Working Together: Communities of Practice in Medicine as a Core Experience in Climate Change Adaptation
Vol 10 #16. December 29, 2021
Rini Dass, B.ScN., M.ScN., Adult-N.P.1, Ana Hategan, M.D. 2,✉,iD
1 Assistant Clinical Professor, Adult-Nurse Practitioner, McMaster School of Nursing, McMaster University, Hamilton, ON, Canada
2 Clinical Professor, Geriatric Psychiatrist, Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
✉ Corresponding author. Ana Hategan, Email: [email protected]. iD: https://orcid.org/0000-0003-0221-1154
Climate change has been declared the greatest global health threat of the twenty-first century. There is a need for effective dissemination of emerging evidence on climate-sensitive health risks, as well as innovative interventions to help healthcare systems adapt to and mitigate these consequences. Communities of practice can exemplify effective mechanisms to boost capacity in the intersection between climate change and health, with an emphasis on multidisciplinary teamwork.
The experience of climate impacts on human health
The Earth is about 1.1°C warmer now than it was in the late 1800s . A 2018 United Nations report emphasized that action is needed to limit global warming to no more than 1.5°C in order to maintain the biodiversity for a livable climate [1, 2]. Subsequently, a growing coalition of countries has been committing to net zero emissions by 2050. However, in order to keep global temperature rise below 1.5°C, nearly half of carbon dioxide emissions reduction must be in place by 2030 . These commitments must be espoused by persevering, convincing, and realistic actions. If the current path of carbon dioxide emissions is maintained while we move ever deeper into the Anthropocene (a term typically used to describe the time during which humans have had a significant impact on our planet), the world will likely see a rise by 4.4°C by 2100 . This will have devastating consequences for life sustainability on Earth as we know it .
The 2018 Intergovernmental Panel on Climate Change (IPCC) special report into the impacts of global warming examined the catastrophic consequences of allowing the world to heat to more than the 1.5°C target set out in the Paris Agreement . Climate change can impact demographic, socio-economic, infrastructural, and institutional capacity, as well as health system resiliency; it can create disruptions in the food supply, housing, work, safety, and human health . So far, climate impacts have manifested from protracted droughts and wildfires, sea level rise and saltwater intrusion, storms, flooding, and water scarcity, to declining biodiversity. This puts the population at risk of relocation and continuous adaptation. This requires health systems adaptation to meet the complexities of the ever changing population needs.
The state of human health is going to be increasingly tested by climate change and ecological affliction. The physical and emotional health of a community is vital to the state of wellbeing of its people. As public awareness of climate crisis and its critical impact heightens, a significant proportion of people may experience distressing level of anxiety symptoms and increased rates of depressive disorder and posttraumatic stress disorder . While many countries are trying to mitigate the effects of global warming, adaptation to climate change requires collective action to strengthen the physical and mental health of the population.
Healthcare systems strengthening through a systems thinking approach
The negative physical and mental health effects of planetary climate changes will be extensive and long term . These effects include the cumulative burden of diagnosable systemic medical and psychiatric illnesses, exposure to poverty, food insecurity, unstable housing, deprivation of nurture, education, loss, stress, and collective trauma . These health effects also have the potential to fracture the very fabric of our social cohesion, collective worth, and overall health, life expectancy, and quality of life.
However, a disease-centered approach in the era of climate change adaptation offers a halted and limited understanding of the scope of social and cultural environment on health [5, 6]. The medical field has the chance to reimagine its practice to be relevant to the task of maintaining healthy, humane, and equitable communities in order to meet the Sustainable Development Goals . The Sustainable Development Goals are the proposed actions by the United Nations to achieve a “better and more sustainable future for all” ; they address issues such as climate change, environmental degradation, inequality, poverty, peace, and justice. Their main goal is the wellness of all people in the face of global climate adaptation.
We need cultural change, learning, and leadership to propel changes in healthcare systems and policy that put emphasis on the work of care, prevention of illness, and promotion of health, a two-pronged approach on the bilateral association between health and climate change . This must include at the center the social and environmental determinants of health, combating racial and economic disadvantage and health inequity .
Clinicians, patients, community members, industry sectors, and stakeholders can co-lead and generate an expanded scope and purpose for healthcare systems in the “new normal” of climate change adaptation . Broadened co-ownership of sustainability of health can only add value to the healthcare system’s traditional focus on specific medical disorders. Moreover, healthcare professionals must become familiar with, and advocate for, broader social policies crucial to future population and public health; these should embrace full-on pursuit of equity and planning and budgeting processes that prioritize health, wellness, and wellbeing . We know we can do it; managing the COVID-19 pandemic has already shown the nations the consequences of what joint forces can do when individuals come together in global unity and collective mobilization, and the relationship between health and illness with the goal of advancing equity and social progress [2, 7, 8].
Health sustainability through communities of practice (CoPs)
Health sustainability in the face of climate change may not be as much a political problem, but a cooperation problem. It is time to seize the chance for what we must do as our shared ownership in holding global temperature rise below 1.5°C. In this view, communities of practice (CoPs) have the potential to bring together collaborative endeavours among diverse professional fields and disciplines in response to the recent call to action by medical organizations [10, 11].
Interactive CoP initiatives dedicated to advancing knowledge and action in the field of medicine have started to operate worldwide, and we believe that the focus of climate change mitigation and adaptation should be incorporated. The concept of CoP (a term first introduced by Lave and Wenger and subsequently expanded on by Wenger ) could provide a framework of community learning, emphasizing the social nature of learning . Individuals who share similar concerns or ideas wish to join the community, moving from peripheral to active participation, acquiring the identity of community members and undertaking the community’s objectives . Some authors argue that the collaborative learning process of “thinking together” is what essentially drives the CoP initiatives .
Adding CoPs in medicine to the arsenal of combating climate impacts on health has the potential to actively engage participants in joining the community, creating a welcoming community, expanding the emphasis on explicitly addressing experiential learning and reflection, as well as role modeling and mentoring on climate change action. It can provide professional faculty development to support medical education by integrating climate change-related health issues in core medical curricula. Some argued that lessons learned about building such CoPs have included the need for organizational change from the top of public health, the necessary power of community in intersectoral collaboration on climate change preparedness, and the importance of including the social and environmental determinants of health .
A summary of few existing virtual initiatives to address climate change is illustrated in Table 1. At the authors’ location at McMaster University in Hamilton, Ontario, Canada, there are two emerging CoP enterprises on climate change and health. These include a hospital-based Green Team group, which is an initiative serving as a location where healthcare administrators, researchers, and interested clinicians from across the city can come together to share knowledge, ask questions, generate ideas, and communicate and collaborate with others working in the field of medicine or other fields. The efforts of this group dovetail with a new provincial virtual CoP project named PEACH (Partnership for Environmental Action by Clinicians and Communities for Hospitals and Healthcare Facilities) . PEACH is a partnership of clinicians and communities in Ontario amplifying environmental action in hospital and other healthcare settings (See Table 1) . The PEACH project is a growing network for sharing lessons learned to integrate health capacity within the work of building resilient, humane, and equitable communities. PEACH includes topics on natural systems, transportation, food, buildings/energy, pharmacy, education, and leadership.
Programs such as these can act as blueprints for further development of climate action CoPs. They have the potential to engage, encourage, and empower those in the healthcare sector to take climate action at their own institution. Such initiatives can serve as a roadmap for sustainability, where interested individuals would be able to navigate through several topics related to environmental action and learn how they can make a difference. Therefore, we encourage readers to join a CoP in their region or country, and if one does not exist, it is time to start one.
Table 1. Selected examples from practice of virtual initiatives for climate change adaptation and environmental sustainability in Canada and worldwide
|A Canadian program managed by Health Canada, which aims to help the health sector prepare for and respond to the impacts of climate change; the participating health authorities across 5 provinces and territories are encouraged to collaborate and share best practices on climate change and health|
|A Canadian network that unites efforts across the British Columbia healthcare community to advance the healthcare system toward environmentally sustainable and resilient care for the health of people, place, and the planet|
|CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis)
|A Canadian capacity-building initiative to address healthcare’s contribution to the climate crisis
|Climate Change Adaptation Community of Practice (CCACoP)
|A Canadian interactive online community dedicated to advancing knowledge and action in the area of climate change adaptation; it supports Canadian provinces and territories in their efforts to incorporate climate change adaptation into planning and policies|
|Sustainable Health System Community of Practice & CoP Sustainable Inhaler Initiative
|A Canadian interactive virtual enterprise in medicine; the CoP Sustainable Inhaler Initiative is an Ontario project of the Sustainable Health System Community of Practice|
|The Canadian Association for Global Health
|A Canadian online platform aiming to connect, engage, strengthen, and mobilize the global health community across Canada and internationally through collaborative research, learning, advocacy, policy and practice|
|PEACH (Partnership for Environmental Action by Clinicians and Communities for Hospitals and Healthcare Facilities)
|A Canadian partnership of clinicians and communities in the province of Ontario with the goal to strengthen environmental action in hospitals and other healthcare settings|
|Climate and Resilience Community of Practice
|A United States platform that aims to incorporate adaptation strategies into U.S. Gulf Coast communities’ comprehensive plans, and to learn from each other and develop a set of effective common approaches that will make a difference in becoming a more resilient community|
|International Ecosystem-based Adaptation (EbA) Community of Practice
|A International online tool for knowledge sharing and mutual learning beyond projects, institutions, and regional boundaries, which includes a community of EbA practitioners, planners, and decision-makers|
|An International collaborative platform on climate change adaptation issues, developed and maintained by the Stockholm Environment Institute; it allows practitioners, researchers and policy-makers to access high-quality information and connect with one another|
- Adaptation to global climate change means making securing the physical and mental wellbeing and health of people a common expectation of global governance.
- With the growing expectation of climate-related health impacts, we draw attention to the opportunity of the healthcare leaders to come together through shared involvement in initiatives for health leadership at local, national, and global level.
- The use of virtually mediated communication to develop collaborative learning environments, similar to those suggested in Wenger’s CoP framework, has the potential to educate, engage, and mitigate a number of the challenges faced by clinicians, medical leaders, and healthcare administrators, even in remote locations , in their fight against climate change impacts on health.
- Through the CoP framework, clinicians can meet their needs for multidisciplinary teamwork, have access to a collaborative learning environment, and have ongoing contact with expert resources. The construction of CoPs could potentially address a multitude of concerns identified by clinicians practicing in most affected areas due to climate change.
The authors thank Dr. Myles Sergeant and other members of the PEACH project for support.
The authors report no financial relationships with any companies whose products are mentioned in this article, or with companies of competing products.
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