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Letters to the Editor

Medical School Curricula Should Highlight Environmental Health

Saltzman, Hanna M.

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doi: 10.1097/ACM.0000000000002874
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To the Editor:

As a medical student, I was delighted to see Wellbery and colleagues’ recent argument that medical school curricula should include climate change.1 Medical schools should also teach students about environmental health broadly, a plea that has been made for decades but unfortunately with little resulting change.2,3 At my school, University of Michigan Medical School, we sporadically learn about environmental factors, such as lead poisoning’s disruption of heme synthesis and secondhand smoke’s damage to developing lungs. Concepts like these are important. But teaching environmental health as a handful of individual facts scattered among thousands of other facts misses the bigger pedagogical picture: The human body is not siloed but, instead, continually interacts with and is changed by its environments.

Medical educators could imbue that overarching concept if they deliberately wove environmental health throughout the curriculum. For example, when students learn about risk factors for preterm birth, they should learn about phthalates, which are found in countless plastic-based products.4 When learning about metabolism, students should learn about endocrine-disrupting chemicals such as perfluoroalkyl and polyfluoroalkyl substances (PFAS), found in everyday products like nonstick cookware and food wrappers, that likely have an obesogenic effect.5 When learning about telomeres, students should learn that environmental factors, such as prenatal exposure to air pollution, are linked to decreased telomere length.6 Other examples abound.

As a student, I understand firsthand that medical school curricula are bursting at the seams. Nevertheless, environmental health should not be sidelined. Medical school teaches future doctors how to think. I urge medical educators to train students to think about the human body in the context of its environments.


1. Wellbery C, Sheffield P, Timmireddy K, Sarfaty M, Teherani A, Fallar R. It’s time for medical schools to introduce climate change into their curricula. Acad Med. 2018;93:1774–1777.
2. Schenk M, Popp SM, Neale AV, Demers RY. Environmental medicine content in medical school curricula. Acad Med. 1996;71:499–501.
3. Gómez A, Balsari S, Nusbaum J, Heerboth A, Lemery J. Perspective: Environment, biodiversity, and the education of the physician of the future. Acad Med. 2013;88:168–172.
4. Ferguson KK, McElrath TF, Meeker JD. Environmental phthalate exposure and preterm birth. JAMA Pediatr. 2014;168:61–67.
5. Cardenas A, Hauser R, Gold DR, et al. Association of perfluoroalkyl and polyfluoroalkyl substances with adiposity. JAMA Netw Open. 2018;1:e181493.
6. Martens DS, Cox B, Janssen BG, et al. Prenatal air pollution and newborns’ predisposition to accelerated biological aging. JAMA Pediatr. 2017;171:1160–1167.
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