Exploring medical students’ perceptions and understanding of the health impacts of climate change: a qualitative content analysis

In this study, 32 final-year medical students in the internship phase were invited to participate in the interviews, of whom 15 individuals (47%) participated in the interviews. Among the participants, 13 individuals were aged between 24 and 29 years, and 2 individuals were aged between 30 and 35 years, with a mean age of 28.8 years. The duration of the interviews ranged from 20 to 50 min, with an average of 35 min, depending on the richness of the participants’ information.

Among the interviews, 229 codes were extracted and categorized into three categories (environmental, socio-economic, and health effects) and 23 subcategories. The category of environmental effects had 8 subcategories, including the effects of climate and global warming, environmental damages, effects on ecosystems, air pollution, water pollution, effects on the aquatic chain, effects on agriculture and the food chain, and weather-related hazards. The category of socio-economic effects had 8 subcategories, including population migration, education, employment, security, urban services and resources, infrastructure, vulnerable groups, and economic issues. The category of health effects had 7 subcategories, including health services, personal health, malnutrition, mental disorders, infectious diseases, vector-borne diseases, non-communicable diseases, and injuries. The extracted codes were categorized into different categories and subcategories, which are presented in Table 1. Some of the most important results related to these categories are discussed below.

Environmental effects

This category included 74 codes that were classified into 8 subcategories according to Table 1. The categorized codes in this group included environmental effects and effects of climate change that have significant impacts on the Earth’s climate and various regions, causing global warming, extreme weather conditions in different areas, and destruction of the environment and ecosystems. The environmental effects of climate change lead to air and water pollution, negative impacts on water and food supply chains and agriculture, and can affect the health of individuals and society. Some of the most important findings related to these subcategories are presented in the following sections.

Global warming impacts

One of the most significant impacts of climate change is the alteration of climate patterns, which can lead to shifts in weather patterns and atmospheric changes. Climate change also results in a rise in Earth’s temperature and global warming. This is caused by changes in temperature, solar radiation, increased absorption of sunlight, heat radiation, and ultraviolet radiation due to ozone depletion. These factors contribute to the formation of heat islands, an increase in hot days, and heat waves. Interviewee 7 and 4 commented on this matter, saying, “A rise in temperature exceeding what our bodies can tolerate can adversely affect our health. It can cause dehydration, disrupt our body’s electrical system, and lead to other health issues.”

“When I worked in the surgery department, an unusual and heavy snowfall occurred in Sanandaj city. Naturally, such events lead to an increase in fractures and traumatic injuries.”

Air pollution

Air pollution is a leading cause of death for millions of people worldwide each year [17, 18]. In some cases, droughts can result in the destruction of forests and wetlands, leading to desertification. As soil erosion intensifies over time, the frequency and severity of dust and sandstorms increase, causing unhealthy air for people to breathe. Interviewee 5 discussed the impact of air pollution and dust storms in Khuzestan province, Iran, saying, “The sandstorms from Iraq cause respiratory problems such as COPD and other respiratory issues for people. These problems also contribute to an increase in cancer rates among the people of Khuzestan, making the cancer rate in this province twice as high as in other regions of the country.”

Water pollution

Climate change can result in increased heavy rainfall and floods, drought, and higher water temperatures, ultimately leading to changes in the quality of drinking water. These changes create new conditions for the growth of bacteria and viruses, leading to various human diseases when exposed to contaminated water. Additionally, water scarcity can also affect human health, particularly during drought conditions. Floods can also cause water pollution and limit access to drinkable water by infiltrating groundwater sources or contaminating freshwater purification systems. Interviewee 11 discussed the impact of droughts and floods on water scarcity and pollution, saying, “Droughts result in water shortages, which have implications for public health. When there is a lack of water, people are forced to quench their thirst with unsafe water, resulting in health problems. Furthermore, floods have health effects, as they can contaminate the city’s water treatment systems and lead to water pollution. Clean water supplies are affected, and the water’s cleanliness is compromised.”

Socio-economic effects

Economic and social effects were categorized into 54 codes under 8 sub-domains, as shown in Table 1. These categorized codes include the economic and social impacts of climate change on various individuals and groups.

Population displacement and migration

The health impact of displacement and migration due to climate change is often exacerbated when combined with other factors, such as chronic poverty and marginalization. Climate change will lead to increased urbanization as a result of increased flooding and drought, and the destruction of agricultural land. In addition, the destruction of homes and shelters due to climate change-induced disasters can lead to forced displacement and migration of individuals, which can ultimately affect their mental and physical health. Interviewee number 8 stated regarding this issue, “Floods can cause damage and leave people under rubble, leading to casualties. The destruction of homes forces people to live in other places, such as refugee camps, where people are in closer contact with each other and have fewer sanitary facilities. They have to use public facilities which can increase the transmission of infections among people.”

Education

Climate change threatens children’s rights to education at a global level [18]. Currently, nearly half of all children reside in countries that are highly susceptible to the effects of climate change, and the majority of these children are also exposed to vulnerable conditions. Climate events often result in damage to school infrastructure or even their destruction, which can ultimately cause children to permanently drop out of school. Also, due to forced migration, the opportunity to get an education is limited for some children. Consequently, climate change can ultimately lead to a decline in the overall literacy rate of society.

Interviewee number 3 stated regarding this issue, “For example, in crisis-stricken areas, access to food is reduced, and people lose everything they have and are unable to meet their needs. Thus, they are forced to work to meet their own and their children’s needs, and they may have to sacrifice their education. In addition, because they cannot meet their basic needs, they may not be able to meet many of their health needs. This can lead to a significant decrease in the health literacy of that region, and when the health literacy of that region decreases, diseases related to that region may increase.”

Infrastructure

Disasters or extreme weather events, can have destructive effects infrastructure, resulting in various consequences. The destructive effects of climate change on infrastructure can result in significant human and financial losses. Interviewee number 11 stated, “Personal hygiene is affected even if proper health services are not available, especially in this area, where children and women are mostly affected. We know that they have physiological needs regardless of their circumstances. For example, women have their menstrual cycle and need to maintain personal hygiene. When they cannot follow these practices, they are more likely to develop certain female-related problems or diseases. Similarly, children who do not have access to proper sanitation facilities, such as bathrooms or toilets, are constantly exposed to unclean environments outside their homes, which can lead to various diseases.”

Health effects

This category, which was extracted from the study and consisted of 101 codes, is divided into seven subcategories, including health services, personal hygiene, malnutrition, mental disorders, infectious diseases, vector-borne diseases, non-communicable diseases, and injuries. The findings related to these subcategories are presented below.

Health services

Climate change can lead to changes in temperature, humidity, and seasonality patterns, which can change the pattern of diseases and lead to an increase in disease burden, resulting in more visits to health centers and hospitals. Climate-related disruptions to supply chains, aid delivery, and patient transport can increase the workload and fatigue of healthcare workers, as well as an increase in casualties and patients requiring medical attention. Also, the occurrence of these disasters and climate events can lead to an increase in deaths, seizures, accidents, trauma, fractures, and drownings. Participant 3 mentions that, “for example, an increase in diseases such as malaria, or diseases for which we have vaccines, may cause a community to lose access to vaccination, leading to an increase in disease burden and pressure on hospitals”. Also, participant number 10 says, “We witnessed the recent snowstorm and saw that most people who forced themselves to travel ended up in the hospital with issues such as falling, trauma, and hypothermia. In many cases, they were also faced with injuries from slipping or car accidents.”

Personal hygiene

Personal hygiene refers to the daily habits individuals practice for their own health, such as bathing, brushing teeth, washing hands, washing clothes, and cleaning dishes. Climate change can lead to drought and water scarcity, making it difficult to access clean and hygienic water for daily needs. On the other hand, the loss of housing and pollution of water sources due to the environmental impacts of climate change can lead to a lack of clean water for personal hygiene or even drinking purposes. Participant 10 explains, “The loss of water resources can result in irregular bathing habits and compromised oral hygiene. Additionally, floods can disrupt water and sewage systems, leading to an increase in infectious diseases that were previously uncommon among the population.”

Malnutrition

In this study, malnutrition refers to individuals’ inability to access sufficient water and food to meet their daily needs due to the effects of climate change. With water insecurity and the prevalence of climate change-related diseases, storms create a perfect storm for unprecedented global nutrition crises. Malnutrition leads to a decrease in vitamins and minerals in the body, which can result in stunted growth in children, kwashiorkor, anemia, scurvy, and rickets.

Participant 12 explains, “The lack of access to food and the increase in food prices due to climate change is causing certain communities to have less access to food. This leads to a smaller dietary intake, malnutrition, and health problems that put their well-being at risk”.

Mental disorders

Climate change and global warming can also lead to an increase in forced migration, which can lead to stress, depression, and anxiety disorders. The rise in climate change-related disasters can result in mental health issues such as post-traumatic stress disorder, adjustment disorder, and depression. Additionally, it can contribute to an increase in physical illnesses that are often accompanied by psychological distress. Heat waves and high temperatures can also cause mood disorders, anxiety disorders, cognitive decline, and social anxiety disorders. Participant 14 states, “The increasing heat and destruction of homes can lead to psychological damage, such as obsessive–compulsive disorders, anxiety disorders, and post-traumatic stress disorder. It can also increase the risk of suicide”.

Communicable disease

The increase in temperature and the decrease in access to clean water, as well as the increase in the population of insects such as mosquitoes, ticks, and cockroaches, can lead to an increase in waterborne infections such as cholera, amoebiasis, and gastroenteritis. Participant number 3 says, “Due to the shortage of water or lack of access to purified water, some people are forced to use stagnant water. Stagnant water contains various microorganisms such as cholera and amoebiasis, which can cause severe diarrhea, vomiting, and other diseases related to those infections.”

Vector-borne diseases

The term “vector-borne diseases” in this study refers to the diseases that are transmitted through the increase in the population of vectors due to changes in seasonal patterns, temperature, and humidity. Increased rainfall can increase the amount of stagnant water and create more breeding grounds for many vectors. Droughts can also create suitable conditions for vector breeding by forming pools of stagnant water. Participant number 9 says, “Water sources that were previously flowing like springs are now becoming stagnant, which increases the risk of parasitic diseases. The population of mosquitoes, ticks, and other vectors also increases, which in turn increases the risk of certain diseases.”

Non-communicable diseases

The term “non-communicable diseases” refers to cardiovascular diseases that are exacerbated by the effects of climate change, including severe heat waves, dust storms, increased pollution, and decreased air quality. Some of these non-communicable diseases, including cardiovascular diseases such as heart attacks, heart failure, arrhythmias, and hypertension, as well as some cancers, respiratory diseases, mental disorders, trauma, and malnutrition, are likely to increase in frequency and severity due to the effects of climate change, especially in individuals with underlying conditions. Participant number 3 states: “Sandstorms can cause new respiratory diseases that the area has not experienced before and exacerbate asthma. Increased pollution can also jeopardize heart health by increasing the incidence of heart attacks, arrhythmias, and heart failure.”