with community organizing tools for climate action. In teams of three or four, fellows learned principles of organizing and worked on climate advocacy projects in their own communities.
Last week, a study was published in Academic Medicine examines the results of the fellowship’s first year (it is now in its third). From pre- and post-fellowship surveys, the study found that participants improved their understanding of the historical context of climate change and the health inequalities it creates, and also gained confidence in their ability to do something about it.
“What I was excited about is that people’s sense of purpose and community has really increased,” said Gaurab Basu, a primary care physician and director of education and policy at Harvard’s Center for Climate, Health and the Global Environment, who co -conduct of the community. (We previously covered his efforts to brings climate material to Harvard’s medical school curriculum.) At the start of the fellowship, only 47 percent of healthcare organization associates agreed that they had the tools to combat climate change at their organization, and even fewer felt equipped to combat climate change in their local communities. After the training they received, these numbers jumped above 90 percent, according to the surveys taken by fellows.
“We really feel that health professionals understand the connections of climate change and air pollution and ecological degradation on health, but they feel really intimidated by it. It feels very big and overwhelming,” Basu said. “Education for me is a vehicle to support individuals to be activated and to see that they can actually be in a position to make change.”
Pedja Stojicic, the other co-director of the Climate Health Organizing Fellowship and an instructor at Harvard’s TH Chan School of Public Health, trained to be a doctor in his native Serbia. He also “got an education in activism out of necessity,” he said, growing up in the ’90s during the Yugoslav Wars and the dictatorship of Slobodan Milošević. “As young people, we just felt the need to resist this and lead our country to democracy,” he said.
Later, as a doctor, he also helped organize a coordinated response to the HIV/AIDS epidemic in Eastern Europe. But he came to find the practice of medicine—working with one patient at a time—somewhat limiting. “Then I had the pleasure of learning about community organizing, in the tradition of the civil rights movement and farm workers union here in the United States,” he said. “Those experiences of learning how to learn something I had been practicing for a long time helped me connect the dots. Like, it’s not just something you can do. It’s also something you can potentially pass on to other people.”
Stojicic’s approach to teaching others transitioning into advocacy, which he learned from the famed organizer and educator Marshall Ganzfocus on community building first, and then activate that community toward a specific goal.
The curriculum of the Healthcare Organization Society followed an arc of five main skills: storytelling, relationship building, team building, strategizing, and taking action. This formal assignment lasted for half the year; the fellows met each month for virtual training sessions with experienced community organizing trainers, and also participated in three weekend courses. For the next six months, fellows continued to meet monthly with their coaches to develop their community projects.
Dr. Sheetal Rao, one of the fellows, co-founded a nonprofit called Nordson Green Earth to increase tree equity in the Chicago area. Courtesy of Dr Sheetal Rao
Part of this training involves a kind of mindset shift, Stojicic said, for clinicians who are used to being the one with the answers, literally prescribing the solutions. “Community organizing teaches us something else. You have to start with people, build relationships with people and then together ask the question: ‘What is the project we want to undertake together?'”
Gabriel Cisneros, a pediatrician in Pittsburgh and a year one fellow, said he didn’t see himself as an activist or a community organizer before going through this training. “So much of my training was focused on patient care and protecting children from disease and prescribing medicine and those kinds of things,” he said. He had long been interested in the environment and had even studied it as an undergraduate, but he did not see that it had any bearing on his daily work as a doctor – until he received a “wake-up call” . in 2020. As he and other health care workers grappled with the pandemic, a wildfire broke out in California, near the home where Cisneros grew up and where his young daughter was visiting her grandmother.
The compounding crises hit close to home. “It made me go back to my original background in this area and think about, ‘What is my role as a pediatrician to protect the health of our patients with this climate crisis — which is a health crisis,'” Cisneros said. And it turns out there were other doctors who had the same kind of experiences and thoughts.”
Cisneros participated in the community with two of his colleagues, and through their training, Clinicians for Climate Action was born – a community of concerned colleagues at the University of Pittsburgh Medical Center, or UPMC. As their capstone project for the community, the group successfully advocated for their employer to sign the Health Sector Climate Pledgecommitting to reduce their greenhouse gas emissions by 50 percent by 2030.
It started with a petition that Cisneros and others circulated among the staff. “Not by spraying the whole system,” he said, “but by personal requests to colleagues we worked with and knew would be interested. From that we grew our membership manifold. It was set around Earth Day of 2022, and I think within a week we had close to 300 names — doctors, nurses, medical students, all different health professionals. And we basically had a positive response right away that the CEO supports it.”
Since signing the pledge, UPMC phased out the use of an anesthetic called desflurane, which is also a powerful greenhouse gas. Other initiatives include rolling out EV charging stations to encourage greener transport to and from the hospital sites.
“We’re working to figure out how we can balance the needs of our patients while not contributing to emissions,” Cisneros said. “This is a massive undertaking. We are even still learning all the ways in which we as a system contribute to warming.”
In a somewhat similar vein, another capstone project in the fellowship’s first year involved lobbying the American Medical Association to declare climate change a public health crisis – which it did in June 2022.
Other groups have focused more on local initiatives to improve health and equity in their communities—such as working with a nonprofit to strengthen tree equity in and around Chicago, or helping to map and mitigate. flood vulnerability in Milwaukee.
For Cisneros, climate action feels personal. He fights for a livable future, not only for his young patients, but for his own daughter, who is now 10. And he feels a sense of duty to use the platform and authority he is afforded as a physician. “When I talk, people listen,” he said. “Other people I feel a little bad for — they should, like, disrupt plays to get their message out. And here I am given opportunities to speak and be listened to. So that’s why I was and will continue to be a part of this.”
Stojicic, for his part, believes that people who choose to become health care providers are already choosing a life of advocacy, in essence, on behalf of their patients. It is not too great a leap to extend that advocacy beyond the hospital to the societal level.
“Clinicians, in many ways, as they practice, as they have these deep, trusted relationships with their patients, they will see the pain of the world,” Stojicic said — including, increasingly, the pain of life with the impact of a rapidly changing climate. “And when they start to see that, anybody will ask themselves the question: What can we do about it?”
As the study of community participants showed, people giving concrete answers to that question – what can I do, and how – produced productive results, both for people’s attitudes about climate change and for the work they could then do in their communities.
But the community also shows something else: Becoming a climate advocate (or an advocate for any social issue) does not mean abandoning everything else. For health professionals, adding advocacy on top of an incredibly demanding job seems like it can be aggravating already high burnout rates – but the focus on building community first allowed the fellows to lean on their teams and step away from work for times when other priorities required their attention. This does not indicate a lack of commitment, Stojicic emphasized, but rather it shows a commitment to give your full self, when you can, and a sense of trust in the community you have taken care to build.
– Claire Elise Thompson
More exposure
A parting shot
Another interesting climate-and-health story: Gabriel Carrasco, an epidemiologist in Peru, is working to build an early warning system for disease outbreaks that are becoming more common due to climate-related factors. The Washington Post covered Carrasco’s work in an interactive feature look at how the AI-powered system will track the patterns that lead to increased exposure to things like dengue fever, and hopefully one day be able to predict outbreaks early. In this photo, a team of researchers examines a pool of standing water – mosquito breeding grounds – marked in drone images.
