Bioethics Forum Essay
Are We Ready to Treat a World on Fire? Climate Literacy in Medical Education
What does it mean to become a physician in a world defined by climate change? I started asking myself this question not in a lecture hall, but on a small island off the coast of Africa. Before beginning medical school last year, I spent my gap year teaching English in the Canary Islands, a place of extraordinary biogeodiversity and rich culture. But for certain periods throughout the year, when the sky turned orange and the air thickened, the environment I had come to love left its mark on the health of people around me.
When I entered medical school, I was eager to study how environmental conditions affect disease. But it soon became clear that this critical component remained inadequately integrated into U.S. medical education. In a 2020 survey of medical students, 83.9% believed that the effects of climate change belonged in the core medical school curriculum, while just 13.0% reported receiving adequate climate health education. This gap forces our generation to question the future of patient care: Will we be adequately trained to recognize environmentally mediated illnesses and ask the right questions when patients face wildfire smoke, agricultural pollutants, extreme heat, or particulate matter? Will we recognize how these exposures interact with health and disease and disproportionately affect vulnerable communities?
Formal medical education shapes the questions we are taught to ask, the risk factors we learn to recognize, and the patient experiences we are trained to consider relevant. If environmental exposures are increasingly influencing patterns of disease, then environmental health can no longer remain a peripheral component of medical training. This integration is especially important as medicine pursues innovative therapies and preventive strategies targeting environmentally mediated illnesses.
Emerging research exploring biological pathways, therapeutic targets, and public health interventions to mitigate damage from particulate matter exposure and chronic airway inflammation could prove transformative for firefighters, agricultural workers, and communities living near recurrent wildfires. Meaningful scientific innovation, however, requires a medical curriculum that provides a foundational understanding of the biological, environmental, and societal forces underpinning disease. By limiting environmental health literacy within medical training, we are curtailing future clinicians’ ability to critically evaluate these conditions, develop effective treatments, and pursue innovative therapeutic strategies.
This training gap clashes with reality as patients affected by environmental exposures are already walking into clinics every day: farm workers laboring through wildfire smoke, children breathing polluted air in under-resourced neighborhoods, elderly patients facing extreme heat. These patients’ care will soon fall under the responsibility of my generation. Without adequate environmental health literacy, we will miss environmental etiologies driving chronic disease and remain ill-equipped to counsel patients on mitigating ongoing health risks.
This inability to properly care for patients transforms an educational gap into an ethical compromise: a failure of beneficence when we cannot offer our patients comprehensive care, of nonmaleficence when our blind spots allow preventable harm to become their burden, and of justice when those burdens fall heaviest on those with the fewest resources to absorb them. So long as medical education leaves these blind spots unaddressed, the health of our patients will suffer. The ethical obligations medicine has always claimed — to heal, to do no harm, to serve equitably — cannot be fully honored by physicians who are unable to recognize the environmental forces shaping their patients’ lives.
The path forward does not require reinventing the wheel; we just need to add a spoke. Environmental health literacy can be woven into existing classes through case-based discussions that situate clinical presentations within their environmental contexts, expert voices from environmental medicine and public health, and the integration of environmental history-taking into clinical training. These interventions are practical, achievable, and, frankly, long overdue.
Supported by faculty mentors and fellow students, I am currently developing an environmental health elective at Weill Cornell for third- and fourth-year medical students. The course aims to equip students to recognize how exposures to pollutants, toxins, and climate-related hazards manifest on the wards. Through clinical scenario analysis and collaboration with environmental health specialists, students will learn to answer patients’ questions about climate change and health, to take meaningful environmental histories, and to incorporate that lens into everyday clinical reasoning. Establishing this elective is a vital step toward fulfilling the ethical responsibilities my classmates and I accepted when we entered medical school. Other medical schools have begun integrating climate and environmental health into their curricula, as well.
Meaningful change in medicine rarely arrives fully formed. It is built, incrementally, by students, educators, researchers, and advocates willing to ask whether the medicine we are learning is truly prepared to serve the world we are inheriting.
Benjamin Persons is a medical student at Weill Cornell Medicine. LinkedIn: Benjamin Persons
Author’s Acknowledgement: I am deeply grateful to Inmaculada de Melo-Martín, a Professor of Medical Ethics at Weill Cornell Medicine and a Hastings Center Fellow, whose continued mentorship and encouragement made this essay possible. Her guidance and expertise in navigating the ethical dimensions of environmental health education and medicine’s role in addressing climate-related health challenges have been invaluable. I am also grateful to Dr. de Melo-Martín and the entire Weill Cornell Division of Medical Ethics for fostering an intellectual home where conversations on patient-centered ethics and environmental health continue to shape how I think about medicine’s role in addressing the health challenges of climate change.
