Policy & Education

What does ‘planetary health’ mean? Definitions, critical questions and implications

Author: Ben Daley1
Author Affiliation: 1SOAS, University of London

‘Planetary health’ has emerged as a new concept within public health, a new multidisciplinary field of study, and a call for action and policy change in relation to human health and the environment. But what exactly does ‘planetary health’ mean? To what extent – and in what ways – is the field a novel development in the intellectual landscape? Does it represent a distinctively new approach to the study of health and environmental change, or simply a re-framing of pre-existing (and well-worn) debates in the closely-related fields of ecological public health, global health, environmental change and sustainable development? Are there genuinely new insights to be gained – and truly novel intellectual and policy contributions to be made – by work that addresses planetary health explicitly? Or does the rhetoric of planetary health represent simply another attempt to drive environmentalist concerns higher up policy agendas and to reach new constituencies by linking those concerns explicitly with health needs? Here, these questions are examined critically and the potential importance and contribution of the field is evaluated, with some important implications. In this analysis, the field of planetary health is best regarded as an extension of public health concerns to the planetary scale, focusing particularly on the interactions between health and global environmental change (although it overlaps with other, closely-related fields of study). The field of planetary health does not yet cover new ground, but it does frame health and environmental concerns in new ways which can appeal to broader constituencies. But there is a danger that the field of planetary health – if insufficiently focused on its core concern – could become merely another form of vague, aspirational but ultimately almost meaningless form of academic endeavour. Therefore, there is an urgent need for greater conceptual clarity about the distinctive scope and concerns of planetary health, especially given that the health impacts of global environmental change have long been the subject of scholarly concern in other fields. Yet this also presents an opportunity: for work on planetary health to create genuinely new understandings of the diverse, intricate, complex and context-specific ways in which global environmental change and health are interrelated. Arguably, if work in planetary health can achieve greater conceptual clarity – and can develop new theory about the complex interactions between health and global environmental change – then it could yield genuinely new insights (rather than just new rhetoric) into the complex connections between health and global environmental change.

New age public health professionals –enabling millennials to engage with the future of the planet

Authors: Anne-Thérèse McMahon1,Dr Joanna Russell1Bridget Kelly1 ,Heather Yeatman1
Author Affiliations: 1School of Health and Society, Faculty of Social Sciences, University of Wollongong;

Background: Diminishing agricultural resources, climate change, increasing global populations and environmental damage has heightened awareness in academia and the global community about the importance of robust and sustainable food systems. Well trained public health professionals who are able to work across disciplines and across community interest groups are required to ensure food practices are not only sustainable but support global population health. In light of these imperatives the public health discipline at University of Wollongong developed a new course to enable graduates in public health to achieve positive impacts in societies that we are yet to imagine.

Methods: A curriculum review of the undergraduate public health coursework at the University of Wollongong was conducted in 2015 through a series of online surveys of past and present students, external stakeholders and consultation with eminent public health professionals. Qualitative and quantitative data were gathered on the skills and knowledge requirements for future public health professionals. The current programs were also mapped against relevant professional competencies, undergraduate public health programs at other Australian universities and the Australian Qualifications Framework.

Results: Key areas of focus identified by the stakeholders consulted included: the need for more practical skills and work placement experiences; additional topics such as health economics, food services; as well as climate change and sustainability. These were placed within a social sciences framework that promotes critical analysis and social theory, engagement and leadership within communities, advocacy, values (human rights and justice) and planetary responsibility. Food and Society was one of three major areas of study. It was designed to equip students with the skills and attributes to apply innovative approaches to food and nutrition across the life course, sustainable food systems, and food education, promotion and advocacy from local to global. Coursework emphasises food systems and sustainability, food sovereignty and power, as well as the important role food plays in social inclusion and the welfare state.

Interpretation: Key imperatives within the changing food system need to be addressed by a broad ranging capable workforce including public health professionals to ensure the food systems are not only sustainable but support both the environment and health within populations. The new major will have ongoing evaluation involving community food producers, students and graduates as well as discipline experts.

Climate-health curricula among international health professions schools: a survey

Authors: Brittany Shea1,2, Jeffrey Shaman3Kim Knowlton3,4
Author Affiliations: 1Columbia University Mailman School of Public Health; 2Global Consortium on Climate and Health; 3Climate and Health Program, Columbia University Mailman School of Public Health; 4Natural Resources Defense Council 

Background: Climate change is already affecting human health in a variety of ways, including impacts on heat-related illnesses, infectious diseases, foodborne diseases, allergies and respiratory conditions, cardiovascular disease, and mental health. These impacts are expected to adversely affect human health, especially in more vulnerable populations. Yet, understanding of the climate-health nexus remains incomplete with a modest number of experts, significant gaps in knowledge, and few developed educational programs or curricula in health professions schools. To bridge this gap, it is critical to include climate and health, planetary health, and sustainable development topics in health profession schools’ curricula as a foundational part of student education. The Global Consortium on Climate & Health Education (GCCHE) was formed to help fill this need, by securing commitments from health professions schools around the world to educate their students on the impacts of climate change and other planetary changes that impact human health and well-being, and to provide the curricular resources and guidance needed to implement those commitments. (Aim): The GCCHE aims to develop a baseline assessment of current climate-health education as a first step toward improving this educational content.

Methods: We are conducting an ongoing survey of climate-health curricula among GCCHE members to determine existing course and programmatic offerings, identify gaps in education, and understand challenges to instituting more comprehensive curricula.

Findings: As of January 4, 2018, preliminary results reveal that most respondents already offer some climate-health education, typically as part of a required core course or a climate-health standalone elective course; however, the majority do not offer planetary health modules, courses, or programs. Of the respondents that do offer planetary health, the majority are linked or integrated with climate-health modules or programs. Most respondents are discussing adding climate-health offerings and have received positive feedback supporting this addition from students, faculty, and/or administration, but have encountered challenges trying to institute climate-health curriculum, including a lack of time and funding to support content development and a lack of space in core curricula.

Interpretation: There is a pressing need for climate-health curricula growth in health professions schools. The GCCHE baseline survey results provide an international context that can inform development of adaptable climate-health content targeted to health professions’ curricula. Lessons from the survey will serve GCCHE schools globally as they expand climate-health expertise among the next generation of global health leaders.

Attitudes towards climate change and sustainability: A cohort study of student nurses and midwives exposed to sustainability education

Authors: Janet Richardson1, Paul Warwick1Jane Grose1Daniel Clarke1
 Author Affiliations: 1Plymouth University

The Lancet Countdown on Climate Change calls for urgent action on health and climate change; however limited attention is given to the pedagogical approaches needed to respond to these challenges.

The aim of this study was to explore the extent to which attitudes changed during a course of nurse education in which sustainability featured as a topic. Additionally, we assessed the usefulness of the resources and the pedagogical approach used.

METHODS
A cohort study assessed students’ attitudes towards sustainability and climate change in each year of their academic studies. Students participate in scenario-based sessions specifically designed to raise awareness about sustainability, climate change and health in each year of their three-year course. The ‘Sustainability Attitudes in Nursing Survey’ (SANS) questionnaire used in this study was developed and piloted at Plymouth University (UK) in order to assess the impact of sustainability awareness sessions. It has subsequently been translated for use with German, French, Spanish, Swedish and Arabic speaking students. Students were also asked questions about the usefulness and perceived relevance of the sustainability sessions and the pedagogical approach.

RESULTS
Significant differences were found between year 1 and year 2 scores (with more agreement in year 2) on the statements: Climate change is important for healthcare (p=0.000); Issues about climate change should be included in the curriculum (p=0,000); Sustainability is an important issue for nursing / midwifery (p=0.000); Sustainability should be included in the curriculum; I apply sustainability principles at home. Significant differences were found between year 2 and year 3 scores on the statements: Sustainability is an important issue for nursing / midwifery (p=0.004); I apply sustainability principles at home (p=0.03). Mean scores indicate that the change was in the direction of higher scores (more agreement with the statements) in year 2 than in year 3. Feedback on the relevance and usefulness of the scenario-based approach showed more than 95% of participants rated the sessions positively in year 2 and more than 84 % rated the year 3 session positively.

CONCLUSIONS
Our findings indicate that teaching sustainability and climate using scenario-based approaches can lead to positive attitudes toward these subjects; the greatest changes appeared to be between years 1 and 2. Furthermore, the feedback on the scenario-based pedagogical approach was positive, and students found the sessions interesting, engaging and enjoyable. 

Using art and story to explore how primary school students in rural Tanzania understand planetary health: research in process

Authors: Elizabeth VanWormer1,4Jesca Mlawa2Elizabeth Komba2Christopher Gustafson3, Jenny M. Dauer4
Author Affiliations: 1School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln; 2Friends of Ruaha Society, Tanzania; 3Department of Agricultural Economics, University of Nebraska-Lincoln; 4School of Natural Resources, University of Nebraska-Lincoln

Background: The global planetary health community increasingly recognizes the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students’ current concepts of linkages among the health of humans, animals, and shared environments may advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania have direct experience with these connections as they share a water-stressed, but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on agricultural (crop and livestock) production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students’ understanding of connections between human health and environment.

Methods: Working with 26 village primary schools in Iringa Rural District, Tanzania, we adapted an art and story outreach activity to explore student perceptions of planetary health concepts. Following a standardized training session, a lead teacher at each primary school helped students, aged 12 to 15, form small teams to independently develop and illustrate a story centered on themes of how human health depends on water sources; wildlife; livestock; climate; and forest or grassland resources. Students were encouraged to discuss these themes with their teachers, peers, and families while developing their stories to gain broader as well as historical perspectives. During October – November of 2017, the students generated stories that incorporated solutions to challenges within these themes. Written materials and illustrations were collected from each school along with data on gender and tribe of the group members. We translated all stories from Swahili to English for analysis.

Preliminary Findings and Interpretation: A total of 1,043 students in 168 groups participated in the art and story activity, with groups containing an average of six students (range: 4 to 11 students). In our preliminary review, students identified diverse connections between human health and environmental change through pathways including clean air and water provision by forests; altered food, fuel, and medicinal resources; contact with animals and their waste; livelihood impacts; and cultural values. We are in the process of coding and analyzing the student submissions to explore and describe their understanding of planetary health and identify potential differences among student groups related to village, gender and tribe.

Emancipatory Nursing: opportunities for action in the Anthropocene

Authors: Fiona Hanley1
Author Affiliations: 1Dawson College/Collège Dawson

Nurses have a long history of advocating for the health and well-being of vulnerable populations, and in reaching out to the most marginalised to offer relief. The emerging discipline of Planetary Health brings an opportunity to highlight the intricate relation between nursing, health and the environment, and the potential to add an important voice to collaborative efforts in addressing the crisis brought by environmental decline.
There is an urgency for nurses to emerge from the shadows of political, economic, social and cultural domination and colonisation, to engage in critical debate in asserting nursing’s unique knowledge and commitment to health. This presentation will highlight this unique knowledge, and reflect on the potential for nurses to undertake an emancipatory role in adopting planetary health as central to the discipline, and as a key factor in transforming the response to the crisis facing the global community.
Despite ecological disaster facing the planet, there is a prevailing disconnect in nurses’ formalised conceptualisation of environment, which remains limited for the most part to the psychosocial domain of the individual or family. This lack of environmental consciousness in the wider nursing profession, has undermined nurse’s efforts in expressing their voice, and reinforced the lack of recognition of nurses as key players in defending the health of the wider global community. There remains a vast reserve of untapped potential for nursing leadership in reaching for solutions.
A number of nursing leaders and scholars from the time of Nightingale have urged nurses to advocate for healthier environments and bring knowledge about environmental health determinants to their practice. Now a renewed global movement of nurses calls for a re-appropriation of environmental health within nursing, recognising the multiple opportunities for action, and highlighting innovative approaches in education, practice and research. Nurses have a strategic position for providing leadership in environmental health. They make up the largest proportion of the health care workforce, and are involved in decision-making for health across the lifespan. They rank high in public trust, have a unique perspective due to their holistic focus, and provide care and health education at an individual, community or population level. Nurses are also responsible for health promotion, illness prevention, relief of suffering, restoration of health, and care of the dying, with compassion at the core of their practice.

In formal and informal settings, nurses are taking on the challenge with educational outreach and collaboration amongst nurses and bringing new hope for transforming and contributing to planetary health.

We propose a greater recognition of the crucial role of nursing in addressing the crisis facing us all, and of the inclusion of nursing’s unique perspective in reaching for solutions, and in crafting an effective response from the ground up.

Using art and story to explore how primary school students in rural Tanzania understand planetary health: research in process

Authors: Elizabeth VanWormer1,4, Jesca Mlawa2, Elizabeth Komba2, Christopher Gustafson3, Jenny M. Dauer4
Author Affiliations: 1School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln; 2Friend of Ruaha Society, Tanzania; 3Department of Agricultural Economics, University of Nebraska-Lincoln; School of Natural Resources, University of Nebraska-Lincoln

Background: The global planetary health community increasingly recognizes the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students’ current concepts of linkages among the health of humans, animals, and shared environments may advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania have direct experience with these connections as they share a water-stressed, but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on agricultural (crop and livestock) production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students’ understanding of connections between human health and environment.

Methods: Working with 26 village primary schools in Iringa Rural District, Tanzania, we adapted an art and story outreach activity to explore student perceptions of planetary health concepts. Following a standardized training session, a lead teacher at each primary school helped students, aged 12 to 15, form small teams to independently develop and illustrate a story centered on themes of how human health depends on water sources; wildlife; livestock; climate; and forest or grassland resources. Students were encouraged to discuss these themes with their teachers, peers, and families while developing their stories to gain broader as well as historical perspectives. During October – November of 2017, the students generated stories that incorporated solutions to challenges within these themes. Written materials and illustrations were collected from each school along with data on gender and tribe of the group members. We translated all stories from Swahili to English for analysis.

Preliminary Findings and Interpretation: A total of 1,043 students in 168 groups participated in the art and story activity, with groups containing an average of six students (range: 4 to 11 students). In our preliminary review, students identified diverse connections between human health and environmental change through pathways including clean air and water provision by forests; altered food, fuel, and medicinal resources; contact with animals and their waste; livelihood impacts; and cultural values. We are in the process of coding and analyzing the student submissions to explore and describe their understanding of planetary health and identify potential differences among student groups related to village, gender and tribe.

Advancing Planetary Health Through Shared, Cross-sector Methods for Action Planning and Evidence Evaluation

Authors: Joshua Goldstein1,2Heather Tallis1,2Katharine Kreis1,3Lydia Olander1,4Claudia Ringler1, 
Authors:1Bridge Collaborative; 2The Nature Conservancy; 3PATH; 4Ecosystem Services Program, Nicholas Institute for Environmental Policy Solutions, Duke University; 5Environment and Production Technology Division at the International Food Policy Research Institute

Background:
Solving major challenges in planetary health requires integration of diverse bodies of evidence that remain largely segregated. The health, development and environment sectors increasingly realize that they cannot achieve their respective goals by acting in isolation. Yet, as they pivot to act collectively, they face challenges in finding and interpreting evidence on sectoral interrelationships, and thus in developing effective evidence-based responses. Each sector already uses some form of evidence-based research, design and action planning, but methods vary and ideas about the strength of evidence differ, creating stumbling blocks in the way of integrated impact for planetary health.

Methods:
Principles and recommendations were developed through a rapid, iterative process undertaken by the Bridge Collaborative. The effort involved >100 experts from 90 organizations representing academic and research institutions, non-profit organizations, research networks, private sector entities, and bilateral and multilateral parties in health, development and environment sectors. Participants were organized into six working groups. Each group was led by co-primary investigators from at least two of the three focal sectors, and each group had membership from all three sectors. Groups were formed around topical challenges including climate change, sustainable food and nutrition, sanitation and water security, and clean air. Each group independently developed and tested ideas regarding principles for cross-sector collaboration, aligned methods for results chain development and evidence evaluation, and barriers to cross-sector advancement. Working group results were integrated into a synthesis set of principles and recommendations culminating in consensus by the co-PIs and Bridge Collaborative Secretariat.

Findings:
We identified six principles for cross-sector collaboration that are important precursors to integrated evidence development and use. Amongst a set of 20 recommendations to improve cross-sector planning, we highlight three recommendations to advance integrated evidence practice: 1) the creation of compatible results chains, 2) the use of all relevant evidence to evaluate strength of confidence, and 3) the evaluation of the strength of confidence using a unified rubric.

Interpretation:
The recommendations for results chain creation and evidence evaluation provide a common language and advance a consistent methodology for the expansion of reference results chains to include multiple sector impacts. Access to reference results chains that include multiple sector impacts could help researchers and practitioners in planetary health realize new plausible interventions, expose the types of impacts that may warrant further exploration, and help identify additional expertise that would be valuable to engage in research or planning efforts.

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