Okay, hello out there in TV land. I'm going to start just making some noise with the hopes that the noise that I'm making will settle down some of the more outspoken members of our audience. And while waiting for people to arrive, I know that's right after lunch, so it'll take a little bit of time for them to get going. But I think what we will get going, I'm just going to introduce the topic before we get into the first real lecture, so hopefully people will continue to trickle in during that time. So, you know, those of us up here on the stage thought, geez, you know, we have a big E in our name, and what's the biggest health threat facing humanity right now? It turns out to be climate change is going to be driving a lot of stuff. So we felt it really important to begin thinking about the role of occupational medicine physicians, not only in learning about the stuff themselves and applying that in our work in occupational health, but also as teachers, teachers to learners at all levels, including practicing physicians in other specialties. So that's what this talk is going to be about. Let's see. Interesting, it changes up there, but not on my screen. It's weird. So what we hope to accomplish, then, is to give you some resources that you can access and methods available for teaching health professionals at all levels about how to incorporate climate-related health issues into their professional work. We also are hopefully going to further engage you in ACOM efforts to teach our own membership about their role in addressing the occupational and environmental health effects of climate change. Now, I'm going to see if I do it on the — does that do anything? No, it still doesn't do anything. What if I touch it? Anyway, weird, very strange. If I touch my screen, it moves, so that's good. So no one has any disclosures. It's a weird kind of thing, which I don't know why. The clicker is doing — sometimes it does it here, and sometimes it's not doing it there. I don't know if you can help fix that problem that may continue to be annoying. Don't do both. Just use the clicker only. I was, and it wasn't — Oh, I see. I'm sorry. You're trying to advance. This is the future of OEN in technology. There you go. Oh, that's mine. That's mine. This is you, right? No, no. It's this one, right? No, McClellan. Gotcha. Does everybody have a nice lunch? Great. Thank you. Thank you. I don't know what that was all about. Okay. So anyway, so for this first part, I am going to be speaking as well as Dr. Fagan, and I'm a professor emeritus at the Geisel School of Medicine at Dartmouth. I teach for a couple of decades a course in the MPH program on environmental health sciences and policy. And two years ago, I launched a course on climate and health, and I'm a past president of ACOM. And Dr. Fagan has practiced OEM for at least as many years as I have in Cleveland, Ohio, and then went to OSHA, as many of you may know, where she was a medical officer from 2009 to 2019. Presently, she's the director of the Department of Health and Human Services. In 2019, presently, she's doing some consulting, some teaching. She's an adjunct assistant professor in the Department of Bioethics at Case Western Reserve School of Medicine in Cleveland. And she's also served as the chair of the environmental health section for a number of years, for a while anyway, helping to try to keep us all in line. So I told you this. First two objectives. The third objective is really your choice. So what we're going to try to do is to try to make this as engaging as possible, as opposed to sit there. So we're going to have a breakout at the end, and we're going to have, we have four speakers here. We may be able to do this in one or maybe two breakouts, depending on how many more people come, to talk about really how you go about doing this and getting your experience and sharing so it's a teach-all, learn-all kind of experience. So, that said, I'm going to turn it back over to you, Kathy, and I think it should all work. So you push. That one. Okay. Hi. Thank you. I'm going to give you a timer. Okay, good. Yeah, you can nudge me if you need to. Again, I have no disclosures. So, you know, I learned about climate change back in 1980 when I was doing my MPH at UIC, and it was kind of a warning back then. Well, it's not so much a warning anymore, right? It's here. Our kids are learning it in grade school. They're learning it in high school, college. When I talk to MPH students and med students, they really know the basics, which is good. And it's actually climate and health education is everywhere now. You know, Bob talked to me about doing this last winter, and I thought, oh, yeah, it's a nice idea, and then all of a sudden I'm seeing it everywhere. So this was a summit in Cleveland in March, and it brought together people from all disciplines and from not just Cleveland, but also nearby Pittsburgh and Toledo. We talked about things, you know, not just clinical stuff, but things as broad as algae blooms in Lake Erie and tiny forests and greening the ORs. We had surgery residents presenting research papers on decreasing plastics and one-time use materials in the ORs. These were surgery residents. Oh, my gosh. Okay, so also that same month in March, the World Health Organization came out, launched this really nice piece, which Dr. Berenji may talk about, but we have in our resources, and they launched it. The keynote speaker was Arnold Schwarzenegger, and you can go and watch that. It was really interesting. And then in April, which was during National Public Health Month, which was also, I've got to read it, Worldwide Climate and Justice Education Week. There were probably lots of things. This happened to be one conference. I'm also happy to report that ACOM rejoined the Medical Society Consortium on Climate and Health, which is a group of over 100 partners in medical societies trying to speak with one voice. If you go to PubMed, you can feel, oh, pay shoes first. Pay shoes. So who knows what pay shoes are? Pediatric Environmental Health Specialty Units. Okay, we all need to know what these are. I'll talk to you a little more about them later, but they're medical experts around the country on pediatric environmental health. And then if you go to the literature, there's hundreds, thousands of articles on climate health and education. This was from Case Western Reserve School of Nursing on putting climate health into their curriculum. So I'm going to give you my experience. First time teaching on climate and health at Case Western Reserve School of Medicine in the bioethics department last fall. I joined with a professor there, Dr. Monica Garrick, who knows the ethics part because, you know, I don't know a lot of it. But we thought, and they'd never had a course in occupational and environmental health bioethics. And this was not just climate. It was really, we thought we'd just do it all. But we made it a small course because we were just starting out. And we met once a week in the fall. And we had seven students, so it was a really small course. And there were five master's in bioethics students who took the course, one PhD bioethics students, and one nursing student. So we had seven students. You can see what the objectives were. So, you know, what do we talk about, you know, once a week for 15 weeks? Well, we had lots of ideas. But we went to the students and asked them what they wanted to learn, too. So we kind of combined that with things that we thought we wanted to teach. And this is some of the topics. We kind of weaved environmental justice throughout the sessions. They were very interested in ag workers. So we had a session on climate change and agricultural workers, heat exposure, wildfires, air pollution, pesticides. And one of the things that struck them as ironic was that the workers who give us our food are generally low paid, may live in food deserts, and we talked about that. When we talked about air pollution, we brought in an activist from the Cleveland area who helped a community keep a coal-fired power plant out of their neighborhood and talked about that whole process and what the discussions were back and forth with the community. We talked about do animals have rights? You know, do sentient living things have rights? And then, well, what about trees and rivers and oceans, non-sentient parts of nature? Do they have rights? I told them the story of silica, which you all know, and environmental justice, starting in the Depression with the Hawks Nest Tunnel workers in Gauley, West Virginia, over 700 of whom died of acute and accelerated silicosis, and 75% of them were black. Up to the present, where we have countertop workers dying of acute silicosis who are primarily immigrant workers. We talked about on-site workplace clinics and the ethical challenges for the on-site workplace staff who may have dual, confronting dual loyalties, may not have adequate supervision or adequate policies and procedures in place to provide good medical care. Reproductive and children's health, we covered stuff there. We brought in someone, a resident from East Palestine, invited them to talk about the train derailment and how that affected their community and her own family. So, lots of stuff. Here's some of the examples of some of the ethical issues we grappled with. So, in 2019 in Toledo, the city of Toledo voted a Lake Erie Bill of Rights, saying that Lake Erie should have the right to exist, flourish, and evolve naturally. And, of course, this allowed then citizens to bring suits against companies that might pollute, that might be polluting Lake Erie. Well, then those same companies went to a federal judge and got them to overturn, got that judge to overturn the Bill of Rights, saying that it was, you know, really outside Toledo's municipal jurisdiction to do this and it was too vague. But, the fight's still going on. And, this is part of a big, a lot of art that's going on in Cleveland around environmental health and nature. And, this is a really big, big, big, big neon sign that's on the science museum on the lake, looking out at the lake. We also, when we talked about reproductive rights, we told them about the Johnson Controls story back in 1990, where UAW brought suit against this battery company because they were barring women from working in lead jobs, which were the higher paying jobs, unless they were sterilized. And, we talked about the issues around women workers' rights and fetuses' rights and unborn children's rights and, you know, considered the principles of bioethics, justice, non-maleficence, beneficence, and what am I forgetting? One more. What am I forgetting? One more. Anyway, we did that. And, let's see. Then, we talked about population, you know. Should there be voluntary or mandatory population control, you know, to address the problems our planet is experiencing? You know, is that ethical or not? That was a really interesting discussion. Here is a sample of the text and the readings we did. So, we used this text by David Resnick, who is a bioethicist at NIEHS. He wrote this in 2012. It's a little old, but it's really nice and well-written and really, you know, hits the major issues. And so, it was a nice text for us to use. We then had every student read Braiding Sweetgrass. So, who's read Braiding Sweetgrass? Okay. So, Braiding Sweetgrass is written by Robin Wall Kimmerer. Now, I'm going to just check my notes. She is a plant, she's a Ph.D. plant biologist. And, there she is. And, she's also a plant ecologist and a member of the Potawatomi Nation. She's a gifted author. It's an incredibly great book to read, really interesting. So, she weaves Native American values with the science of climate change and planetary health and challenges our relationship to our world. We also had a lot of other readings in both peer review and gray literature. And then, we had students, students had projects and papers and things like that. So, one of them was, whose park is it anyway? So, one of the students looked at the park by his house, which is part of the Cleveland Metro Park System. And, thought about the ethical questions, ethical theories of anthropocentrism, which is that only people, humans, have moral status, versus biocentrism, which is that all living things, both sentient and non-sentient, have moral status. And, kind of thought about all this in his paper. And, his main question was, can a park ever be truly biocentric? It was really interesting. Another student, I'm going to read her stuff because it was fun. Let's see. Okay. Here it is. I should be better organized. Okay. So, the second student, the second thing in there is, does picking your own cherries take away jobs from farm workers? So, she talked about the fact that her family had a tradition of picking cherries. She said, in a way, I was raised by cherries, orchards of them. And, she said, my visits to cherry orchards connected me to nature and the outdoors. But, did they disconnect me from labor? And, she went on to do, you know, to look at what do farm workers do and how do they get paid and what are their hazards and working conditions. And, one of the points she made, I thought was a great point, was that during COVID, farm workers were deemed essential workers, but they still faced deportation. So, she had some great thoughts. And, you can see the other ones there. There were a lot more. But, I won't go into them all. Now, we then asked the students after the course, we asked them these questions. And, the first thing we asked them was, what surprised you about what you learned? And, what they said was that, you know, they came in kind of thinking, oh, we know environmental stuff. You know, we learn it. We know this stuff. But, they realized that they only knew kind of superficial information. And, in each of our sessions, we really dove fairly deeply into the topic. And, that really surprised them. And, they really liked it. And, they felt that they learned a lot from that. They also said that they appreciated and were surprised by how relevant these topics were to medicine, to health, and to bioethics. And, they really liked the community people that we got in to talk about what they call the lived experience. What would they like to have covered that we didn't? They wanted, most of them are going into healthcare. You know, I think three of them were going to apply to med school. And, we had the nursing student. And, so, they really would like to understand how these issues relate to clinical practice more. So, they wanted that. They also thought burnout in healthcare might be a really good topic. And, they wanted more environmental justice. They wanted that. So, how did they envision implementing what we taught them? And, what I was really happy to see was that they really felt both environmental and occupational health. They wanted to put that into whatever they do. They want to bring that in. They all talked about wanting to take a good environmental and occupational history. Yay! And, you know, what I think is that they begin to understand that occupational and environmental health is important in understanding patients in the broader context. And, that they will be better, whatever they go into, they will be better at improving the health and safety of their patients. So, what would they do differently as a result of the course? They ended up talking mostly about their own behaviors. You know, like, well, eating less meat or not buying as much stuff, you know, over consumerism. Using reusable water bottles. And, then, they had lots of suggestions for how the course, you know, other things we can do for the course. One of the things they said is, give us more assignments. That was surprising. I think they really enjoyed learning about this stuff and wanted to do more. Okay. And, I'm almost done. So, I'm going to conclude. So, first, I want to point out that I think we have a really good set of seven principles, seven principles of ethics. And, I highlighted ones that I thought were important for this talk. One that we promote a safe and healthy workplace. And, it's not just the plant floor, that it's the greater environment. Uphold ethical standards. I point this one out because I think we actually have an ethical responsibility to teach. To teach our colleagues. To teach our patients about lots of things but environmental and climate change. And, maintain professional competency. So, many of us don't know but should know that there's a whole list of environmental health competencies that are part of our boards and that we need to know those. One thing you could do tomorrow, I think, I'm gonna try to do this in Cleveland. I think every health professional, not just us, not just us, everybody should know how to prevent heat-related illness and death and should know how to write work restrictions that follow a climatization protocol so that when orthopedic surgeons send someone back to work after an ankle fracture, they know this and they'll write the correct work restrictions so that worker doesn't die like a U.S. postal worker did a few years ago. And we should know what's going on in the community, what's the air pollution level. We should know if there's a train derailment. And we should teach our colleagues. And then we can learn from our colleagues. So that's coming back to the PESHUs. The PESHUs have been around for 26 years. There is one PESHU in every of the 10 EPA regions. You should know where your PESHU is. You can talk to them if you have a pediatric environmental health question. There's a lot of toxicologists involved in these PESHUs, but we can also provide resources to them. They do education, but if they get a call for a referral, they need to be able to refer people to other clinicians. So know your PESHU. And now I'm gonna end with a quote from Braiding Sweetgrass. The moral covenant of reciprocity calls us to honor our responsibilities for all we have been given, for all that we have taken. It's our turn now, long overdue. Whatever our gift, we are called to give it and dance for the renewal of the world in return for the privilege of breath. Thank you. I think we have time to take one question. If anyone wants to now, we're gonna break out later, but anyone wanna ask a question right now? If not. Yeah, let's just keep going, and then we can break out and really talk, which will be fun. Okay, so I should do this, probably, huh? There you go. Oh, great, thank you. You're welcome. Let's see if I can get it to do this. That's not what I wanted. Okay, so I'm gonna tell you about a course that I launched, as I mentioned before, on climate and health. It's in our MPH program at Dartmouth, and the students for this are wonderfully diverse. We have clinically trained people, nurses and physicians. Residents, as well as people relatively green behind the ears out of college, and people from all over the world. So a wonderful diverse group to bring different perspectives. So the first thing I did with this course is to say what are the big ideas that we wanna get across? We certainly wanted to say what every major health organization has said, and that is that climate change is the single biggest health threat facing humanity. I also wanted them to learn that climate change will exacerbate existing health inequities, but will be shared by all. That public health cannot be effectively managed separately from animal and ecosystem health. In other words, this one health concept or planetary health concept. As well, that systems thinking and intervention at every level of society, including international collaboration, will be necessary to mitigate and adapt to the mounting crisis. And then finally, and importantly, in a theme that went throughout, and we did assign Braden Sweetgrass as well, and I really encourage you to read it. It is a fabulous read. A really interesting approach to weaving science with indigenous knowledge, with western scientific approaches. So we ran throughout the course this concept that indigenous practices provide wisdom that should be integrated with climate science. So at the end of this course, I wanted people to be able to interpret the scientific consensus on climate change, its drivers and its indicators, to be able to integrate the indigenous perspective of the environment within the scientific concept of the ecosystem, to assess the interrelationships between climate change, science, environmental justice, and public health outcomes, to be able to critically analyze strategies for mitigation of climate change and adaptation to its impact on public health, to be able to practice climate communication skills, and, and this is very important to us in putting this course together, is not only to develop confidence, but also optimism about their personal and social capacity to minimize the public health impact of climate change. I think many of you are aware of the incredible concern around climate anxiety, particularly in our younger generation. So the last thing we wanted to do was to make people more anxious. So here's how we laid out the foundation for this course. It was a short course, only over five weeks, but we had two sessions, or in other words, two classes, about two hours each, each week. So we started with this concept of finding our place. And, and this was really something that we wanted to go throughout the whole, the whole session. So when we talk about climate change and global health, we can get very big and feel very removed from what's happening, so that we can begin to think that climate change affects those people in Pakistan, or it affects those polar bears in the Arctic. But with me in New Hampshire, it's not gonna affect me. So we really wanted people to begin, in fact, we give them that as their initial assignment, is to think about a space that makes them feel good and comfortable. We'll get into that a little bit more. We also brought the indigenous perspective and this concept of nature's giving and receiving as per Brading's sweet class. The second week, we taught them some tools around visualizing the impact of climate change as one set of tools to help them learn, but also to teach others about, in a graphic way, about the impact of climate change on health. We also brought in, as you did, advocates in from Vermont, we're right on the border, to talk about climate justice advocacy and an advocate who had helped put together a Vermont's plan for climate advocacy and adaptation. And then the third week, we talked about worker protection and we specifically focused on the role of healthcare in terms of greenhouse gas emissions and how to mitigate that. We actually had a student that I was working with who we actually ended up publishing a paper together that looked at how telehealth could mitigate greenhouse gas emissions, actually, in a very unbelievably significant way. Then the fourth week, we talked about building community resilience and creating policy. And so we brought in an expert on multi-solving. In other words, we're not only solving a climate-related issue, but we may be solving a physical activity issue, for example. And we gave them some tools and I'll show some of those to you in terms of how to create these various policies and approaches. And then in the final one, we talked about managing natural disasters and gave them some tools which I'll expose you to about how to simulate the impact of various policy packages on desired public health outcomes. And then we also had a optional field trip. This I stole directly from Robyn's book, Braiding the Sweet Glass, where she realized that it didn't really make a difference and her botany class was bored, except for three people in the front row. I guess that includes you, Beth, and you, Ray, and not so much those in the back. But if we could go out into the community right now and experience, say, an urban heat island, it might strike you a little bit stronger. So we had a session where we went out to a Native American's farm and he taught us about indigenous agriculture. The other thing is, this is not an occupational medicine problem. This is a multidisciplinary problem. And so we didn't teach this class ourselves. We brought in as many disciplines as we could find to try to talk to this particular issue. What are the teaching methods we use? Well, we use readings, of course. We used a lot of videos. We had both formative and summative assignments. We had lots of, in every class, we had in-class group activities. This in-class group activity was run by a Native American who was teaching us how to make pemmican, which is a highly nutritious, dense form of, like a kind of a much better kind bar, if you will, out of materials that had been farmed locally. That was really fun and really, really engaging. We had discussion boards, and then we had this field experience I told you about. So this was a grid of the types of assignments that we had. And I want to first point out that we had a Slido survey at the beginning and at the end, and this was related to how optimistic they were about the world, if you will, and how they could make a difference in society would affect this, as well as their confidence in various aspects of climate science. The formative assignments included the, we had a quiz, we had discussion boards. We started with this concept of a sense of place where they chose a place that we said made them feel safe and comfortable and healthy, and then asked them, and usually those were places that they grew up in, and then we asked them, how has that place changed? And asked them and tried to have them think about this concept of solastalgia, this distress that's associated with environmental degradation, to really personalize this experience of climate change and environmental degradation. We had them do a perspective on how to think about incorporating an indigenous perspective with an ecosystem scientific perspective. We had them work using O-Net, thinking about job tasks, and now how climate change might affect the health risks and then how they could go about adapting those workers. And then we asked them to bring in a visualization of healthcare-related greenhouse gas emissions. We had them put together, as I mentioned, a visual model of, and I'll show you an example of that, about how climate might impact public health. And then as their final project, we had them put together a climate adaptation plan using some of the strategies for education that NIEH has put together. So the visual model, I wanted to just show you a little bit of that. And so there's this conceptual model of how climate drivers create exposure pathways that can result in health outcomes, all of that occurring within a context, both a social and behavioral context that will modify these health outcomes and the exposures, as well as an environmental and institutional context, such as land use and et cetera, et cetera, geography. So this is the visual model of climate change. Impact, I gave them as an example of what I wanted them to do. So you can see there's climate drivers here, such as increased precipitation and increased temperatures that then create an environmental condition, such as the precipitation causing flooding, which also, by the way, could be increased by increased water temperature because of the global warming. And then how the environmental condition could then create environmental hazards, such as contaminated water that could lead to water-related infections. And then who are the most vulnerable populations? And then you can see that begin, these arrows begin to point in more than one direction at more than one type of environmental hazard and health outcome and more than one type of vulnerable population. And as you may or may not know, there's some good tools online now that the CDC has put together to identify vulnerable populations, one from an environmental justice and then from more of a social vulnerability index. And there's a climate vulnerability index also available now. So, and then this is made more complex. We brought groups together then who showed how flooding in fact could, you know, I came up with a few hazards and then my colleague came up with more hazards. And then we begin to get more of a understanding of the interactions between all of these different kinds of things. So the culminating project was for them to create a climate adaptation plan for that special place that they started the course with for their chosen community. And they built this in an iterative way over the course. So they chose a location, they created visualizations of climate data that you can pull off of various websites. We gave them those access to those resources. And then we had them document the relationship of environmental condition to the respective climate drivers using that visual model I showed you. And then we asked them to identify who are the stakeholders in your chosen place, in your community? What are the community assets that may be at risk? What are the climate hazards? And to characterize this climate risk. We wanted them to build something that they could actually take home or to that special place that they could bring to the town council or whatever to make it real, so real people and how they would contact them. And then we asked them to consider what are the various resilience options and the feasibility, the economic, the political, the social, cultural feasibility of their suggested adaptation plan to prioritize those interventions and then to add references. We then asked them to practice their climate communication on a tool called VoiceThread where they were able to present this to, in this case, their colleagues. And then they looked at their colleagues' work and provided feedback on that. So in the last, one of the last classes, we had them use modeling software to create policy to cost-efficiently mitigate climate-related health outcomes. So this is a website. I really encourage you to look into this. And this handout, by the way, is on the swap card so you don't have to worry about forgetting this. It's a really fun tool to play with. So what they were said to do was to chose the county or country where they chose to create an adaptation policy and then enter the simulator. And then they were asked to choose a package of policies. So you'll see these sectors like transportation, electricity supply, or industry. And under each one of these sectors, you can see there are opportunities for specific policy packages to choose. So for example, under the cross-sector, I did the dropdown here, and it says you could exempt process emissions from the C-TACs or you could end existing subsidies. Then what I asked them to do was to choose. So in this simulator, you can choose a variety of outcomes. It could be CO2 emissions, but I wanted them to choose public health outcomes. So this is just one example of a public health outcome of avoided deaths. And this has to do with avoided deaths if the US actually keeps to its nationally determined contribution pledge through Paris Accords, if we actually did this. These are the deaths, the number of deaths that would be saved through 2050. And you probably can't read it, but at the bottom, each of the colors has to do with the amount of deaths saved per policy. So for example, the red one has to do with, the two ones at the top have to do with EV subsidy and vehicle fuel economy standards. So as I mentioned, we wanted to know how would people feel about their experience, not just was it a good course, did they like the way I prepared my speeches and the course assignments, et cetera, but what did they really learn? And so the good news is that most of them learned a lot, but this slide has to do with the worry piece. Because as I mentioned, this is what I was worried about was that this would end up just creating more anxiety, more worry, and as we have learned, the more worried and anxious you are, there is a potential then to drop out and to become apathetic and to feel as though you can't do anything, at least, or depressed. And in fact, during my course, one of the climate scientists who spoke in our course said that one of his lab technicians committed suicide. I mean, it makes me emotional right now. Because he committed suicide, he was so overcome by concerns about what he was learning about climate science. So this is a big deal, and I think it's really important for us to understand this. There's a lot of discussion about how to have this kind of communication and what actually engages people. Should we be optimistic, or should we tell them like it is, or can we do both at the same time? Some people say, well, you know, it really has helped to scare people about smoking. And it has, but as we know, we didn't just wave our hand at someone and said, this is gonna kill you. There was a whole environmental context that was necessary to really move the needle from that perspective. So like our current president, Dr. Saito, did, we also did a cloud response. And this was the one word that they came out with that made me very hopeful that we had actually done our job. We both did make people worry a bit more. We want, I mean, you should be, as you've learned, it's kind of good to be a little anxious before you give a talk or you give a performance of some sort. But you wanna be confident in your skill sets, and you wanna be hopeful that you're gonna succeed. And so I'm delighted to say that, in fact, this class, the approach that we took, did create a group of graduates who were both more knowledgeable, a bit more charged up in terms of being anxious, but also hopeful that they could personally make a change and that society would finally get its act together collectively and make a difference. So with that, what I'd like to do is to have some more fun. And it's not really that much fun just doing this Q&A kind of thing. So what we're gonna do is we're gonna come down as peers with you and talk about your experiences in talking to people, teaching people, and you can obviously query us more about our approaches. And I think we probably should do two groups, I think. And so maybe this side and this side. And obviously we need to come together for this, and I hope no one leaves during this session, because this should be one of the more fun parts. So yeah, please come up, come up so that we can.

climate change

health impacts

occupational medicine

education for health professionals

community resilience

policy creation

natural disasters management

climate adaptation plans