Dear Class of 2024,
You are embarking on a career in medicine during one of the most pivotal times in our nation’s history. Each of you has an intimate experience with COVID-19, whether through first-hand contact with the disease or through the efforts to minimize its spread. And over the course of the next four years, your understanding of this coronavirus will only deepen.
The venerable institutions you are attending have put forth their best efforts to ensure that you’ll graduate as intellectually competent physicians. You’ll be armed with the knowledge of exactly which cells and cytokines interact to produce the cascade of chemicals that cause the signs and symptoms you’ll come to recognize as COVID. By the time you reach your residency, you’ll know the pathophysiology, histology, clinical features, diagnostics, treatments, and complications of this and hundreds of other diseases, syndromes, and pathologies that afflict humankind.
And while there’s much you need to know to be a doctor, many of you didn’t enter into this field because of your interest in basic science. If you’re like most medical students, you entered into medicine to help people. You’re learning anatomy, physiology, pharmacology, pathology, embryology, immunology, and so many other subjects in order to one day help a sick person to heal, to live, to thrive. You proudly stood up, in spirit with those that came before you, and took a sacred oath to “do no harm” and to “apply, for the benefit of the sick, all measures that are required.” But as we know, medicine is only one of the measures that we can apply in order to support good health and wellbeing.
The practice of medicine is a necessity in the human experience, but the care you, as a future physician, provide to your patients will not be enough to ensure good health. We know that regardless of how much we learn in the classroom or on clinical rotations, no amount of medicine can mitigate the effects of the upstream determinants of health. In fact, upon examining health outcomes, clinical care has shown to account for only 20 percent of someone’s health. The remaining 80 percent of a person’s health is determined by their behaviors, socioeconomic factors, and their physical environment.
So, consider for a moment the health of individuals impacted by recent disasters like the wildfires in the Pacific Northwest or the hurricanes bombarding the Gulf Coast. Nothing that even the most skilled pulmonologist can do will ever clear the ash from those people’s lungs. No procedure or surgery will ever resolve the emotional impact of watching floodwater or storm surges destroy your home. But, it does not require a natural disaster for the environment to impact an individual’s health.
Right now in our country and all across the globe, people are struggling with asthma, COPD exacerbations, malnutrition, food insecurity, and mental health disorders related to increasing ambient air temperatures, worsening pollution, and more frequent natural disasters. Being of a low socioeconomic status or racial minority puts an individual at even higher risk to be affected by a changing climate. As future health care providers, it is imperative to understand the impact the environment has on health, because not only is climate change part of the pathophysiology of many diseases, it is also part of the oath you took upon receiving your white coat: “I will protect the environment, which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.”
In this tumultuous time, it may seem overwhelming to know where to begin and what actions to take. All the courses that you are sitting in today will not be enough to ensure that you live up to the oath. As future physicians, we can use our voice to advocate for initiatives that will support the health and wellbeing of people by creating conditions that protect the environment. When asked about improving systems, Dr. Donald Berwick said, “I need three things: the will to change; ideas, alternatives to the status quo; and the management of change as an ongoing process.” We are developing the skills necessary to practice medicine. Now, it’s time we take these skills and apply them to that which affects health outcomes more than anything: the environment. Our earth is ill, and we must strive to heal it.
Heidi Schoomaker, Haley Probst, and Marcela Betancourt are medical students.
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