Feature Stories


Ana Toepel and Deborah Fleischer, Green Impact, September 2018


Five Reasons to Embed Environmental Health into Medical Education

For the past several years, UCSF has been responding to the growing body of evidence that documents the lifelong role of the environment in shaping our health by working to integrate environmental health into its curriculum for medical students. The UCSF School of Medicine’s Bridges Curriculum , a visionary four-year curriculum launched in 2016, has already incorporated environmental health material into its Life Stages Block and its Core Inquiry Curriculum.

The Environmental Health Initiative (EHI)—a collaborative transdisciplinary network of academics across UCSF committed to solving the growing burden of chronic diseases by identifying and preventing harmful environmental exposures—is spearheading the move to integrate environmental health into the UCSF medical curriculum. According to Annemarie Charlesworth, MA, Associate Director of the EHI, the goal is to embed environmental health in all four years of medical education for all students.

A conversation with Charlesworth generated these five reasons environmental health should be a focus throughout medical school instruction:

  1. Scientific evidence shows that environmental exposures contribute to many chronic health conditions;
  2. Environmental exposures can affect health across the lifespan, from preconception through old age;
  3. There are things people can do to reduce harmful environmental exposures, and health professionals need information, resources, and tools to counsel patients on prevention;
  4. Health professionals can play a critical role in advocating for public policy that protects our environment and prevents harm; and
  5. It is about as upstream as you can get in terms of promoting positive health outcomes.

Environmental Health Needed in Medical Education

An article in San Francisco Medicine from UCSF’s Program for Reproductive Health and the Environment (PRHE) cites the “emerging normalization of environmental health in healthcare delivery and practice.” Due to increased scientific evidence linking adverse health outcomes to ubiquitous exposure to industrial chemicals, and climate change threatening our global survival, health professionals now recognize that human health and environmental health are inextricably connected. In 2015 the leading global voice of reproductive health professionals, the International Federation of Gynecology and Obstetrics (FIGO), came out with policy recommendations that included making environmental health part of health care. Guidelines such as this have spurred health professionals to make efforts toward this end, such as advocating for sustainably produced food in their institutions and in policy arenas and bringing conversations about preventing exposure to pesticides into the exam room.

To advance environmental health research and education across all disciplines at UCSF, Professor Tracey J. Woodruff, Director of UCSF’s PRHE, and UCSF Associate Professor Dianna Laird co-founded the EHI with seed funding from the Department of Obstetrics, Gynecology, and Reproductive Sciences. As noted on the EHI website, research shows that what medical professionals learn in school influences their attitudes and practices throughout their lifetime of work in health care. Thus, in order to have a health care system that values and addresses environmental health, environmental health science must be integrated into the foundation of health professional learning.

Bridges Curriculum Integrates Environmental Health

The UCSF Medical School has already started addressing this need for environmental health instruction by weaving it into two blocks of its Bridges Curriculum for medical students:

  • The Inquiry Block. The Bridges Curriculum contains an Inquiry Immersion Block where students take a deep-dive into specific health issues, and for the last two years environmental health was a key feature in this block. Through collaboration with Dr. Michelle Hermiston, Co-Director of the Core Inquiry Curriculum, this year the course presented an overview of environmental health issues and why they’re important, followed by a case study on environmental exposures and infertility that unfolded over 2 weeks. The case study was based on the Story of Health, co-authored by UCSF Assistant Clinical Professor Dr. Mark Miller, Co-Director of the UCSF Pediatric Environmental Health Specialty Unit (PEHSU).
  • The Life Stages Block. Working in collaboration with Life Stages Co-Director, Dr. Naomi Stotland, UCSF’s PEHSU faculty, and medical students, the EHI is creating interdisciplinary environmental health educational modules that will be incorporated into the Life Stages curriculum, providing medical students with evidence-based, clinically relevant environmental health information across their patients’ lifespans. The aim is to help students understand the science, so they will be able to recognize the environmental drivers of health and make recommendations to patients for prevention. This year the material will be presented as a part of reproductive and pediatric health topics.

In addition to the Bridges curriculum, since 2015, Dr. Robert Gould, Associate Adjunct Professor in the Department of OBGYN & Reproductive Sciences, has been the course director for the popular elective course Women’s Health, the Environment, and Health Professional Activism. 

Moving forward, the plan is to create modules that integrate environmental health into all of the life stages in the block, and, ultimately, to incorporate environmental health into other curricular areas, such as organ systems, community health, epigenetics, and clinical assessments. In June, Charlesworth and Patrice Sutton, MPH, Research Scientist, presented a proposal to the UCSF Medical Student Education Mapping and Integration Committee to add a topic steward for environmental health to the Committee, as an important step towards achieving this goal. Charlesworth expressed that “the long-term goal is to roll out environmental health education in all four UCSF schools—and generally to integrate more sustainability issues, including climate health, into UCSF’s education of the next generation of health professionals.”

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