A group of physicians and health experts are calling for Western Canada’s first new medical school in more than half a century to incorporate a model of medicine based on “planetary health.”
In November 2021, Premier David Eby announced Simon Fraser University’s Surrey campus would receive $4.9 million in start-up money to build a medical school with the aim of accepting students by 2026.
In an open letter released Wednesday, 20 doctors and university health experts called on the B.C. government and the university’s leadership to better train physicians to treat the root causes of illness instead of individual symptoms.
“Much of the billions of dollars of resources in B.C. is focused on treating disease. But we know it’s way more cost effective preventing it,” said Kiffer Card, an assistant professor in SFU’s Faculty of Health Sciences and one of the letter’s signatories.
Studies have shown only between 10 and 20 per cent of a patient’s health is determined by access to a doctor, says Card. The other 80 per cent, he says, depends on the environment a person lives in and the human relationships they are exposed to.
Planetary health takes the idea of public health — that human health matters at a population level and depends on how people interact — several steps further, so that the future health of humanity and the planet “are inextricably linked,” according The Lancet, a leading medical journal.
“Future health threats on the health system is going to be pandemics, but also mass heat deaths and droughts,” said Tim Takaro, a practicing physician and professor emeritus also from SFU’s Faculty of Health Sciences.
“Our feeling is that our doctors are not prepared for this.”
Training doctors in planetary health would prepare them to improve patient health outside of the clinic at a time the World Health Organization has warned a warming planet poses the “single biggest health threat” to humanity, claim proponents.
On some fronts, the threat to human health has already reached grim levels.
In early 2021, a group of scientists warned the planet has crossed five “planetary boundaries” — thresholds beyond which the natural functions of nature are fundamentally changed.
“There are nine broad areas that could just take out humans,” said Bruce Lanphear, a public health physician and professor in SFU's Faculty of Health Sciences.
To date, biodiversity loss, greenhouse gas-driven climate change, biogeochemical flow (impacted by heavy fertilizer application), land-system change (think deforestation and desertification), and toxic chemical concentrations (the latest to make the list) have all reached tipping points.
Ocean acidification, the ozone layer, atmospheric aerosol loading, and access to fresh water remain below what scientists consider planetary boundaries.
But Lanphear warns every boundary is interconnected, and when one is crossed, the health of much of the planet's living systems are put at risk.
“We get all caught up on genetics, but what is really driving diseases and death today is environmental triggers,” he said.
B.C. doctors trying to change clinical medicine
In the face of growing environmental threats, some B.C. physicians have already moved to change the way they practice medicine.
In the summer of 2021, wildfire smoke had blanketed Nelson, B.C., for weeks. One of several patients suffering smoke exposure came in to see Dr. Kyle Merritt in his emergency department at Kootenay Lake Hospital. He picked up the patient’s chart and for the first time in his 10-year career penned the diagnosis: “climate change.”
“If we're not looking at the underlying cause, and we're just treating the symptoms, we're just gonna keep falling further and further behind,” he told Glacier Media at the time.
Planetary health also overlaps with what can seem mundane but often end up as profoundly dangerous human social situations. Social isolation, for example, is a leading risk factor for seniors. If an older person is trapped in an overheated apartment or falls down the stairs without anyone around to help them, the results can be fatal, Card said, pointing to hundreds of deaths during the late June 2021 heat dome that scorched British Columbia.
It’s not just seniors that would benefit from better social and mental support. In a study published in January 2022, Card found the heat wave led to a 13 per cent average rise in anxiety over the effects of climate change.
In response to such rising anxieties, physicians like Vancouver-based family doctor Melissa Lem have been instrumental in advancing a Canada-wide health network that empowers health professionals to prescribe time in nature.
A growing body evidence has shown spending time in natural environments such as forests can reduce mental health problems and chronic disease, improve birth outcomes and even help children succeed in life.
That science, along with Lem’s experience during the 2021 heat wave, helped push the doctor to launch PaRx, A Prescription for Nature. It offers practical resources for health-care providers to prescribe nature for a minimum of 20-minute sessions, adding up to at least two hours a week.
“You write it down in an email or on a piece of paper and hand it to them,” she said.
Institutionalizing a new approach to medicine
The latest call to incorporate planetary health into doctors' education seeks to institutionalize past efforts. The doctors coming out of such a medical school, say proponents, would have more tools to help people cope with everything from food insecurity to loneliness and the effects of climate change.
A lot of the preventative medicine the open letter calls for revolves around things people might not want to talk about.
On Vancouver Island, 40 per cent of patients report mental health problems, Card said, and nationally, food insecurity has huge knock-on effects for up to nearly six million Canadians.
“You can prescribe bus passes. Prescribe access to a food bank,” he said. “We need to have referral pathways to fundamentally connect people with things that they need.”
The chances new doctors will see multiple patients with breathing problems from wildfire smoke are only increasing. But some might not realize that almost 8,000 Canadians die premature deaths every year because of polluted skies.
Armed with that knowledge and backed by a system that allows them to quickly refer patients to community supports, a doctor could send patients to seek refuge in an air-conditioned library or even prescribe them a HEPA filter for their home.
“Doctors spend 15 to 20 minutes with patients — at most. They don’t have time to go about this in a roundabout way. They definitely need supports and structures in place,” Card said.
Med students leading the way
While some doctors have pushed to do things differently, the idea of thinking beyond clinical approaches to medicine has already “caught on like wildfire,” among med students, Card says.
Last year, a group of Canadian medical residents released a guide to integrating planetary health into training for family physicians. It recommends doctors empower patients with education and resources to survive extreme weather events, to educate patients on how to adopt low-carbon lifestyles and to help advocate for change in the communities they serve.
“It’s about the most pressing health threats facing Canadians and most people around the world — and that is climate change and the collapse of ecosystems,” said Takaro. “Young doctors are asking for this.”
At the same time, because doctors are so respected, Card says they come to play leadership positions in communities. That puts them in a good position to communicate the local health consequences of water contamination or smoke exposure to regional authorities and policymakers.
Lanphear, for his part, says doctors trained in planetary health would also be better equipped to take up positions on medical advisory boards or public office and guide health-care systems toward preventative measures.
“You don’t just provide a prescription pad,” Card said.
According to a 2021 report from Canadian medical students, the country’s 17 existing medical schools have made some progress integrating planetary health education into their curricula in the last few years.
But Card said medical schools still only offer a few hours of training or a single course. No school curriculum has been built from the ground up incorporating planetary health as part of what Card described as “a revolutionary, 21st-century approach to medicine.”
“There’s a lot of opportunity here,” he added. “The question is, is there enough will among senior doctors and professional bodies?”