Ethical Considerations of Climate Justice and International Air Travel in Short-Term Electives in Global Health

Adriana Dhawan Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota;

Search for other papers by Adriana Dhawan in
Current site
Google Scholar
PubMed
Close
,
Zoe Rammelkamp Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota;

Search for other papers by Zoe Rammelkamp in
Current site
Google Scholar
PubMed
Close
,
Johnstone Kayandabila Arusha Lutheran Medical Centre, Arusha, Tanzania;
Eastern and Southern Africa Management Institute, Arusha, Tanzania;
London School of Tropical Medicine & Hygiene, London, United Kingdom

Search for other papers by Johnstone Kayandabila in
Current site
Google Scholar
PubMed
Close
, and
Vishnu Laalitha Surapaneni Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota;

Search for other papers by Vishnu Laalitha Surapaneni in
Current site
Google Scholar
PubMed
Close

ABSTRACT.

In July 2022, the American Society of Tropical Medicine and Hygiene Green Task Force advocated to acknowledge the health impacts of climate change, particularly on those in low- and middle-income countries, and called on global health organizations to act. Simultaneously, academic medical centers are resuming Short-Term Electives in Global Health (STEGH) as travel restrictions imposed during the COVID-19 pandemic ease in most countries. International flights by trainees from academic medical centers in high-income countries (HIC) on these electives encapsulate the climate injustice of who generates carbon emissions and who bears the impacts of climate change. Using “decolonization” and “decarbonization” as guiding principles, we suggest several strategies that global medical education programs in HIC could implement. First, restructure rotations to halt STEGH with minimal benefit to host institutions, optimize trainee activities while abroad, and lengthen rotation duration. Second, programs can calculate the carbon impact of their STEGH and implement concrete measures to cut emissions. Finally, we urge academic medical centers to promote climate-resilient healthcare infrastructure in host countries and advocate for climate solutions on the global stage.

INTRODUCTION

Short-Term Electives in Global Health (STEGH) are programs that typically facilitate volunteers and trainees from high-income countries (HIC) to travel to low- and middle-income countries to participate in a variety of programs, usually for a period of weeks.1 At academic medical centers, STEGH may be available for medical students, postgraduate trainees, or faculty in areas of clinical care, research, or public health. The COVID-19 pandemic halted STEGH, with many programs pivoting to maintain international collaborations virtually.2 As travel restrictions imposed during the COVID-19 pandemic ease in most countries, academic medical centers in high-income countries that facilitate STEGH are navigating how to reinstate rotations.

In general, the purpose of STEGH is primarily a practical educational experience for trainees, exposing them to health systems, medical conditions, and cultural contexts that differ from their home institution. The literature shows tangible benefits to trainees from HICs who engage in STEGH, ranging from physical exam and intercultural communication skills to cost-conscientiousness and resource allocation.36 There is value in collaborating with individuals with different medicocultural practices and engaging in dialogue that fosters a culture of inquiry. Importantly, STEGH can be career changing for participants, demonstrating associations with employment choices in public health and underserved primary care, and engagement in equity work.4,7,8

However, there are ethical concerns around multiple aspects of STEGH, including “medical voluntourism” and the need to decolonize medical global health education.912,16 As such, many educational programs are working to improve bilateral exchange and are revisiting long-standing practices in STEGH.1,1315 Critical program review and pre-departure orientation education acknowledging problematic histories of colonialism and White saviorism are being implemented across U.S.-based academic medical centers.10,16,17 However, one consideration that has yet to feature prominently in the discussion about the harms and benefits of STEGH is climate change.

Climate change is the greatest threat to global public health in the 21st century, with stark inherent inequities.18 HICs have historically contributed the majority of emissions, leading to global warming. The United States, the single largest contributing country, emitted 25% of global cumulative CO2 emissions from 1751 to 2017, whereas Africa as an entire continent contributed 3%.19 Conversely, health impacts of climate change including sequelae of extreme heat, poor air quality, drought, flooding, and other extreme weather events are borne disproportionately by those who have contributed least to the problem – those in low-middle income countries, low-income communities, and Indigenous peoples.2022 These same communities also suffer more from extractive industry processes and environmental pollution.23 To prevent worsening health impacts, it is clear that we need urgent action to reduce emissions.24

In response to the need for robust climate action, the American Society of Tropical Medicine and Hygiene (ASTMH) Green Task Force advocated that the global health community acknowledge the health impacts of climate change as part of its scope and engage in practices to address it.25 In this perspective piece, we focus on the role of international flights for STEGH from academic medical centers, which encapsulate the climate injustice of who generates emissions and who bears the impacts. Scientific and academic communities are already critically appraising whether international flights are necessary to facilitate productive conferences.26,27 Similarly, the Association of American Medical Colleges recommended medical residency interviews be conducted virtually in 2022–2023 after recognizing the carbon footprint generated by interview travel and other equity considerations.28,29 Aviation, a hard-to-decarbonize sector, is estimated to have contributed to 4% of global warming prepandemic through its CO2 (∼2.4%) and non-CO2 emissions.30,31 Although 4% may seem negligible, only a small fraction of the world’s population is responsible for it, highlighting flying as a privileged activity.32 Gössling and Humpe33 estimated that 1% of the world population emitted 50% of CO2 from commercial aviation. Within higher education institutions, air travel can contribute 30% or more of an institution’s carbon footprint.34,35,36

We argue that an ethical conflict of duty exists for academic medical centers that encourage, facilitate, and finance trainee travel on STEGH. Using “decolonization” and “decarbonization” as guiding principles (see Box 1), we reflect on the carbon impact of STEGH and how global health educators at academic medical centers can promote innovative strategies that embrace climate justice. Here we propose solutions to restructure rotations to align with these principles, acknowledge ecological impact, and engage in advocacy for public policy on climate.

Box 1 Definitions

  • Decolonization: In the context of global health education, decolonization “reaches beyond removal of colonial power and dismantling of colonial structures to include decolonization of the mind that made the colonizer feel superior and the colonized inferior by enforcing structural drivers of discrimination and barriers to self-determination.”16

  • Decarbonization: The process by which countries, individuals, or other entities aim to achieve zero fossil carbon existence. Typically refers to a reduction of carbon emissions at the source (Intergovernmental Panel on Climate Change).37

  • CO2 equivalent (CO2-eq) emission: The amount of carbon dioxide (CO2) emission that would cause the same integrated radiative forcing or temperature change, over a given time, as an emitted amount of a greenhouse gas (Intergovernmental Panel on Climate Change).37

RESTRUCTURING ROTATIONS

Review STEGH offerings.

The demand for STEGH from trainees has grown significantly over the past decades, with more than half of U.S.-based academic medical centers now offering international electives as a component of medical training.46,38 This appears driven by both globalization and increased interest from trainees in experiential learning opportunities, with programs adapting to draw applicants.5,38 There is significant variation in the structure of current STEGH. Academic medical centers should critically review their existing programs for high-quality characteristics such as bilateral, longitudinal relationships with host sites, robust pre-departure orientation, and on-site faculty support for trainees.9,10,13,14,16,17 Institutions whose STEGH offerings are sporadic, unsupported, and of a unilateral nature should consider the limited benefits to host partners and potential harms of continued rotations, including climate impact. Emulating the University of Pennsylvania, they should narrow STEGH offerings by halting international travel on rotations of limited benefit and reallocate support to quality programs, pivot to remote virtual collaboration, or reinvest in local underserved communities.9

Activities abroad.

As noted earlier, academic medical centers should emphasize that STEGH relationships should not be extractive in medical training or climate impact. It is important to acknowledge that STEGH participants generally do not fill critical human resource gaps at host institutions and, when poorly executed, reflect “voluntourism,” impeding opportunities for local practitioners, undermining local health infrastructure, and potentially harming patients.1,11,12,39 If traveling, trainees should take part in research or clinical activities that require in-person presence as a component of longitudinal programs showing demonstrable benefit to host institutions and professional communities. Passive learning via observation and lecture-based programs should be reconsidered given developments in virtual capabilities. In collaboration with host partners, academic medical centers can outline participant expectations that optimize clinical engagement and define appropriate scope of practice for participants’ level of training prior to commencing STEGH placements.

Rotation duration.

Currently, there is significant variation in the duration of STEGH during medical residency. Literature to support an optimal duration is sparse, with most studies on this topic found in pediatrics. For example, a 2016 study summarized that U.S. pediatric residency program electives ranged from 3 to 8 weeks in duration and could not identify the reasons for the recommended duration of 4 weeks.40 The American Board of Pediatrics publication Global Health in Pediatric Education: An Implementation Guide for Program Directors cited their expert opinion of 4 to 6 weeks in 2018, with a 4-week minimum.7,41 There appears to be no association with destination (e.g., distance traveled from sponsoring institution) and length of rotation. Current U.S. accreditation requirements largely ignore time spent outside the sponsoring institution toward minimum requirements for graduation, thus limiting rotation duration for most trainees. Others have advocated maximizing the duration of international electives at the individual rotation and accreditation levels.4,40 We strongly support these measures and would argue that contiguous time abroad not only facilitates a better clinical learning experience but minimizes emissions from multiple flights.40 Institutions sponsoring STEGH in distant host countries should consider greenhouse gas emissions and host partner needs when determining the frequency and minimum duration of the elective, and provide concrete support (e.g., administrative, financial) to host institutions to accommodate trainees for longer rotation durations.

ACKNOWLEDGING ECOLOGICAL IMPACT

Expanding carbon literacy.

Several medical schools across the United States are already integrating climate change into the curriculum.42,43 Global health programs, specifically, pre-departure programs, should highlight the geographically specific climate-health impacts being faced by the host country in addition to locally relevant history and decolonization practices. Education could include the carbon footprint of global health activities such as STEGH and ensuring learners are given tools to engage in sustainable behaviors. At the authors’ institution, for example, trainees participated in an interdisciplinary mock global climate negotiation exercise called “En-ROADS Climate Solutions Simulation” with a climate-policy expert and an economist. This training not only helped participants understand the disproportionate impacts of climate change and the need for urgent action but also highlighted science-based climate targets (as outlined by the IPCC’s 2018 Special Report on Global Warming of 1.5°C) and the impact of specific policies to reach them.44

Internal analysis of carbon footprint.

Academic medical centers that facilitate any health-related or other international electives can conduct an internal analysis of their impact using available online tools. For example, a website is available that incorporates multiple calculators and methods to calculate flight emissions (https://travel-footprint-calculator.irap.omp.eu/), including radiative forces indices to account for non-CO2 effects.45 Using this tool, we estimate that between 2014 and March 2020, our global health program facilitated at least 126 metric tons of CO2-eq emissions through reimbursed trainee travel to our most frequented site in Tanzania alone.45 A majority of the 33 rotations were only 4 weeks long. Using the US Environmental Protection Agency and ClimateWatch databases, on average, a single trainee roundtrip flight contributed more than 1.5 times an average Tanzanian citizen’s yearly CO2-eq emissions.46,47 Travel to Tanzania was only approximately one-third of our global health program activities during this time, and institution-wide analysis including all sites and other exchange programs would reveal further eye-watering comparisons. Such analyses can not only serve as opportunities to reflect on climate injustice but also help generate short- and long-term emissions reduction targets and implementation plans to reduce an institution’s carbon footprint.

Offsetting considerations.

Many commercial airlines offer optional carbon offsets for purchase through programs that plant trees, conserve forests, or fund renewable energy projects, thus theoretically negating the climate impacts of flights. Some universities have implemented offsetting schemes to variable effect.35,36 However, the authors recommend against academic medical centers purchasing offsets as a singular climate solution that allows programs to continue “business-as-usual” and ultimately fail in reducing greenhouse gas emissions.4850 For example, in 2016, the European Union Commission concluded that 85% of the offsetting projects analyzed had a “low likelihood” of actual emissions reductions.50 The offsetting industry is complex, and concerns include lack of transparency and undervaluation at current price points.51,52 Case studies have also described how offset market-driven reforestation projects have displaced Indigenous peoples from their land, leading to the term “carbon colonialism.”53,54 Many frontline communities (i.e., communities that are hit first and worst by harms of environmental damage) reject offsetting as a real climate solution. Offsetting is often considered a “greenwashing” solution because it ignores community effects of fossil fuel extraction such as public health impacts from air, water, and soil pollution, biodiversity loss, and loss of land sovereignty.5356 Instead, academic medical centers should focus on implementing solutions to reduce actual emissions and collaborate with host institutions to identify, develop, and fund climate solutions in the host country, as noted in the ASTMH Green Task Force recommendations.

ENACTING SYSTEMS CHANGE GLOBALLY

In addition to reducing emissions, academic medical centers and their associated educators, clinicians, and researchers should engage in broader climate advocacy efforts. STEGH agreements could incorporate climate and health-associated infrastructure development as identified by the host institution as a component of the partnership. For example, funding a transition to renewable energy such as solar panels might provide reliable electricity and uninterrupted patient care while also improving air quality, mitigating climate change, and providing health co-benefits. Academic institutions can also deepen their interdepartmental collaboration to support novel host country initiatives. United efforts by environmental science, engineering, and agriculture departments to support host site programs addressing energy and food systems would have a greater impact than single siloed projects. In addition, through bidirectional learning, academic medical centers could develop and implement sustainability practices that fit the local context of host countries.

Taking influence to the broadest scale, healthcare workers should be empowered to advocate for action to mitigate climate change and develop climate-resilient communities.55 Global health professionals, in particular, have a unique opportunity to elevate the voices of those most impacted in low- and middle-income countries and actively advocate for public policy change targeting actual emissions reductions. Academic programs can create opportunities for learners and health professionals to engage in climate advocacy on local and national stages, such as organizing legislative “lobby days” and participation in the annual United Nations Conference of Parties conferences.

CONCLUSION

Academic medical centers in HICs that sponsor STEGH should recognize the intersectionality of colonialism and medical voluntourism with the inequitable burdens of climate damage and ongoing contributions to carbon emissions. STEGH are a valuable tool for medical education; however, academic medical centers should recognize the ethical conflict of duty that international travel for global health training poses. Principles of “decolonization” and “decarbonization” should guide academic medical centers collaborating with host institutions to reconceptualize STEGH in three major ways. First, programs should restructure rotations to promote equitable partnerships that foster education and minimize carbon emissions, such as through longer rotation duration, virtual interactions, and halting international travel that is of little value to host institutions. Second, programs should include carbon literacy and acknowledge the ecological impact of STEGH, such as through an internal carbon emissions analysis that can frame impact and accountability for programs. Finally, academic medical centers should leverage their considerable resources and personnel to advocate on the global stage and invest in proposed solutions from host institutions that can address climate-induced impacts on health.

ACKNOWLEDGMENTS

We thank Sarah Sponsler and Becca Freese for their administrative and statistical assistance and Kristina Krohn, Brett Hendel-Paterson, and Mike Sundberg for their thoughtful manuscript feedback.

REFERENCES

  • 1.

    Shah S, Lin HC, Loh LC, 2019. A comprehensive framework to optimize short-term experiences in global health (STEGH). Global Health 15: 27.

  • 2.

    Krohn KM et al., 2021. Global health education during the COVID-19 pandemic: challenges, adaptations, and lessons learned. Am J Trop Med Hyg 105: 14631467.

  • 3.

    Ojo I, Wu A, Lauden S, Slusher T, Gladding S, Danich E, Howard C, 2022. Long-term impact of global pediatrics curriculum, experience, and mentorship in pediatric residency. Am J Trop Med Hyg 106: 10571062.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P, 2009. Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 84: 320325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P, 2007. Global health in medical education: a call for more training and opportunities. Acad Med 82: 226230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, Peck RN, 2018. Impact of global health electives on US medical residents: a systematic review. Ann Glob Health 84: 692703.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Evert J, Stewart C, Chan K, Rosenberg M, Hall T, 2008. Developing Residency Training in Global Health: A Guidebook. San Francisco, CA: Global Health Education Consortium, 119.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Reece J, Dionne C, Krupica T, Lerfald N, Sizemore J, Sofka S, 2020. Can global health opportunities lead to an increase in primary care physicians? J Glob Health 10: 020387.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Gambrah-Sampaney CO, Passman JE, Yost A, Gaulton GN, 2019. How should schools respond to learners’ demands for global health training? AMA J Ethics 21: E772E777.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Garba DL, Stankey MC, Jayaram A, Hedt-Gauthier BL, 2021. How do we decolonize global health in medical education? Ann Global Health 87: 29.

  • 11.

    Sullivan N, 2017. The Trouble with Medical “Voluntourism.” Sci Am. Available at: https://blogs.scientificamerican.com/observations/the-trouble-with-medical-voluntourism/. Accessed December 29, 2022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Sullivan HR, 2019. Voluntourism. AMA J Ethics 21: E815E822.

  • 13.

    Pitt MB, Gladding SP, Majinge CR, Butteris SM, 2016. Making global health rotations a two-way street: a model for hosting international residents. Glob Pediatr Health 3: 2333794X16630671.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Renaud-Roy E, Bernier N, Fournier P, 2020. Host perspective on academic supervision, health care provision and institutional partnership during short-term electives in global health. Med Educ 54: 303311.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    De Visser A, Hatfield J, Ellaway R, Buchner D, Seni J, Arubaku W, Najjuma JN, Hollaar G, 2020. Global health electives: ethical engagement in building global health capacity. Med Teach 42: 628635.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC, 2021. Decolonizing global health education: rethinking institutional partnerships and approaches. Acad Med 96: 329335.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Daffé ZN, Guillaume Y, Ivers LC, 2021. Anti-racism and anti-colonialism praxis in global health-reflection and action for practitioners in US academic medical centers. Am J Trop Med Hyg 105: 557560.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Costello A et al., 2009. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 373: 16931733 [erratum in: Lancet. 2009 Jun 27;373(9682):2200. PMID: 19447250].

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ritchie H, 2019. Who has contributed most to global CO2 emissions? Our World in Data. Available at: https://ourworldindata.org/contributed-most-global-co2. Accessed December 2022.

    • PubMed
    • Export Citation
  • 20.

    Athansiou T, 2019. Can Climate Change Fueled Loss and Damage Ever Be Fair? EcoEquity. Available at: https://www.ecoequity.org/2019/12/can-climate-change-fueled-loss-and-damage-ever-be-fair/. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 21.

    St. Louis ME, Hess JJ, 2008. Climate change: impacts on and implications for global health. Am J Prev Med 35: 527538.

  • 22.

    Romanello M et al., 2021. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 398: 16191662.

  • 23.

    World Health Organization , 2021. Ambient (Outdoor) Air Pollution, Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. Accessed June 2022.

    • PubMed
    • Export Citation
  • 24.

    Intergovernmental Panel on Climate Change , 2018. Summary for policymakers. Global Warming of 1.5°C. An IPCC Special Report on the Impacts of Global Warming of 1.5°C above Pre-Industrial Levels and Related Global Greenhouse Gas Emission Pathways, in the Context of Strengthening the Global Response to the Threat of Climate Change, Sustainable Development, and Efforts to Eradicate Poverty. Cambridge, UK: Cambridge University Press, 324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    American Society of Tropical Medicine and Hygiene (ASTMH) Green Task Force members ; Dumre SP, LaBeaud AD, Ehrlich H, Vazquez Guillamet LJ, Ondigo BN, Sadarangani SP, Wamae CN, Whitfield K , 2022. Why climate action is global health action. Am J Trop Med Hyg 107: 500503.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Bousema T, Selvaraj P, Djimde AA, Yakar D, Hagedorn B, Pratt A, Barret D, Whitfield K, Cohen JM, 2020. Reducing the carbon footprint of academic conferences: the example of the American Society of Tropical Medicine and Hygiene. Am J Trop Med Hyg 103: 17581761.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Yakar D, Kwee TC, 2020. Carbon footprint of the RSNA annual meeting. Eur J Radiol 125: 108869.

  • 28.

    Donahue LM, Morgan HK, Peterson WJ, Williams JA, 2021. The carbon footprint of residency interview travel. J Grad Med Educ 13: 8994.

  • 29.

    American Association of Medical Colleges , 2022. AAMC Interview Guidance for the 2022–2023 Residency Cycle. Available at: https://www.aamc.org/about-us/mission-areas/medical-education/aamc-interview-guidance-2022-2023-residency-cycle. Accessed December 29, 2022.

    • PubMed
    • Export Citation
  • 30.

    International Energy Agency , 2022. Aviation. Paris, London: IEA. Available at: https://www.iea.org/reports/aviation. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 31.

    Klöwer M, Allen MR, Lee DS, Proud SR, Gallagher L, Skowron A, 2021. Quantifying aviation’s contribution to global warming. Environ Res Lett 16: 104027.

  • 32.

    Hopkinson L, Cairns S, 2021. Elite Status: Global Inequalities in Flying. Available at: https://policycommons.net/artifacts/1439908/elitestatusglobalinequalitiesinflying/2067509/. Accessed December 29, 2022.

    • PubMed
    • Export Citation
  • 33.

    Gössling S, Humpe A, 2020. The global scale, distribution and growth of aviation: implications for climate change. Global Environ Change 65: 102194.

  • 34.

    De Jonge Akademie , 2020. Flying High but Flying Less. Available at: https://www.dejongeakademie.nl/publicaties/2015998.aspx. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 35.

    Schmidt A, 2022. University air travel and greenhouse gas mitigation: an analysis of higher education climate policies. Int J Sustain Higher Educ 23: 14261442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Kaeppler C, Holmberg P, Tam RP, Porada K, Stryker SD, Conway K, Schubert C; Medical Student Global Health Study Group, 2021. The impact of global health opportunities on residency selection. BMC Med Educ 21: 384.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Intergovernmental Panel on Climate Change , 2018. Annex I: glossary. Matthews JBR Global Warming of 1.5°C. Cambridge, UK: Cambridge University Press, 541562.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Cherniak W et al., 2017. Host perspectives on short-term experiences in global health: a survey. Lancet Glob Health 50: 11221130.

  • 39.

    Keating EM, Lukolyo H, Rees CA, Dziuban EJ, Ferris MG, Schutze GE, Marton SA, 2016. Beyond the learning curve: length of global health electives. Int J Med Educ 7: 295296.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    St Clair NE et al., 2018. Global health in pediatric education: an implementation guide for program directors. American Board of Pediatrics Global Health Task Force Publication, in collaboration with the American Academy of Pediatrics Section on International Child Health and the Association of Pediatric Program Directors Global Health Learning Community. Available at: bit.ly/globalhealthpedspdguide. https://www.abp.org/content/global-health-program-directors-guide-chapter-7. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 41.

    University of Colorado School of Medicine Climate & Health Program. Available at: https://medschool.cuanschutz.edu/climateandhealth/education/medical-students. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 42.

    Emory Office of Sustainability Initiatives , 2020. Climate Crisis and Clinical Medicine Virtual Elective for Medical Students. Available at: https://sustainability.emory.edu/climate-change-elective-for-medical-students-virtual-classes-and-recordings-in-spring-2020/. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 43.

    En-ROADS Climate Solutions Simulator Climate Interactive. Available at: https://www.climateinteractive.org/en-roads/. Accessed May 20, 2022.

    • PubMed
    • Export Citation
  • 44.

    Barret D, 2020. Estimating, monitoring and minimizing the travel footprint associated with the development of the Athena X-ray Integral Field Unit – an on-line travel footprint calculator released to the science community. Exp Astron 49: 183.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    ClimateWatch , 2022. Available at: https://www.climatewatchdata.org. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 46.

    U.S. Environmental Protection Agency , 2022. Greenhouse Gas Equivalencies Calculator. Available at: https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculatorUpdated. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 47.

    Grayson B, Freya C, Chegwidden OS, Hamman JJ, Jeremy F, Danny C, 2022. California’s forest carbon offsets buffer pool is severely undercapitalized. Front Forests Global Change 5, doi: 10.3389/ffgc.2022.930426.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    West TAP, Börner J, Sills EO, Kontoleon A, 2020. Overstated carbon emission reductions from voluntary REDD+ projects in the Brazilian Amazon. Proc Natl Acad Sci USA 117: 2418824194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Cames M, Harthan R, Füssler J, Lazarus M, Lee C, Erickson P, Spalding-Fecher R, 2016. How Additional Is the Clean Development Mechanism? Analysis of the Application of Current Tools and Proposed Alternatives. CLlMA.B.3/SERl2013/0026r. Prepared for the Directorate-General for Climate Action (DG CLIMA). Berlin: Oko-Institut, INFRAS, Stockholm Environment Institute (SEI). Available at: https://ec.europa.eu/clima/sites/clima/files/ets/docs/clean_dev_mechanism_en.pdf.

    • PubMed
    • Export Citation
  • 50.

    Knorr A, Eisenkopf A, Fichert F, Forsyth P & Niemeier H-M Aviation and Climate Change. London: Routledge, 130144.

  • 51.

    Trove Research Group , 2021. Future Demand, Supply and Prices for Voluntary Carbon Credits—Keeping the Balance. Available at: https://trove-research.com/wp-content/uploads/2021/06/Trove-Research-Carbon-Credit-Demand-Supply-and-Prices-1-June-2021.pdf. Accessed Jan 1, 2023.

    • PubMed
    • Export Citation
  • 52.

    Finley-Brook M, Thomas C, 2011. Renewable energy and human rights violations: illustrative cases from indigenous territories in Panama. Ann Assoc Am Geogr 101: 863872.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Lyons K, Richards C, Westoby P, 2014. The Darker Side of Green: Plantation Forestry and Carbon Violence in Uganda. The Oakland Institute. Available at: https://www.oaklandinstitute.org/sites/oaklandinstitute.org/files/Report_DarkerSideofGreen_hirez.pdf. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 54.

    Brockington D, Ponte S, 2015. The green economy in the Global South: experiences, redistributions and resistance. Third World Q 36: 21972206.

  • 55.

    AmazonWatch , 2021. Statement: Offsets Don’t Stop Climate Change. Available at: https://amazonwatch.org/news/2021/1006-statement-offsets-dont-stop-climate-change. Accessed January 2, 2023.

    • PubMed
    • Export Citation
  • 56.

    Jameton A, 2017. The importance of physician climate advocacy in the face of political denial. AMA J Ethics 19: 12221237.

Author Notes

Address correspondence to Adriana Dhawan, Division of Hospital Medicine, University of Minnesota, Mayo Memorial Building MMC 741, 420 Delaware St. SE, Minneapolis, MN 55455. E-mail: dhawa027@umn.edu

Authors’ addresses: Adriana Dhawan, Zoe Rammelkamp, and Vishnu Surapaneni, Division of Hospital Medicine, University of Minnesota, Minneapolis, MN, E-mails: dhawa027@umn.edu, ramme007@umn.edu, and vsurapan@umn.edu. Kayandabila Johnstone, Arusha Lutheran Medical Centre, Arusha, Tanzania, Eastern and Southern Africa Management Institute, Arusha, Tanzania, and London School of Tropical Medicine & Hygiene, London, United Kingdom, E-mails: johnskay3@hotmail.com or kay.johnstone@lshtm.ac.uk.

  • 1.

    Shah S, Lin HC, Loh LC, 2019. A comprehensive framework to optimize short-term experiences in global health (STEGH). Global Health 15: 27.

  • 2.

    Krohn KM et al., 2021. Global health education during the COVID-19 pandemic: challenges, adaptations, and lessons learned. Am J Trop Med Hyg 105: 14631467.

  • 3.

    Ojo I, Wu A, Lauden S, Slusher T, Gladding S, Danich E, Howard C, 2022. Long-term impact of global pediatrics curriculum, experience, and mentorship in pediatric residency. Am J Trop Med Hyg 106: 10571062.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Drain PK, Holmes KK, Skeff KM, Hall TL, Gardner P, 2009. Global health training and international clinical rotations during residency: current status, needs, and opportunities. Acad Med 84: 320325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P, 2007. Global health in medical education: a call for more training and opportunities. Acad Med 82: 226230.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, Peck RN, 2018. Impact of global health electives on US medical residents: a systematic review. Ann Glob Health 84: 692703.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Evert J, Stewart C, Chan K, Rosenberg M, Hall T, 2008. Developing Residency Training in Global Health: A Guidebook. San Francisco, CA: Global Health Education Consortium, 119.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Reece J, Dionne C, Krupica T, Lerfald N, Sizemore J, Sofka S, 2020. Can global health opportunities lead to an increase in primary care physicians? J Glob Health 10: 020387.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Gambrah-Sampaney CO, Passman JE, Yost A, Gaulton GN, 2019. How should schools respond to learners’ demands for global health training? AMA J Ethics 21: E772E777.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Garba DL, Stankey MC, Jayaram A, Hedt-Gauthier BL, 2021. How do we decolonize global health in medical education? Ann Global Health 87: 29.

  • 11.

    Sullivan N, 2017. The Trouble with Medical “Voluntourism.” Sci Am. Available at: https://blogs.scientificamerican.com/observations/the-trouble-with-medical-voluntourism/. Accessed December 29, 2022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Sullivan HR, 2019. Voluntourism. AMA J Ethics 21: E815E822.

  • 13.

    Pitt MB, Gladding SP, Majinge CR, Butteris SM, 2016. Making global health rotations a two-way street: a model for hosting international residents. Glob Pediatr Health 3: 2333794X16630671.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Renaud-Roy E, Bernier N, Fournier P, 2020. Host perspective on academic supervision, health care provision and institutional partnership during short-term electives in global health. Med Educ 54: 303311.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    De Visser A, Hatfield J, Ellaway R, Buchner D, Seni J, Arubaku W, Najjuma JN, Hollaar G, 2020. Global health electives: ethical engagement in building global health capacity. Med Teach 42: 628635.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC, 2021. Decolonizing global health education: rethinking institutional partnerships and approaches. Acad Med 96: 329335.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Daffé ZN, Guillaume Y, Ivers LC, 2021. Anti-racism and anti-colonialism praxis in global health-reflection and action for practitioners in US academic medical centers. Am J Trop Med Hyg 105: 557560.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Costello A et al., 2009. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 373: 16931733 [erratum in: Lancet. 2009 Jun 27;373(9682):2200. PMID: 19447250].

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ritchie H, 2019. Who has contributed most to global CO2 emissions? Our World in Data. Available at: https://ourworldindata.org/contributed-most-global-co2. Accessed December 2022.

    • PubMed
    • Export Citation
  • 20.

    Athansiou T, 2019. Can Climate Change Fueled Loss and Damage Ever Be Fair? EcoEquity. Available at: https://www.ecoequity.org/2019/12/can-climate-change-fueled-loss-and-damage-ever-be-fair/. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 21.

    St. Louis ME, Hess JJ, 2008. Climate change: impacts on and implications for global health. Am J Prev Med 35: 527538.

  • 22.

    Romanello M et al., 2021. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 398: 16191662.

  • 23.

    World Health Organization , 2021. Ambient (Outdoor) Air Pollution, Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. Accessed June 2022.

    • PubMed
    • Export Citation
  • 24.

    Intergovernmental Panel on Climate Change , 2018. Summary for policymakers. Global Warming of 1.5°C. An IPCC Special Report on the Impacts of Global Warming of 1.5°C above Pre-Industrial Levels and Related Global Greenhouse Gas Emission Pathways, in the Context of Strengthening the Global Response to the Threat of Climate Change, Sustainable Development, and Efforts to Eradicate Poverty. Cambridge, UK: Cambridge University Press, 324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    American Society of Tropical Medicine and Hygiene (ASTMH) Green Task Force members ; Dumre SP, LaBeaud AD, Ehrlich H, Vazquez Guillamet LJ, Ondigo BN, Sadarangani SP, Wamae CN, Whitfield K , 2022. Why climate action is global health action. Am J Trop Med Hyg 107: 500503.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Bousema T, Selvaraj P, Djimde AA, Yakar D, Hagedorn B, Pratt A, Barret D, Whitfield K, Cohen JM, 2020. Reducing the carbon footprint of academic conferences: the example of the American Society of Tropical Medicine and Hygiene. Am J Trop Med Hyg 103: 17581761.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Yakar D, Kwee TC, 2020. Carbon footprint of the RSNA annual meeting. Eur J Radiol 125: 108869.

  • 28.

    Donahue LM, Morgan HK, Peterson WJ, Williams JA, 2021. The carbon footprint of residency interview travel. J Grad Med Educ 13: 8994.

  • 29.

    American Association of Medical Colleges , 2022. AAMC Interview Guidance for the 2022–2023 Residency Cycle. Available at: https://www.aamc.org/about-us/mission-areas/medical-education/aamc-interview-guidance-2022-2023-residency-cycle. Accessed December 29, 2022.

    • PubMed
    • Export Citation
  • 30.

    International Energy Agency , 2022. Aviation. Paris, London: IEA. Available at: https://www.iea.org/reports/aviation. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 31.

    Klöwer M, Allen MR, Lee DS, Proud SR, Gallagher L, Skowron A, 2021. Quantifying aviation’s contribution to global warming. Environ Res Lett 16: 104027.

  • 32.

    Hopkinson L, Cairns S, 2021. Elite Status: Global Inequalities in Flying. Available at: https://policycommons.net/artifacts/1439908/elitestatusglobalinequalitiesinflying/2067509/. Accessed December 29, 2022.

    • PubMed
    • Export Citation
  • 33.

    Gössling S, Humpe A, 2020. The global scale, distribution and growth of aviation: implications for climate change. Global Environ Change 65: 102194.

  • 34.

    De Jonge Akademie , 2020. Flying High but Flying Less. Available at: https://www.dejongeakademie.nl/publicaties/2015998.aspx. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 35.

    Schmidt A, 2022. University air travel and greenhouse gas mitigation: an analysis of higher education climate policies. Int J Sustain Higher Educ 23: 14261442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Kaeppler C, Holmberg P, Tam RP, Porada K, Stryker SD, Conway K, Schubert C; Medical Student Global Health Study Group, 2021. The impact of global health opportunities on residency selection. BMC Med Educ 21: 384.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Intergovernmental Panel on Climate Change , 2018. Annex I: glossary. Matthews JBR Global Warming of 1.5°C. Cambridge, UK: Cambridge University Press, 541562.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Cherniak W et al., 2017. Host perspectives on short-term experiences in global health: a survey. Lancet Glob Health 50: 11221130.

  • 39.

    Keating EM, Lukolyo H, Rees CA, Dziuban EJ, Ferris MG, Schutze GE, Marton SA, 2016. Beyond the learning curve: length of global health electives. Int J Med Educ 7: 295296.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    St Clair NE et al., 2018. Global health in pediatric education: an implementation guide for program directors. American Board of Pediatrics Global Health Task Force Publication, in collaboration with the American Academy of Pediatrics Section on International Child Health and the Association of Pediatric Program Directors Global Health Learning Community. Available at: bit.ly/globalhealthpedspdguide. https://www.abp.org/content/global-health-program-directors-guide-chapter-7. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 41.

    University of Colorado School of Medicine Climate & Health Program. Available at: https://medschool.cuanschutz.edu/climateandhealth/education/medical-students. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 42.

    Emory Office of Sustainability Initiatives , 2020. Climate Crisis and Clinical Medicine Virtual Elective for Medical Students. Available at: https://sustainability.emory.edu/climate-change-elective-for-medical-students-virtual-classes-and-recordings-in-spring-2020/. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 43.

    En-ROADS Climate Solutions Simulator Climate Interactive. Available at: https://www.climateinteractive.org/en-roads/. Accessed May 20, 2022.

    • PubMed
    • Export Citation
  • 44.

    Barret D, 2020. Estimating, monitoring and minimizing the travel footprint associated with the development of the Athena X-ray Integral Field Unit – an on-line travel footprint calculator released to the science community. Exp Astron 49: 183.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    ClimateWatch , 2022. Available at: https://www.climatewatchdata.org. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 46.

    U.S. Environmental Protection Agency , 2022. Greenhouse Gas Equivalencies Calculator. Available at: https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculatorUpdated. Accessed January 3, 2023.

    • PubMed
    • Export Citation
  • 47.

    Grayson B, Freya C, Chegwidden OS, Hamman JJ, Jeremy F, Danny C, 2022. California’s forest carbon offsets buffer pool is severely undercapitalized. Front Forests Global Change 5, doi: 10.3389/ffgc.2022.930426.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    West TAP, Börner J, Sills EO, Kontoleon A, 2020. Overstated carbon emission reductions from voluntary REDD+ projects in the Brazilian Amazon. Proc Natl Acad Sci USA 117: 2418824194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Cames M, Harthan R, Füssler J, Lazarus M, Lee C, Erickson P, Spalding-Fecher R, 2016. How Additional Is the Clean Development Mechanism? Analysis of the Application of Current Tools and Proposed Alternatives. CLlMA.B.3/SERl2013/0026r. Prepared for the Directorate-General for Climate Action (DG CLIMA). Berlin: Oko-Institut, INFRAS, Stockholm Environment Institute (SEI). Available at: https://ec.europa.eu/clima/sites/clima/files/ets/docs/clean_dev_mechanism_en.pdf.

    • PubMed
    • Export Citation
  • 50.

    Knorr A, Eisenkopf A, Fichert F, Forsyth P & Niemeier H-M Aviation and Climate Change. London: Routledge, 130144.

  • 51.

    Trove Research Group , 2021. Future Demand, Supply and Prices for Voluntary Carbon Credits—Keeping the Balance. Available at: https://trove-research.com/wp-content/uploads/2021/06/Trove-Research-Carbon-Credit-Demand-Supply-and-Prices-1-June-2021.pdf. Accessed Jan 1, 2023.

    • PubMed
    • Export Citation
  • 52.

    Finley-Brook M, Thomas C, 2011. Renewable energy and human rights violations: illustrative cases from indigenous territories in Panama. Ann Assoc Am Geogr 101: 863872.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Lyons K, Richards C, Westoby P, 2014. The Darker Side of Green: Plantation Forestry and Carbon Violence in Uganda. The Oakland Institute. Available at: https://www.oaklandinstitute.org/sites/oaklandinstitute.org/files/Report_DarkerSideofGreen_hirez.pdf. Accessed July 13, 2023.

    • PubMed
    • Export Citation
  • 54.

    Brockington D, Ponte S, 2015. The green economy in the Global South: experiences, redistributions and resistance. Third World Q 36: 21972206.

  • 55.

    AmazonWatch , 2021. Statement: Offsets Don’t Stop Climate Change. Available at: https://amazonwatch.org/news/2021/1006-statement-offsets-dont-stop-climate-change. Accessed January 2, 2023.

    • PubMed
    • Export Citation
  • 56.

    Jameton A, 2017. The importance of physician climate advocacy in the face of political denial. AMA J Ethics 19: 12221237.

Past two years Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1229 1229 45
PDF Downloads 275 275 24
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save