Written for Hotter Than a Habanero, a blog dedicated to promoting discussions on climate science at the Meadows Center for Water and the Environment, Texas State University, Jones reflects on emerging paradigmatic shifts and trends in climate health.

There’s a term that describes the difficulty of understanding a crisis while in the midst of it: “the fog of war.” Coined in 1832 by Prussian military analyst Carl von Clausewitz, it describes the challenge of putting together a big picture in a chaotic, ever-changing environment. Although information is essential, Clausewitz observed, much of it is “contradictory, a still greater part is false, and by far the greatest part is of a doubtful character,” a reality which produces the “difficulty of seeing things correctly.”1

The fog of war, climate edition. Photo Source: The New Statesman

Climate change has been like the fog of war, especially at the intersection of nature + health. Although scientific research, empirical data, and indigenous knowledge have established a solid and viable connection between human health and the environment, this narrative has long played out as a tale of contradictions, falsehoods, and blame-shaming. Climate scientists have been labeled alarmists, indigenous knowledge dismissed, and researchers’ energies diverted by the need to defend what constitutes a basic fact. Such is the fog of war. It’s been difficult to see things correctly.

Dealing with complexity when we cannot see the pieces? Photo Source: ClimateChangeFork Blog

There are signs that the fog of war is beginning to dissipate, and as it does, it’s evident that a new discourse on nature + health is on the horizon. Within the past few years, change has been tacitly unfolding – funding for eco-health research has increased, public health resources specific to climate change have been created,2 peer-review medical journals dedicated exclusively to nature and human health have emerged, and in an unprecedented move, the medical community has banded together to issue an urgent call to action for the impending public health crisis caused by climate change.3 Indeed, even the taboo and stigma once attached to merely using the term “climate change” has begun to wane.

Many doctors have begun to observe the effect of climate on health. According to Renee Salas at Massachusetts General Hospital, an increasing number of patients are presenting climate-related illnesses, including heat exhaustion, respiratory problems from air pollution and a longer allergy season, and climate-enhanced vector-borne diseases (e.g., from ticks, mosquitoes). The cost of increases in these diseases has been estimated at over $820 billion per year. Photo Source: Grist / J-Elgaard 

It has been said that three creative ideas are central to science — order, causes, and chance.4 It’s the latter, the idea of chance, that is at work lifting the fog of war. Like many paradigmatic shifts, the nature + health paradigm shift is largely the result of chance, triggered by the accidental coming together of seemingly unrelated events and phenomena — the COVID-19 pandemic, the record-breaking global heat waves in 2022, and the millennial generation coming into their own.

The pandemic changed everything. It changed the way we work and leisure, as well as the value we attach to both; it changed the way we shop and buy groceries, how we educate our youth, and even how we communicate with each other. The pandemic also changed how we access health care, build hospitals, and prioritize health and well-being. At the same time, COVID-19 exposed deep cracks and crevices in equity and justice, ranging from the disproportionate burden women continue to shoulder for childcare to massive gaps in the distribution of wealth and widespread disparities in access to green and blue spaces.5 Just as historians did following the 1918 flu pandemic, historians assessing COVID’s impact will likely find that the COVID-19 pandemic was a great game changer, a catalyst for shifting demographic patterns, social dynamics, consumer consumption, and economic policies. And perhaps even a shift in the nature + health paradigm after the fog of war finally clears.

Although research is still emerging, it’s clear that there was a significant increase in outdoor activities during the pandemic and that this exposure resulted in less depression, anxiety, and stress and more happiness and life satisfaction. The pandemic also appears to have impacted the personal connection many of us have with nature. Restrictions in movement and travel and the stress of living through the pandemic became a conduit for developing deeper and more meaningful connections to nature. Research is showing that people took more time to appreciate and engage with everyday nature, including listening to birds sing, noticing butterflies, and cultivating backyard gardens. One national study found that the most helpful thing nurses did to deal with pandemic burnout and fatigue was “spending time in nature.”6 Notably, this response ranked higher than “regular exercise,” “having a safe place to stay,” or even “spiritual connections,”6 reaffirming what has long been known – nature heals.

As early as 400 B.C., the father of medicine, Hippocrates, observed that the physician treats, but nature heals. Photo Source: Wevorce

This past summer, record-breaking heat that swept across the globe became another catalyst for shifting the discourse on nature + health. It was hotter, faster, and stronger, making it virtually impossible to ignore or deny the effects of climate change. We saw public transportation systems crash, destructive wildfires ignite, devastating droughts, food production compromised, and thousands and thousands of people die, 20,000 in Europe alone. We also saw cities struggle for the first time with the reality of urban heat islands;7 Chief Heat Officer positions were created, early warning heat alert notification systems were put into place, and community initiatives were launched to protect vulnerable populations disproportionately impacted by extreme heat. Science was filtered through a different cultural lens this past summer. The unequivocal link between increased hospital admissions, spikes in emergency room visits, and surges in violence, crime, and mortality during extreme heat assumed a new reality. The summer of 2022 made it abundantly clear that heat is not just a matter of physical discomfort or inconvenience, it’s a matter of public health.

Another critical factor linked to the impending shift in the nature + health paradigm is that a new generation is coming of age, the millennials, and they are bringing with them new ways of thinking and doing green. Born in the digital age, millennials are tech-savvy, prioritize a work-life balance, and demand collaboration and transparency in the workspace. They are also health-conscious, socially aware, and determined to break away from business-as-usual norms. Frustrated by the medical community’s ongoing failure to prepare students to meet the rigors and challenges of climate change — only 6% of medical schools currently offer courses on environmental health — a small group of medical students gathered to create change. They developed the Planetary Health Report Card, a metric tool that rates medical schools on a range of eco-health issues, including curricula content, interdisciplinary research, and campus sustainability.8 Since its inception in 2019, this report card has evaluated more than 60 medical schools in five countries and has been used to leverage curricula change successfully in medical education. Business is becoming anything but usual. Next up? Gen Z, which has already been dubbed “the climate career generation” for their activism and commitment to changing the eco discourse.

Schematic representation of the concept of Planetary Health Report Card. Photo Source: Centers for Disease Control and Prevention

Of course, only time will tell how this eventually plays out, but one thing is certain. Change is on the horizon, propelling new visions, approaches, and solutions at the intersection of nature + health. The other certainty is that this change cannot be sustained in a vacuum or transpire on its own; change is neither automatic nor guaranteed. This is an all-hands-on-deck, a stand-up and be counted, and a where are you self-check-in moment for all of us. The words of Martin Luther King Jr. seem apropos: “Change does not roll on the wheels of inevitability but comes through continuous struggle.” Ready?9

Dr. Rose Jones has a doctorate in Medical Anthropology from Southern Methodist University and extensive experience in academic and applied research. Her areas of expertise include planetary health, qualitative methods, and nature-based solutions. She is preparing to launch the Texas Trees Foundation’s Nature Lab, a think-and-do green tank dedicated to creating change at the intersection of public health and environmental science.


  1. I first encountered the “fog of war” concept in a guest blog written by Michelle Moon for “Essential Evaluators,” a blog I co-created for the American Alliance of Museums during the COVID-19 pandemic. Moon succulently and eloquently captured the “fog of war” concept, and I cannot improve her words.
  2. Heat.gov is a web portal created last year by the National Integrated Heat Health Information System to provide heat and health information and resources to the public.
  3. Winston Choi-Schagrin. Medical Journals Call Climate Change the ‘Greatest Threat to Global Health.’ New York Times, September 7, 2021. https://www.nytimes.com/2021/09/07/climate/climate-change-health-threat.html
  4. Jacob Bronowski. (1992) The Scientific Revolution and the Machine IN The Common Sense of Science. Vintage Books, New York, pp.23-32.
  5. Managing the Need to be Treed. Dallas Tree Equity Report. Texas Tree Foundation, 2022. https://texastreesfoundation.box.com/s/ah2ww655xakq10p0617iafqndowkov2z.
  6. American Nurses Foundation, Pulse on the Nation’s Nurses COVID-19 Survey Series: Mental Health and Wellness Survey 2, December 2020.
  7. Urban Heat Island Management Study. Texas Trees Foundation, 2017. https://www.texastrees.org/wp-content/uploads/2019/07/Urban-Heat-Island-Study-Final_Print-Logos.pdf
  8. Planetary Health Report Card: Medical Students for a Sustainable Future. https://ms4sf.org/planetary-health-report-card/
  9. Check out Nature Lab, the new “Think-and-Do” green initiative Texas Trees Foundation is launching to facilitate change at the intersection of public health and the environment. https://www.texastrees.org/nature-lab/

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