After four generations, an emergency focus on climate change

This story is part of a series of graduate profiles ahead of Commencement ceremonies.

One might think that Julia Malits’ arrival on a medical school campus was nearly preordained, since her mother, grandmother, and great-grandmother were all doctors.

Her mother, a New York anesthesiologist, is the daughter of an Uzbek psychiatrist who came with her family to the U.S. in 1980. Once here, Malits’ grandmother repeated her residency and certification requirements so she could continue to practice in her new home. Malits’ great-grandmother also practiced psychiatry in Uzbekistan, though after arriving with her daughter, she was old enough that she opted not to practice in the U.S.

“After going through and studying for the boards, I have a new appreciation for what that entailed,” Malits said.

Malits said their example was hard to miss, and fostered in her an interest in healthcare from an early age, one that would begin with a focus on individual patients and eventually lead to an even broader interest in health and the environment.

“It came really through lots of conversations with my family and identifying at a young age that I wanted to be in the practice of healing,” Malits said of her own interest in medicine.

This spring, Malits will officially carry on the medical tradition of women in her family. She’ll graduate from Harvard Medical School with an M.D. to go with the master’s degree in public health she earned during a break between her third and fourth year of medical studies.

In June, Malits is planning to enter the joint emergency medicine residency at Massachusetts General and Brigham and Women’s hospitals. She said she was drawn to the specialty because of the urgent and diverse nature of the care, the teamwork required, and because emergency physicians are often the ones who first see people injured during heat waves, hurricanes, and other manifestations of the world’s changing climate, another interest of hers.

When Malits was a child growing up in New York, she always had an affinity for the outdoors, enjoying both the mountains and the seacoast. She began her undergraduate studies at Barnard College but transferred to Cornell after a year, and it was in the environs of upstate New York that her love of the outdoors blossomed.

“Cornell was the perfect place for me to spend time outdoors,” Malits said.

Malits graduated with a degree in biology in 2016 and took two years off before heading to medical school. She worked as an advocate for victims of sexual assault and domestic violence in several hospital emergency departments.

In addition, she conducted research at New York University Medical School’s Division of Environmental Pediatrics, studying how PFAS, the so-called “forever chemicals” that have grabbed headlines in recent years, are impacting child health. She also took her love of hiking to Tanzania, climbing the African continent’s highest mountain, Mount Kilimanjaro.

She came to HMS in the fall of 2018, eager to begin her clinical training, but also to continue her work in environmental health.

“I was really excited, primarily to learn clinical medicine and to have the opportunity to care for patients,” Malits said. “But I was also excited to continue engaging in the work at the intersection of health and the environment, including toxic chemical exposures, climate change, air pollution, and so on.”

Malits took a year off from her medical studies to study for an MPH in occupational and environmental health at Harvard’s T.H. Chan School of Public Health. Aaron Bernstein, interim director of the Chan School’s Center for Climate, Health and the Global Environment, said Malits served as a “student ambassador,” fostering gatherings among students with an interest in climate change. She also worked on C-CHANGE’s project to create a climate tool kit for health clinics across the country, a collaboration with Americares that went live in the fall.

Malits’ work on the project involved conducting research on the health impacts of heat waves. It also involved creating resources — such as checklists for clinic staff, guidance on developing action plans, and advice for patients struggling with diabetes, kidney disease, dementia, and other ailments during extreme heat — to help the clinics, which serve many of the nation’s disadvantaged communities, prepare for climate-driven impacts.

“She did the lion’s share of the work, with regard to both the research about climate issues that pertain to resilience for frontline clinics and also the drafting of many of the resources that are now deployed to clinics around the country,” Bernstein said.

Bernstein said Malits has a deeply held commitment to the issue and a belief that steps taken over the next decade will be key in determining the extent of impacts in the future.

“She’s brilliant, hard-working, and deeply passionate about climate change and what it means to health and health equity,” Bernstein said, adding that emergency medicine will likely give her more exposure to patients impacted by climate-change-related events than some other specialties. “There are many doctors who see very clearly how climate-change-related extreme events land people in their emergency departments. It’s just so visible. If someone gets heat stroke, the first place they’re going for medical care is most likely an emergency department. Someone who is directly affected by a wildfire is going to show up in an emergency department.”

Malits also worked with the group Students for Environmental Awareness and with faculty members to develop and distribute course-related materials that can be used to integrate climate-change-related health themes into HMS courses. The materials include everything from quiz questions to videos to clinical vignettes.

“Climate change is the biggest public health threat of our century, and there are a number of ways that climate change impacts our health and also how healthcare is delivered to patients,” Malits said. “It’s important for all medical students and physicians to have an understanding of how climate change impacts health because it affects patients, no matter what specialty physicians are practicing in.”