The vision
“Medicine is a practice. And it’s not hard for people who were trained as clinicians to see that there’s another practice that they can learn, which is community organizing.”
Pedja Stojicic, instructor at Harvard’s school of public health
The spotlight
As climate impacts intensify, health care professionals are increasingly finding themselves at the front lines. From the perils of extreme heat to the spread of infectious diseases, climate change is a health crisis. Doctors, nurses, and other practitioners are reckoning with this in their day-to-day work — and, increasingly, finding themselves thrust into the broader struggle for climate mitigation and justice. Because of this, they’re also a great test group for understanding what it takes to move someone from resignation to empowerment. It turns out, there’s a blueprint that anyone can follow. And one recent effort with health professionals is showing the way.
In 2022, the Center for Health Equity Education and Advocacy at Cambridge Health Alliance, a Harvard teaching hospital, launched a fellowship to equip health care professionals with community-organizing tools for climate action. In teams of three or four, fellows learned principles of organizing and worked toward climate advocacy projects in their own communities.
Last week, a study was published in Academic Medicine examining the results of the fellowship’s first year (it’s 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 inequities 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 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-directed the fellowship. (We’ve previously covered his efforts to bring climate material to Harvard’s med school curriculum.) At the outset of the fellowship, only 47 percent of the health organizing fellows 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, those numbers jumped above 90 percent, according to the surveys fellows took.
“We really feel like health professionals understand the connections of climate change and air pollution and ecological degradation on health, but they feel really daunted by it. It feels very big and overwhelming,” Basu said. “Education, for me, is a vehicle for supporting individuals to get activated and to see that they actually can really 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 T.H. Chan School of Public Health, trained to be a physician in his home country of Serbia. He also, “out of necessity, got an education in activism,” 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 that and to lead our country toward 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 farmworkers’ union here in the United States,” he said. “Those experiences of learning how to teach something that I was practicing for quite a long time helped me kind of connect the dots. Like, this is not just something that you can do. This is also something that you can potentially pass on to other people.”
Stojicic’s approach to teaching others that transition into advocacy, which he learned from the famed organizer and educator Marshall Ganz, focuses on community building first, and then activating that community toward a specific goal.
The curriculum of the health organizing fellowship followed an arc of five major skills: storytelling, relationship building, team building, strategizing, and taking action. This formal instruction lasted for half the year; the fellows met every month for virtual training sessions with experienced community-organizing coaches, and also participated in three weekend courses. For the next six months, fellows continued to meet with their coaches every month 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 these trainings involves a sort of mindset shift, Stojicic said, for clinicians who are used to being the ones with the answers, literally prescribing the solutions. “Community organizing is teaching us something else. You need to start with people, build relationships with people, and then together ask the question, ‘What is the project that we want to take on collectively?’”
Gabriel Cisneros, a pediatrician in Pittsburgh and a year one fellow, said that he didn’t see himself as an activist or a community organizer before going through this training. “So much of my education has been focused on patient care and protecting kids from illness and prescribing medicines and that sort of thing,” he said. He had long been interested in the environment, and even studied it as an undergrad, but he didn’t see that it had any bearing on his day-to-day work as a doctor — until he received a “wake-up call” in 2020. While he and other health care workers were grappling with the pandemic, a wildfire erupted 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.“That made me go back to my original background in this area and think about, what’s 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 were having those same kinds of experiences and thoughts.”
Cisneros participated in the fellowship 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 fellowship, the group advocated, successfully, for their employer to sign the Health Sector Climate Pledge, committing to reduce their greenhouse gas emissions 50 percent by 2030.
It began with a petition that Cisneros and others circulated among the staff. “Not, like, by spamming the entire system,” he said, “but through personal requests to colleagues that we worked with and we knew would be interested. From that, we grew our membership severalfold. This was timed around Earth Day of 2022, and I think within a week we had almost 300 names — doctors, nurse practitioners, medical students, all different health care professionals. And basically right away we had a positive response that the CEO was supportive of this.”
Since signing the pledge, UPMC has phased out the use of an anesthetic called desflurane, which is also a potent greenhouse gas. Other initiatives include rolling out EV charging stations to encourage greener transportation to and from the hospital sites.
“We’re working on figuring out how we can balance the needs of our patients while not contributing to emissions,” Cisneros said. “It’s a massive undertaking. We’re even still learning all the ways that we as a system contribute to warming.”
In a somewhat similar vein, another capstone project in the first year of the fellowship involved lobbying the American Medical Association to declare climate change a public health crisis — which it did in June of 2022.
Other groups focused more on local initiatives to improve health and equity in their communities — like working with a nonprofit to bolster tree equity in and around Chicago, or helping to map and mitigate flood vulnerability in Milwaukee.
For Cisneros, climate action feels personal. He’s fighting for a liveable 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 that he is afforded as a physician. “When I speak, people listen,” he said. “Other people I feel a little bit bad for — they have to, like, disrupt plays in order to get their message out. And here I’m given opportunities to speak and be listened to. So that’s why I’ve been a part of this and will continue to be.”
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’s not too big a leap to extend that advocacy outside of 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 living with the impacts of a rapidly changing climate. “And when they start to see that, anybody would ask themselves the question: What can we do about it?”
As the study of fellowship participants showed, giving people concrete answers to that question — what can I do, and how — yields productive results, both for people’s attitudes about climate change and for the work they were then able to do in their communities.
But the fellowship also shows something else: Becoming a climate advocate (or an advocate for any social issue) doesn’t mean forsaking all else. For health care professionals, adding advocacy on top of an incredibly demanding job would seem like it could worsen already high rates of burnout — but focusing on building community first allowed the fellows to lean on their teams and step away from the work for periods of time when other priorities demanded their attention. That doesn’t signal a lack of commitment, Stojicic emphasized, but rather it shows a commitment to giving your full self, when you’re able, and a sense of trust in the community that you took care to build.
— Claire Elise Thompson
More exposure
- Read: how a spate of infectious diseases are spreading due to our changing climate (Grist and the AP)
- Read: how emergency doctors in Phoenix dealt with extreme heat this summer (Grist)
- Read: an opinion piece making the case for why more clinicians should get involved in organizing on a number of issues (Visible Magazine)
- Watch: a video exploring how some health professionals are working to better prepare their colleagues and their institutions for climate’s health impacts (PBS NewsHour)
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 looking 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 investigates a pool of standing water — mosquito breeding grounds — flagged in drone imagery.
