'Lack of training in environmental health'

Medical students in Israel, the United States and Europe are not receiving adequate environmental health education, a study sponsored by the Haifa-based Public Health Coalition has reported.

The report, called “Our Health and Environment,” was conducted by Stephanie Rieger, a coalition fellow at the University of Haifa International School.

“Our primary care physicians, no matter what area of the world they are attending, place little emphasis on environmental toxicology in regards to their core and elective courses,” Rieger wrote in a summary editorial printed alongside the study.

Out of the 25 universities that Rieger surveyed – 10 in United States, 10 in Europe and five in Israel – there were only six environmental health courses offered in clinical medicine programs.

Two of the courses were at Harvard University as electives, one was at University of Chicago as an elective, two were at the University of Iceland as electives and one was at the University of Bologna as an elective.

The sixth, at Bar-Ilan University in Ramat Gan, was a required course, where the school “educated clinical physicians about environmental concerns, stating that its ‘curriculum will focus not only on patient care, but also on healthy lifestyles, with specific regard to environmental factors.’” In the United States, Johns Hopkins University, the University of Pennsylvania, Stanford University, the University of California, San Francisco, Washington University in Saint Louis, Yale University, Columbia University and Duke University all fail to offer environmental health courses, according to Rieger’s report. The same applies in Europe for the University of Cambridge, University of Oxford, the Imperial College of London, University College of London, Trinity College of Medicine, University of Barcelona, University of Gothenburg and University of Athens.

Likewise, in Israel, Ben- Gurion University in Beersheba, the Israel Institute of Technology-Technion’s Bruce Rappaport Medical School in Haifa, the Hebrew University of Jerusalem and Tel Aviv University’s Sackler School of Medicine do not offer environmental health courses, the report said.

Rieger stressed that the findings demonstrate that the globe’s primary care physicians require “a more comprehensive education in respect to environmental health,” especially since environmental concerns are escalating as of late.

In the report, Rieger emphasized how dangerous contaminated soil, dust or water can be, and explained how humans can easily absorb many of these same toxins while they are suspended in the air. Such air contamination can have short-term impacts, such as headaches, nausea, bronchitis and pneumonia, but can also cause long-term problems, like chronic respiratory disease, lung cancer, heart disease and brain and neural damage.

As testaments to this argument, Rieger brings in examples of the London “Smog Disaster” of 1952, the Southeast Asian Haze Disaster of 1997, the Bhopal, India, Pollution Disaster of 1984, the Yokkaichi Asthma Outbreak in Japan from 1960 to 1972, and closest to home – the Haifa Bay air quality situation, which she attributes to production, transportation and industry.

“As human beings continue to have momentous impacts on the environment and its resources, core education seems to be the best device for providing the public with medical professionals that understand the ramifications human actions and behavior patterns that influence their health and environment,” Rieger wrote.

“Since exposure to air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels, it is imperative to educate our primary care physicians and health workers about this imminent risk to make certain that when medical attention is needed, it is delivered in an efficient and accurate manner.”

Illnesses caused by environmental factors are often misdiagnosed because it is sometimes difficult to determine which pollutants are causing symptoms and isolate the culprits, the report argues. Therefore, it is crucial to supply primary health providers with the comprehensive knowledge necessary to be able to make as accurate diagnoses as possible, according to Rieger.

To accomplish this, she suggests that medical schools throughout the world lacking environmental health programs should use the select programs that do exist as models for developing their own. More advocacy for funding to public medical schools is also crucial, she adds. While most of these universities have environmental studies courses within their institutions, they do not incorporate these courses in their medical school curriculums.

“The public relies on primary care physicians to improve their health and well-being, it should be of the upmost importance that the education of these individuals is all-encompassing,” Rieger wrote.

In response to the report, Prof. Dan Blumberg, deputy vice president and dean for research and development at Ben-Gurion University, said that “there is no doubt that environmental factors play a key role in health and wellbeing.

“Educating healthcare providers on the risks and illnesses associated with the environment is much required,” he told The Jerusalem Post. “BGU as a leading institute in environmental research and local and international health schools has always understood that these issues are strongly connected.”

While agreeing that environmental health education is important, Prof. Shmuel Shapiro, deputy director-general of Hadassah University Hospital and director of the School of Military Medicine at the Hebrew University- Hadassah School of Medicine, warned that the report might be blowing the issue out of proportion.

“It is not necessary to get carried away or go into panic. There are many other important fields that students don’t receive [training on] – it is impossible to get everything,” Shapiro told the Post. “Public health issues and prevention are much more emphasized today than they were in the past.”

Prof. Elihu Richter, also of the Hebrew University- Hadassah School of Medicine, said he finds Shapiro’s response to be “disappointing.”

Richter pointed to events such as the Kishon River disaster and the undetected epidemics of cardiovascular disease among munitions workers as evidence that environmental health education for soon-to-be physicians is crucial.

“Teaching the sentinel event is the key to linking one on one clinical medicine to the search for group risks ‘out there,’” he said.

It is necessary to employ tools of environmental epidemiology to both predict and assess illnesses, and “not wait to count the bodies,” according to Richter.

“From 40 years in the field of occupational and environmental medicine, I can say that the systematic failure to educate physicians to search for work-relatedness of illness and morbidity has led to many disasters which were preventable,” Richter said.