The impact of climate change on human health and well-being is complex. For example, direct effects are related to extreme weather and the increasing frequency and severity of heat waves, droughts, storms, floods, and rising sea levels, which are a threat to coastal cities and island nations, specifically. Floods and storms can result in traumatic injury, drowning, and spread of vector-borne and water-borne infectious disease (Intergovernmental Panel on Climate Change [IPCC], 2014). Health impacts related to rising temperatures may also lead to heat stroke, heat stress, and death, particularly in those with preexisting health conditions, as well as an increase in cardiovascular, respiratory, and kidney-related events.
Health professionals have a key role in addressing the health impacts of climate change at several levels: direct patient care, client and community education, health professions education, and advocacy and health policy development. To this end, Watts et al. (2017) and Watts et al. (2018) argued that health professionals have a responsibility to be public health advocates and communicate not only the threats but also the opportunities related to climate change to both the public and to policy makers. However, this requires an awareness and understanding of what these impacts are and the effects on health and well-being. It is unclear to what extent practicing clinicians are aware of the relationship between health and well-being related to the effects of climate change.
Recognizing that nurses are first line in health education, nursing faculty at the MGH Institute of Health Professions developed the first nurse-led Center for Climate Change, Climate Justice and Health (CCCCJH). This article describes the impetus for developing the Center, priorities and challenges, and our plan for curriculum integration of climate change knowledge topics.
Evidence that human activities have contributed significantly to climate change is unequivocal, and the levels of global greenhouse gas emissions are the highest in history and are continuing to rise (IPCC, 2014). This has led to global warming of 1°C above preindustrial levels. What is most concerning is that this increase in global warming is projected to reach 1.5°C between 2030 and 2052 if the rate of increase remains the same (IPCC, 2018). The delayed response to climate change over the past 25 years has affected human health and well-being and is creating new risks and is exacerbating existing vulnerabilities within communities that threaten human health and well-being, safety, quality of life, and economic growth (U.S. Global Change Research Program, 2018; Watts et al., 2018). Although illness and death from extreme heat are preventable, extreme heat causes more deaths than any other weather-related hazard (Center for Climate and Energy Solutions, 2017).
In addition to the direct effects of climate change on health, ecosystem-mediated impacts of climate change result in a wider distribution and increased burden of vector-borne and water-borne infectious diseases, as well as health sequelae related to poor air quality and allergic disease (IPCC, 2014). Health impacts mediated through human institutions include undernutrition or malnutrition resulting from altered agricultural production, occupational health risks and job loss in outdoor laborers from extreme heat, poor mental health related to extreme weather and disasters, and health impacts related to violent conflict, displacement, and migration that may occur as consequences of climate change (IPCC, 2014)
Shea, Knowlton, and Shaman (2018) argued that for climate and health to be integrated into governance and policy making, climate and health education must be included in all health professions schools globally. Moreover, the U.S. health care system is responsible for approximately 10% of U.S. greenhouse gas emissions (U.S. Global Change Research Program, 2018). A health care workforce that is knowledgeable about the health sequelae related to climate change and the impact on the health care industry may lead to increased environmental sustainability efforts in the clinical, governance, and policy arenas.
Despite the recognition of the important role of health professionals in addressing climate change, there has been no formalized integration into health professions curricula. However, there is a growing interest in advancing these efforts (Leffers, McDermott-Levy, Nicholas, & Sweeney, 2017; Maxwell & Blashki, 2016; McDermott-Levy, Jackman-Murphy, Leffers, & Jordan, 2019; Wellbery et al., 2018). A growing body of literature urges that medical education (Maxwell & Blashki, 2016; Wellbery et al., 2018) and nursing education (Leffers et al., 2017; McDermott-Levy et al., 2019) advance efforts to infuse climate change across curricula.
Nurses play a key role in identifying, intervening, and advocating to improve the health of individuals, communities, and populations impacted by climate change. Recent calls to action have urged that health professionals engage in dialogue and action (Kreslake, Sarfaty, Roser-Renouf, Leiserowitz, & Maibach, 2017; Mercer, 2019; Nicholas & Breakey, 2017). Nurse educators should integrate knowledge regarding the health impacts of climate change in health professions curricula (Global Consortium on Climate and Health Education, n.d.; Leffers et al., 2017).
Development of the CCCCJH
Two nurse scholars within the MGH Institute of Health have focused their work on matters related to climate change, climate justice, and health. However, eight other faculty expressed interest in joining these efforts by forming a steering committee to develop the Center. These nursing faculty offer a variety of perspectives and clinical backgrounds to enrich the Center's efforts. A few are scholars in the areas of global health or public health, but others are simply concerned for the planet and recognize that nurses should play key roles in recognizing the impact of climate change on health. Further, all members of the Center steering committee are fully engaged in a commitment to educate health professionals and the public about the impacts of climate change.
The steering committee began its work by inviting climate scientists in the Boston area to attend a luncheon meeting to discuss the formation of a nurse-led center. These scientists educated the committee and expressed their support for the formation of a center whose primary focus would be on increasing awareness among health professionals and educating them to identify, treat, and prevent health impacts of climate change in their patients and the public.
This meeting, along with an extensive review of the literature and formal and informal needs assessments among local nurses, helped us formulate our mission, core values, and strategic priorities. The name we chose, the Center for Climate Change, Climate Justice and Health, fits these priorities. The mission of the CCCCJH is to lead nurses and other health care professionals in responding to the impact of climate change, climate justice, and health through education, research, and advocacy. Our website and logo identify us as a center within the School of Nursing; however, the CCCCJH serves the entire MGH Institute of Health.
Members of the CCCCJH steering committee began to reach out to climate change experts, legislators, and others who may be interested in developing partnerships. Legislators frequently want to hear from nurses about issues pertaining to health care, so we have taken advantage of these opportunities to communicate the goals of the CCCCJH. Many of the organizations with which we are partnering do not otherwise have nurses at the table, and as a result support adding our voices. We enlisted individuals and organizations in becoming associate and affiliate members of the CCCCJH and launched an electronic newsletter to keep these members apprised of our work. Among our associate members is Renee Salas, MD, MPH, MS, one of the lead authors of the recently released 2018 Lancet Countdown on Health and Climate Change Brief for the United States of America (Salas, Knappenberger, & Hess; 2018), Gina McCarthy, MS, BA, Professor of Public Health Practice and Director of the Harvard School of Public Health Center for Global Health and the Environment (C-CHANGE) is a strong support of the work of the CCCCJH and a keynote speaker at a recent symposium. The launch of the Center was highlighted at a recent American Academy of Nursing meeting with presentations by CCCCJH steering committee members, along with John Balbus, MD, MPH, from the National Institute of Environmental Health Sciences, and Elizabeth Schenk, PhD, RN, FAAN, a key leader in climate, sustainability, and health efforts.
The CCCCJH offered its first continuing education program and its first annual symposium to focus on key issues specific to health professionals and climate change. It is critical that current and future nurses who provide care in our climate-changing environment receive education to offer competence in nursing practice to support knowledge and skill acquisition. Further, nursing education has a critical responsibility to infuse climate and health knowledge across all levels of curricula from baccalaureate through doctoral levels of education (Leffers et al., 2017).
The steering committee is working with our faculty to integrate climate change and climate justice knowledge and scientific literature into our curricula at all levels and to develop credit-bearing courses for health professionals. Our current faculty scholars and visiting scholars will help the Center grow by adding to the scholarship related to climate change and giving voice to the concerns and issues that pertain to patient care. Future grant funding and funded research will help support the Center to become self-sustaining and advance our work. Several physicians who have expressed an interest in developing partnerships have already joined us in our work. As we grow, we plan to add other health professionals to our steering committee so that our work is truly holistic and serves the needs of all health professionals.
A critical area for future efforts is galvanizing our nursing communities locally, regionally, nationally, and internationally to educate nurses across all levels of academic and professional nursing education. This will advance key efforts in developing and implementing climate change knowledge in nursing education and incorporate the most current content.
Recently, the dean appointed a director of the CCCCJH who will lead us as we take the action steps delineated in our strategic plan. Initially, she will receive a stipend for this work, but eventually the work will become part of her faculty workload. One staff member allots 10% of her time to supporting the CCCCJH.
There have been challenges to developing the Center, primarily related to funding and sustainability. The steering committee developed a 3-year work plan to delineate our strategic priorities and the need for funding to accomplish them. As a member of the committee, the dean has been supportive of this work and is providing seed money for research and funding to hire consultants to help us with curriculum integration. The MGH Institute of Health Professions recognizes the need for this important work and is providing some support with the expectation that the CCCCJH will shortly become self-sustaining.
Other challenges include time, because the steering committee members have accomplished the work related to development and launch of the CCCCJH. In addition, our CCCCJH efforts are groundbreaking in focusing primarily on nurses, because there is a scarcity of scholarly literature on the roles of nurses in climate change. Physicians, climate scientists, and other health professionals have been supportive of our work and eager to affiliate with us, and we anticipate opportunities for further collaboration as we move forward as a nurse-led center.
Plans for Curriculum Integration
In our climate-changing world, the impact of climate change on health must be integrated in curricula, research and scholarship, clinical practice, and health policy. It is essential that nurse educators infuse climate change content and knowledge regarding the related deleterious health consequences in all aspects of curricula. Curriculum integration of content related to climate change and the associated health consequences is a key area for further development of the CCCCJH's initiatives. Collaboration among nurse educators across settings exists through key organizations including the American Public Health Association, the Alliance of Nurses for Healthy Environments, and the Nursing Collaborative on Climate Change and Health. These collaborations offer opportunities for sharing our model in addressing climate change in nursing education and enhancing collaboration of nurse educators across settings and regions.
Leffers et al. (2017) emphasized the importance of integrating climate change knowledge into nursing education so that the critical knowledge, skills, and application to clinical practice are evident for nursing students in future clinical practice. The complex challenges of climate change and the subsequent health impacts require integration of climate change mitigation, adaptation, and resilience strategies.
To accomplish this critical goal, the Ecological Planetary Health Model (Figure 1; McDermott-Levy et al., 2019) offers a framework for infusion of climate change education into nursing and health professions education. Within the model, levels of integration of climate change knowledge occur at the individual, family, community, regional, national, international, and Earth level while considering mitigation, adaptation, and resilience efforts related to health consequences of climate change. The Ecological Planetary Health Model highlights the interrelationships and levels of influence that nurses have on behaviors and actions to address climate change and health (Leffers et al., 2017; McDermott-Levy et al., 2019).
The ecological planetary health model. From “Mandate For the Nursing Profession to Address Climate Change Through Nursing Education,” by J. Leffers, R. McDermott-Levy, P.K. Nicholas, and C.F. Sweeney, 2017, Journal of Nursing Scholarship, 49, p. 683. Copyright 2017 by Ruth McDermott-Levy. Reprinted with permission.
Unique differences exist for preprofessional, graduate, and professional development education regarding climate change and associated health consequences. Comprehensive curricular goals, objectives, and infusion across courses and programs are key outcomes. In the Climate Change Recommendations for Nursing Education (Leffers et al., 2017; McDermott-Levy et al., 2019), the authors noted 10 recommendations related to applying the ecological planetary health model (Table 1). These include integrating climate change education and impacts across all levels of education, from preprofessional to continuing professional development; integrating social determinants of health and life span issues; addressing the issues of children as vulnerable populations; focusing on climate vulnerabilities; and integrating the roles of policy and advocacy.
Nurses are in the ideal positions and roles to educate the public about the health impact of climate change, to mitigate the impact, and to engage in resilience efforts. As expert health educators, nurses must lead the way to increase awareness among our health professions colleagues and students. Nurses and other health professionals should learn how to assess patients for changes related to the effects of climate change that include heat extremes, weather-related disasters, air pollution, vector-borne illnesses, climate-related migration, and food and water insecurity.
A key area to consider in nursing education is addressing curriculum integration in educational settings with fewer resources and support for faculty, leadership, and the community. A variety of climate health tool kits exist that are aimed at disseminating knowledge that can be included in nursing curricula. The Alliance of Nurses for Healthy Environments (2018) has developed a nursing-specific Climate and Health Toolkit that offers comprehensive educational materials that nursing faculty can utilize for curriculum integration.
Recruiting non-nurse health professionals to participate in a nurse-led center may offer opportunities for other health professionals who are committed to climate action and education. However, the CCCCJH steering committee is confident that our successes will engage others in this important work. Our highly successful continuing education program, symposium, and media visibility put the CCCCJH in the forefront of our academic institution. It is a key point of pride. The CCCCJH, the first nurse-led center with a focus on educating health professionals on topics related to climate change, is a critical step toward highlighting the importance of nurse involvement in current and future efforts to reduce its negative consequences.
- Alliance of Nurses for Healthy Environments. (2018). Climate and health toolkit. Retrieved from https://climateandhealthtoolkit.org/
- Center for Climate and Energy Solutions. (2017). Resilience strategies for extreme heat. Retrieved from https://www.c2es.org/site/assets/uploads/2017/11/resilience-strategies-for-extreme-heat.pdf
- Global Consortium on Climate and Health Education. (n.d.). Global Consortium on Climate and Health Education core climate competencies for health professionals. Retrieved from https://www.mailman.columbia.edu/research/global-consortium-climate-and-health-education/courses-resources
- Intergovernmental Panel on Climate Change. (2014). Climate change 2014: Synthesis report. Contribution of the working groups I, II and III to the fifth assessment report of the intergovernmental panel on climate change. Geneva, Switzerland: Author.
- Intergovernmental Panel on Climate Change. (2018). Summary for policy-makers. In Global warming of 1.5°C (pp. 3–26). Geneva, Switzerland: World Meteorological Organization.
- Kreslake, J.M., Sarfaty, M., Roser-Renouf, C., Leiserowitz, A.A. & Maibach, E.W. (2017). The critical roles of health professionals in climate change prevention and preparedness. American Journal of Public Health, 108(Suppl. 2), S68–S69. doi:10.2105/AJPH.2017.304044 [CrossRef]
- Leffers, J., McDermott-Levy, R., Nicholas, P.K. & Sweeney, C.F. (2017). Mandate for the nursing profession to address climate change through nursing education. Journal of Nursing Scholarship, 49, 679–687. doi:10.1111/jnu.12331 [CrossRef]
- Maxwell, J. & Blashki, G. (2016). Teaching about climate change in medical education: An opportunity. Journal of Public Health Research, 5, 673. doi:10.4081/jphr.2016.673 [CrossRef]
- McDermott-Levy, R., Jackman-Murphy, K.P., Leffers, J.M. & Jordan, L. (2019). Integrating climate change into nursing curricula. Nurse Educator, 44, 43–47. doi:10.1097/NNE.0000000000000525 [CrossRef]
- Mercer, C. (2019). Medical students call for more education on climate change. Canadian Medical Association Journal, 191, E291–E292 doi:10.1503/cmaj.109-5717 [CrossRef]
- Nicholas, P.K. & Breakey, S. (2017). Climate change, climate justice, and environmental health: Implications for the nursing profession. Journal of Nursing Scholarship, 49, 606–616. doi:10.1111/jnu.12326 [CrossRef]
- Salas, R.N., Knappenberger, P. & Hess, J. (2018). 2018 Lancet Countdown on health and climate change brief for the United States of America. London, United Kingdom: Lancet Countdown.
- Shea, B., Knowlton, K. & Shaman, J. (2018). The need for informed climate-health governance. International Journal of Health Governance, 23, 196–204. doi:10.1108/IJHG-01-2018-0001 [CrossRef]
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- Watts, N., Adger, W.N., Ayeb-Karlsson, S., Bai, Y., Byass, P., Campbell-Lendrum, D & Costello, A. (2017). The Lancet Countdown: Tracking progress on health and climate change. Lancet, 389, 1151–1164. doi:10.1016/S0140-6736(16)32124-9 [CrossRef]
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- Wellbery, C., Sheffield, P., Timmireddy, K., Sarfaty, M., Teherani, A. & Fallar, R. (2018). It's time for medical schools to introduce climate change into their curricula. Academic Medicine, 93, 1774–1777. doi:10.1097/ACM.0000000000002368 [CrossRef]
Climate Change Recommendations for Nursing Education (Leffers, McDermott-Levy, Nicholas, & Sweeney, 2017)
Employ an ecological perspective built from the ecological planetary health model for nursing to ensure the interactive nature of human actions upon global impacts, as well as global effects upon individual human impacts.
Integrate climate change impacts and responses into preprofessional nursing education, graduate-level nursing education, and professional development programs for nurses in practice.
Include both life span and social determinants of health approaches to identify individuals and populations most vulnerable to climate impacts.
Content for the care of children should be specific to the particular vulnerability of children to climate disasters, food and water insecurity, air pollution, vector-borne diseases, diarrheal diseases, and malnutrition.
Include climate vulnerability related to the care of pregnant women and children. In particular, pregnant women are more vulnerable to excess heat events and inhalation of particulate matter that can result in adverse birth outcomes.
Integrate into the care of adults content that addresses the increased vulnerability of various occupational groups and people living with disabilities. Additionally, the impacts of climate change upon those with preexisting chronic conditions must be considered.
Include increased vulnerability to extreme heat events, climate disasters, poor air quality, and waterborne and vector-borne diseases into the care of older adults.
Consider the social factors that contribute to vulnerability for adverse health outcomes from the impact of climate change. Social determinants such as income, education, transportation, neighborhood, housing, language proficiency, social isolation, marginalization, and other social stressors that impact health outcomes must be considered.
Include content regarding the policy and advocacy role of nurses to address health hazards in the environment and to develop policy to reduce climate change health risks through mitigation, adaptation, and resilience.
Integrate the climate change strategies of mitigation, adaptation, and resilience into all content areas for education and practice. This includes efforts to take personal and professional action for mitigation, to prepare for disaster and emergency response, and to work for climate justice to build global resilience.