A pilot program wants to make it easier for NH doctors to talk about climate change
Blakso grew up in New England’s outdoors, spending summers in the White Mountains, or swimming in Newfound lake. She wants to raise her two kids the same way.
But as a climate activist, Blasko worries about how to protect them. So much has changed since she was a child – summers are hotter than they used to be, and there are more days over 90 degrees.
“I feel like I am constantly kind of assessing what I can do to help keep them safe, considering all of the things that they face,” she said.
Her concerns are backed by a growing body of research suggesting kids are uniquely vulnerable to the impacts of climate change.
Experts say they are more likely to develop lung diseases like asthma because of air pollution. In high heat, their small bodies can’t cool off as well, putting them at risk for heat illness. Kids spend more time outside, putting them at a greater risk for insect and tick diseases, which are spreading more as seasons warm.
That weighs on Tricia Lavoie, from Greenfield, Mass., almost daily as she considers ways to protect her two year old daughter from the effects of climate change.
“I think about things like insect borne illnesses, ticks, mosquitos,” she said. “What’s a safe way to protect her from that…short of not going out of the house?”
Like Blakso, Lavoie considers herself climate aware. She’s a social worker, and familiar with climate anxiety. But when it comes to the physical impacts of climate change, she wants guidance – and knows other parents might need it too.
“I’m not sure that our healthcare system is talking about this,” she said. “I’m not sure that parents who maybe are concerned, and are thinking about this, have access to the same information.”
At Dartmouth Hitchcock Medical Center in Lebanon, Dr. Cheryl Anderson is working with a team of New Hampshire doctors to support parents like Lavoie and Blasko.
For the last year, they’ve been working on a pilot project to integrate climate change into patient care. Anderson and her team developed training and resources to help providers talk about five local climate concerns: air quality, extreme heat, extreme weather, ticks and mosquitos, and mental health.
Anderson says it makes sense for doctors to have these conversations, because to some extent, they’re already happening. She often provides guidance to patients about how the environment impacts their health, like when it comes to heat or sun safety.
“That’s something we talk about all the time,” she said. “I think it’s just reframing it in light of the way the climate is changing and knowing that these things are going to become more frequent.”
The American Academy of Pediatrics recommends pediatricians talk with patients about climate concerns, but for some doctors, the idea is daunting.
At the start of the pilot, over half of providers surveyed said they didn’t feel confident speaking about climate change. Some of them worried about patient politics, or having the right information.
Anderson said almost everyone cited the length of patient visits as a challenge.
“Our average visit for a pediatric office visit is about 20 minutes,” she said. “There’s a whole list of routine anticipatory guidance that we’re supposed to be going through during that visit.”
Pediatricians have to cover a lot of ground: administer vaccines, conduct a physical exam and address parent questions.
To work around that, Anderson says her team came up with what she calls “smart phrases,” a few words a provider can use to make the climate-health connection such as: “poor air quality can worsen your child’s asthma or allergies” or “avoid exercising during the hottest part of the day.”
In addition to booklets and posters in doctor’s offices, some practices also added a question to pre-appointment screeners, asking parents if they would like to learn more about climate change.
“I think it kind of puts the ball in the patient’s court of, is this something you want to hear more about, is this something it’s okay to talk about in the room,” Anderson said.
The pilot project is set to end in September. Until then, Anderson and her team will interview pediatricians who participated, and analyze the data they’ve gathered.
Maria Finnegan, a spokesperson with NH Healthcare Workers for Climate Action, said she hopes projects like Anderson’s will help meet an information gap she sees in her advocacy work.
“There’s like a have and have not population and that that has nothing to do with money or wealth – it’s information,” she said. “It’s people who know about this and people who don’t, and there is such a divide.”
In the future, its findings might help inform pediatric care beyond the Dartmouth network, or how Anderson educates medical students.
The Geisel School of Medicine doesn’t yet have an established curriculum around climate change, but Anderson says there is a growing momentum to create one.
Right now, about half of medical schools around the country consider climate change in physician education. Across the state border, Harvard Medical School just completed its first year as one of them.
Madeline Kline, a fifth year student in a dual-degree program with the medical school and the School of Public Health, helped push to include climate change education in her school’s curriculum.
Kline said that the impacts of climate change are directly related to the physiology students are learning, like in the case of air pollution.
“Understanding how different sized particles travel through the lungs is a principle that’s important in medication,” she said. ”We can also learn about that through learning how different air pollution particles affect the lung in different ways.”
Early analysis of the new curriculum suggests positive results, with 80% of the student body reporting it helped increase their understanding of how climate change can impact health.
Kline is an aspiring epidemiologist, and says the knowledge felt critical to her education as part of the next generation of doctors.
She hopes that with more climate education, students entering the field will feel empowered to address climate change through clinical work and advocacy.
“I think that being able to recognize and identify those issues allows you to then be able to intervene,” she said.
Published August 8, 2024