Large-scale Ecological Issues Case Study

University of Alberta
Edmonton, Alberta, Canada

Instructor(s): Guidotti, Tee L.
Subject area: Health / Medicine
Department: Faculty of Medicine
Level: Undergraduate Medical
Number of participants: 115
Duration of exercise: 1 hour
Cost/equipment needed: A 20-page publication called "Human and Ecosystem Health: Canadian Perspectives, Canadian Action," published by the Canadian Public Health Association
Learning objective: Provide Information
Teaching style: In-class Activity

Please note that the copyright for this course project is retained by the instructor.

This case study was used to incorporate global ecological change and destabilization topics into an introductory, required course on occupational and environmental medicine for Phase III medical students at the University of Alberta Faculty of Medicine. The students read the document, "Report of the Task Force on the Implications for Human Health of Global Ecological Change" by the Canadian Public Health Association and answered a set of questions about global ecological change and the role of biomedical research and clinical medicine in address it. The ecosystem and human health case study received the highest ratings by students and the most consistently high ratings.

Case Study # 4
Large-scale Ecological Issues

1. a. What do you think are the three principal hazards to human health likely to result from ecosystem destabilization as described?
b. What information would you want to confirm or correct your impression?

2. a. What do you think are likely to be the three most significant health problems to result from ecosystem destabilization as described?

b. How information would you want to confirm or correct your impression?

3. a. What are the most essential changes that must occur to avoid health problems resulting from global ecological changes?

b. What can physicians do?

4. a. What is the role of biomedical research in dealing with global ecological changes?

b. What is the role of clinical medicine in dealing with global ecological changes?

5. On a scale of 1-10 where 10 is highest, how interesting did you personally find this material?


Excerpts evaluating this case study are taken from the following article: Guidotti, Tee L. "Acceptability to Medical Students of a Curriculum Element on Ecosystem Health," Doctors for the Environment (January 1995), pp. 11-14.

"In 1992 we introduced a one-hour curriculum element on global ecological change and destabilization into CMED 432 the introductory Phase 111 course for medical students on occupational and environmental health. The case study was based on a reading from a report on ecosystem and human health prepared for the Canadian Public Health Association. Students were in 1992 and 1993 required to submit a response to a questionnaire on the issues to demonstrate that they had read and digested the material. The element was well received by the students receiving the highest personal interest score among a series of case studies in the course. A few students tools exception to the material on the grounds that it was not core medical material or that they perceived it to be alarmist or partisan. Individual responses by students demonstrated insightful thinking and considerable enthusiasm however. This experiment in medical education had good results but does not necessarily mean that the existing overloaded medical curriculum can accommodate extensive new material. However it does suggest that a remodeled medical curriculum might profitably incorporate some of this content where it fits but with basic science or clinical content.

...We use here the term 'environmental health' in a broad sense to include the integrity of environmental systems on a regional or larger basis and the implications for human health. This concept of 'ecosystem health' helps one to perceive human health problems as comprising one of a set of outcomes that may result from environmental disturbances. We also introduce concepts associated with the more traditional public health usage of 'environmental health' (human health effects of chemical and microbiological pollution, food contamination, and vector control) in other parts of the curriculum, including some of the content of our course CMED 432, 'Occupational Medicine'. However, this one curriculum element is unique in taking a broader view of what some have called 'ecosystem and human health'.

Very few physicians are rigorously trained in environmental health and most of these are out of the mainstream of medical practice, working in the public health system, government, or in research settings. (4) Even fewer are systematically trained in ecosystem health and when this occurs it is usually because of personal dedication to an issue or because their premedical training happened to include it.

To address this apparent gap in the medical curriculum, we designed an exercise around an authoritative report on ecosystem and human health developed by the Canadian Public Health Association (6) and incorporated it into the introductory course in occupational medicine at the University of Alberta, given to students in their Phase III A, third year.

Methods: Community Medicine 432, 'Occupational Medicine', is a required course for medical students in their third year at the University of Alberta Faculty of Medicine. It is part of a predominantly clinical lecture series for students entering the first half of their clinical phase of education (Phase III A). The course consists of 12 contact hours divided into lectures on toxicology and occupational medicine and for case studies in which students are encouraged to work in small groups. The case studies consist of an introduction, a presentation or reading, a query and response sheet, and a discussion of the current answers. Each case study was evaluated by students for interest and relevance. In 1992, we introduced a module on ecosystem and human health as the fourth case study.

As a reading, we used the text of the Report of the Task Force on the Health Implications of Global Ecological Change, of the Canadian Public Health Association. This is a short (20 page) discussion document, written in a engaging style, that briefly outlines the scientific evidence for a series of well-recognized environmental problems and makes recommendations for concerned health professionals. It is not an activist or political document and does not propose any political or economic measures other than environmentally sound management priorities and sustainability. It is well-documented, but the references are not published with the report. A 'query-response sheet' must be completed and turned in by the students for credit in the course. It consists of eight questions designed to provoke thinking on content and on evaluation questions. There is no correct answer and no grade is assigned, although completion of the assignment was required in 1992 and 1993.

Results: ...Table 2 presents selected responses submitted by individual students for specific items on the query-response sheet. Because the completion of the response sheets was an open book class exercise, they are invalid as a survey of student opinion. Responses were essentially 100% for identifying global warming, ozone depletion, and pollution as major hazards and requesting further documentation, which are quite satisfactory responses. Likewise, almost all concluded that food shortages, toxicity, and climate-related health problems would be among the most significant health problems. Every student also responded that physicians have a duty to educate the public and that science must document the problem further. A small fraction of respondents were very critical of the exercise and a few were openly hostile. Critical comments are summarized in Table 3.

Discussion: The high acceptability of this curriculum element on ecosystem health should be encouraging to efforts to introduce this topic into medical education. It suggests that ecosystem health issues can compete successfully with clinical topics for the attention of medical students. However, it is also clear that there are limitations to the students' capacity to accept new material. We agree with Graber, et al., that this material will work best in the medical curriculum if it is integrated with other, more directly relevant topics.

At present we are reluctant to make this material mandatory because we do not wish to undermine the hard-won acceptance of core material in occupational medicine in the course. This is a particularly difficult time to introduce new material into the medical curriculum because the health care system is in transition and nobody knows what core material will be in a decade. There is, therefore, a tendency to load the medical curriculum with topics that may be critical for the future to ensure that they are not missed.

It should be noted that the alleged partisan or ideological sentiments attributed to the document and its authors are not present explicitly in the text and that the authors hold a diversity of points of view politically. A number of environmental activists find the report too neutral and conservative. Much of the material came from sources associated with the World Health Organization or Environment Canada. Also, the Canadian federal 'Green Plan' was introduced by a Progressive Conservative Government, not by the Liberals. However, the material clearly offended the political sensibilities of at least two students.

The exercise is based on an authoritative document produced in 1991. Inevitably it will require revision but we expect that it will remain acceptably accurate for at least a few more years. At present, it is particularly effective for our purpose because it is self-contained, health-oriented Canadian in orientation and written in a relatively engaging style.

Table 2. Selected Comments from Individual Students

On the role of biomedical research in dealing with global ecological change (4a):

Universal responses: document and monitor the problem.

Show association between ecological destruction and health problems.

Ability to adapt to change presented by a new environment.

To provide qualifiable evidence of the hypothesized health hazards.

Developing new ways or practices that are environmentally friendly and beneficial to health.

To provide solutions which are achievable (not 'stop all pollution').

New, cheap, effective, simple ways of contraception. Bottom line is: overpopulation is #1 problem by far.

On the role of clinical medicine in dealing with global ecological changes (4b):

Document increase in health problems due to ecological destruction. We must take preventive action and not treat the 'end result' of patients who are victims of 'ecological' assault.

Clinical medicine deals with the above issues on an individual basis, so that each patient can be made aware of the changes which are occurring in the global ecosystem...

To develop methods of early detection and prevention of health problems due to global ecological changes.

Table 3. General comments critical of the exercise offered by individual students.

Interesting, but a bit long and scary.

Interesting, but too depressing.

Started out boring, then was mildly shocking, then interesting yet depressing.

A few years ago it was the threat of Ice Age and now it's global warming. It makes some of these arguments put forward as being incredible. Why not create mass hysteria?

Quite interesting but rather tedious. A very socialist perspective which offers little in the way of constructive comments. *

This sounded like a paid political message from Greenpeace... The whole report echoes 'Big Government' ... I presume the authors of the piece are all noted Liberals.*

Task forces, committees, and royal commissions just waste money redefining problems which everyone know about and suggesting courses of action which no one implements. In spite of these criticism, the report was interesting and I do agree (that) it is a problem which the political establishment has not year grasped.

*This reading was not partisan and these political labels do not reflect the actual affiliations of the past members who produced the report. In fact, the report has been criticized by environmental activists as too conservative in its approach. A recent report produced by the Royal Society of Canada comes to essentially the some conclusions."

This document was last modified on 06/14/2000 03:07:51 PM

This resource was acquired by CEEM (Consortium for Environmental Education in Medicine), a program of Second Nature, under the auspices of a NIEHS grant to gather and disseminate environmental health educational resources over the internet in order to help medical and allied health sciences faculty identify, locate and use resources for incorporating environment and health perspectives into their curricula. CEEM has authorized the use of these materials on this website for archival purposes. Please note that the copyright for this material is retained by the instructor and/or contributing institution.