“How is it possible that, despite the incredible impact of the living environment and climate change on people’s health, we only spend 20 hours on this throughout the entire programme?” Students took this question to Ed van Beeck and Lex Burdorf of the Public Health department of Erasmus MC. Burdorf is the head of department, while Van Beeck is responsible for the education branch. They agreed this was a fair question, so they drew up a plan and requested funds to tackle this issue.

“Hotter summers are causing more cardiovascular disease, and poor air quality means more asthma. We can already see the consequences of global warming in the consulting rooms”, Burdorf says. “Wherever you go, these consequences are making people ill. As a result, there is a lot of support for more sustainability in the curriculum at Erasmus MC.”

Everything is about sustainability

Sustainability is a broad concept in this context. It covers the consequences of climate change (‘which is already causing deaths in some parts of the world’, says Burdorf), waste, food and the living environment. In fact, it covers pretty much everything in the field of Social Health Care, so everything external to the body. “The most sustainable treatment is no treatment”, Burdorf argues. In short, prevention is better than cure, and this is crucial in a health care system that is coming under ever more pressure.

While the lecturers discussed the approach on the 24th floor of Erasmus MC, students in teaching space 73 were playing the climate game. The course on sustainability they are currently taking was still an elective last year but is now mandatory for all third-years. As part of this course, the students have to play a card game, which involves linking health consequences to human actions using playing cards. What are the consequences of guaranteeing the supply of food? You need infrastructure, greenhouses and intensive agriculture for this. This form of agriculture uses pesticides to get rid of insects, so what happens if someone ingests these pesticides? The students’ discussion continues.

“The consequence is that you get sad”, student Pieter jokes about the climate game that is supposed to make students think about climate change. Image credit: Tyna Le


“And all of this results in depression”, student Pieter jokes, referring to the last card in the row: mental health. “Well, kind of…” Van Beeck joins in and explains: “Last year, we noticed that some students were a bit downhearted after playing this game. After all, what can you do in the face of such massive problems? We will spend more time on that this year. The best thing you can do as a doctor is to give people hope.”

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Van Beeck uses the changes in prescriptions as an example. It used to be the case that patients would get a standard dose. If a box contained 12 pills, the patient would get 12 pills, even if they only needed 6. The other half would be disposed of. Nowadays, patients get exactly the amount they need. “That prevents a lot of waste. We also focus on how we use gloves, since they are hardly always necessary. In many situations, it is more hygienic to properly wash your hands.”


“I’m not really hearing anything I haven’t heard before”, student Elise admits regarding the game. “But it does make more sense now”, says Tim, who is sitting across the table. That is something she can agree with. There were no large discussions this day, unlike a week before, Julliette Mattijsen says. She is one of the students who hoped to see sustainability better represented in the curriculum. “Last week, we also had students who didn’t really believe in climate change. That resulted in an open and interesting discussion. Ultimately, they recognised that human actions can in some cases have consequences for people’s health.”


“When it comes to sustainability in education, Medicine presents a great example for the other programmes on Campus Woudestein to follow.” This is what Derk Loorbach, professor of Socio-Economic Transitions, said during the last sustainability dialogue, a series of meetings about the sustainable future of the university. Burdorf: “He’s not wrong. I think he said that because we just went ahead and did it. We started discussing sustainability in our education without asking: is this really necessary? I attended some of those dialogues, and I thought, ‘I don’t get it.’ Why spend all that time endlessly debating how useful it is?”

Van Beeck quietly nods while Burdorf speaks. They both consider it a necessity to have doctors think about a sustainable way of working, as well as the impact on the living environment.  For too long, the focus in this programme was on individual health, on everything that takes place inside the human body and on consulting room skills”, says Van Beeck.

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Green birth

The two lecturers argue that the climate, sustainability and global warming should receive more attention than they are able to devote to these subjects in their regular teaching hours. It is important for other specialisations to contribute as well. “We offer training courses to lecturers in other disciplines about how they can incorporate these themes in their education”, Van Beeck says. “At gynaecology, they have started discussing green births, which result in less waste during the birthing process.”

The new curriculum for Medicine, which will kick off in September, will have a stronger focus on case studies. “The first week of the very first introductory period will feature a case study on our living environment”, Burdorf says. “It focuses on the question, ‘How healthy is Rotterdam?’. The students will get data about the health of residents over the past 10 years. The goal is to make them think about where the differences come from. Is it the lifestyle, income, the amount of greenery in the environment? And why do people in Kralingen have a higher life expectancy than those in Zuid? The message: the environment in which you live and study determines your and your neighbours’ health.”

“We really had an idea behind it, but you should have been there during the process.” Image credit: Tyna Le