A climate of caring

Photo by John Russell

Carol Ziegler, DNP’12, MSN’06, spent her younger years discussing climate change with her environmentalist father, but it wasn’t until a trip to Kenya in 2009 that she saw the direct impact it could have on every aspect of a society.

“They’re agrarian, so their lives are dependent on weather,” Ziegler said of the population in Kitale, Kenya. “I’ve always known about climate change, but I didn’t really see the role of health care providers until I was there. That’s when I started tying together the links between health and climate and thought, ‘Where are the nurses, and why aren’t we talking about this?’”

Ziegler joined Vanderbilt University School of Nursing four years later and teaches in the nurse-midwifery/family nurse practitioner dual focus program. She also coordinates global health initiatives for the School of Nursing and is affiliated with the Vanderbilt Institute for Global Health.

Fueled by her interest and commitment to global health, Ziegler applied to teach a University Course in 2018, a new Vanderbilt University initiative to promote novel and creative transinstitutional learning.

She proposed “Planetary Health, Policy and Social Justice,” an innovative class that would explore the intersections of primary health care, planetary health, climate change, social justice and policy. In keeping with the initiative’s focus, it would endeavor to address one of today’s most captivating challenges and be open to undergraduate and graduate students from all 10 Vanderbilt schools.

Ziegler’s proposal was one of five selected for the 2018-19 academic year. The three-credit-hour course launched as an elective in January. Drawing undergraduates from the School of Engineering and Peabody College and graduate students from Nursing, Engineering and Owen Graduate School of Management, the course stresses interprofessional teamwork, cultural sensitivity and addressing health disparities.

Connected solutions

“Climate change is a fundamentally interdisciplinary problem,” said Jonathan Gilligan, PhD, associate professor of Earth and Environmental Sciences in the College of Arts and Science and a guest lecturer for the course. “To understand it, one must understand connections between the economy, energy technology, the Earth’s physical climate system, ecosystems and human health. Each of these things interacts with all of the others, so we can’t make good decisions unless we are thinking about all of the parts.”

Ziegler believes that climate change is the best scaffold for interprofessional learning. “It’s an existential threat, and that’s a good way to get people to align with one another,” she said. “It’s often presented as a political issue, but it’s really about human survival. The increase in weather events and the number of hot days is affecting the lifespan of carbon-based life on Earth. So, the question becomes, ‘How do we move through that in a way that’s not politically divisive and is cooperative rather than competitive?’”

As their community project, PreSpecialty student Joshua Lehrer and Vanderbilt School of Engineering graduate student Charles Doktycz propose that the former University Club be replaced with sustainable housing for graduate students. Photo by Susan Urmy.

According to Vanderbilt Law School Professor Michael Vandenbergh, JD, the David Daniels Allen Distinguished Professor of Law and also a guest lecturer for Ziegler’s course, approaching these issues through a health care lens may help bring unity to an often-controversial topic.

“Climate change is one of the most polarized issues in the country, but support for public health has appeal across the political spectrum,” Vandenbergh said. “When people understand that climate change poses a genuine threat to public health, this perspective can help them keep an open mind to interdisciplinary approaches to research and to adopting common sense solutions.”

The role of nursing

Within the health care spectrum, Ziegler believes nurses are uniquely situated to discuss climate change due to their position on the frontlines of care across the globe.

“Nursing is on the forefront of seeing the impacts of climate change, so I think we’re equipped to speak to how things like air quality and heat will impact people’s health. We’re also equipped to speak to how tertiary impacts like food shortages, conflict and migration will all impact health and health systems,” Ziegler said. “We need to be educated on how these impacts look and how we can help adapt and relay information to our populations and back across to policymakers.”

Nurses are also poised to compress the time it takes to turn health issues seen on the ground into meaningful change.

“We’re good at making issues feel personal. If we can talk to people about quitting smoking and make it personal by relating it to lung cancer — taking this broad, abstract concept and turning it into a physical action you can take to avoid it — then I think we have the language to do that broadly about issues like climate change,” Ziegler said.

Because climate change causes unpredictable impacts that vary by environment, a better understanding of weather-related health consequences can prepare nurses for major public health emergencies as well as inform them of factors that may affect patients over time.

Additionally, since disasters disproportionately impact vulnerable populations, such as those in low-income communities, nurses can help ensure health systems are positioned to provide access to care for all who need it.

“I believe that nurses are vital to addressing the issue of climate change and in helping to design policy solutions in all aspects of health care — local, state-based, nationally and internationally,” said Josh Lehrer, a VUSN PreSpecialty student taking the course.

“I know that nursing is among the most trusted professions in the United States, and that we truly can lead the way toward a more sustainable future for our planet. Most important, we have an obligation to put time and effort toward implementing sustainable development goals with interdisciplinary teams throughout the public, private and nonprofit sectors to ensure the well-being of our patients and communities.”

Lehrer, who receives the Kathleen Suzanne Nelson Memorial Scholarship, is  pursuing his Master of Science in Nursing degree to become an FNP. He enrolled in the class to gain insight on how health care providers can help craft solutions to remedy climate change’s dire impacts.

“We must take bold measures to tackle the imminent threats to human health that climate change is already posing while still providing the best quality care possible,” he said.

Sustainable, interprofessional learning

Ziegler hopes her students coming from different disciplines will use the course to keep climate change at the front of their minds as they grow into leadership roles within their own industries.

Summer Rucker, a civil and environmental engineering major, enrolled in the course in hopes of pursuing sustainability in her work.

“I want to be able to holistically approach climate change so I can involve that thinking in solving world problems in my major of engineering,” Rucker said. “It’s important to understand the natives of the community you are trying to help, to make sure they are aware of every step in the process and to make sure there won’t be any health effects in the future. Always think about the future.”

Ziegler’s course operates in a “flipped classroom” environment, meaning students prepare for interactive work sessions with assigned readings and online learning modules. In-class sessions involve an hour spent with an expert guest lecturer on topics such as carbon mitigation, ecosystem disruption, health impacts, adaptation and policy advocacy.

Guest speakers for the spring 2019 session include Vanderbilt professors Vandenbergh and Gilligan, as well as community leaders such as Sanmi Areola, interim director of Health at the Metro Nashville Public Health Department, and Kimberly Jackson, founder of nonprofit HIDE (Health Impacts of Degraded Environments).

Actionable change

The second hour of each class is dedicated group time for the course’s semester-long, community-based projects, in which students create a health impact model, vulnerability assessment, adaptation assessment and actionable plan for change for a local community.

“The main goal of the project is to have students identify a local population that is at risk to a health impact from climate change,” Ziegler said. “Their charge is to come up with an intervention that addresses human adaptation to climate change while also mitigating the carbon associated with that development.”

Projects range from creating a climate-based Montessori curriculum for students at a local elementary school to working with the Cumberland River Compact on flood mitigation and adaptation strategies in Sumner County. Another group will focus on the Green New Deal movement and explore how the broad, integrative ideology behind it might improve adaptation in Nashville.

Lehrer’s group plans to keep its project close to home by identifying potential holes in Vanderbilt’s own plan for a reduced carbon footprint and proposing action to close any gaps.

“It involves looking at areas of Vanderbilt’s operations where we can work to reduce its greenhouse gas emissions,” Lehrer said. “Efforts are already underway, but it will be great to focus on one or two initiatives to help launch with my fellow classmate and see the progress made as I continue my studies after this course.”

Students will also create policies surrounding their proposed changes, which will be presented at the end of the semester to a panel of judges from the Metro Nashville Public Health Department and other organizations in positions to create meaningful action.

“It’s important for students to understand the difficult trade-offs confronting policymakers, advocates and business managers on environmental issues,” Vandenbergh said. “Students who are exposed to the critical thinking we require on policy issues will be better managers and policy advocates down the road.”

Since most community projects will take longer than one semester, each project will be carried into future classes, which will pick up the process where it was left during the former semester.

“My hope is that by the end of at least the next spring semester, we either have a solid policy we’re helping to move forward that relates to climate in Nashville, or we’ve had some kind of impact on community adaptation,” Ziegler said.

“I don’t want this to just be a class. I want it to have teeth.”