Policy and 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 Russell1, Bridget 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 Shaman3, Kim 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 Warwick1, Jane Grose1, Daniel 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 VanWormer1,4, Jesca Mlawa2, Elizabeth Komba2, Christopher 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 Goldstein1,2, Heather Tallis1,2, Katharine Kreis1,3, Lydia Olander1,4, Claudia 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.

When health care undermines planetary and human health: a conceptual framework

Authors: Martin Hensher1, Ben Canny1, John Tisdell2, John Tisdell3
Author Affiliations: 1School of Medicine, University of Tasmania; Tasmanian School of Business and Economics, University of Tasmania; 3Curtin Learning and Teaching, Curtin University

Background:
Health care is now one of the largest sectors of the world economy, accounting for some 10 per cent of global Gross Domestic Product (GDP). It is implausible that such a large industry would not contribute to human pressure on planetary boundaries. The aim of this project is to develop a conceptual framework that identifies the mechanisms by which the production and consumption of health care may cause damage to both natural systems and to human health, by applying concepts from ecological economics to the study of health care systems.

Methods:
A review of the ecological economics and sustainable consumption literature on overconsumption, misconsumption and uneconomic growth; review of the literature on the environmental impacts of health care; review of the literature on overuse, overdiagnosis and overtreatment in health care. Synthesis of review results into a conceptual framework to identify areas of impact and potential for action to reduce impacts.

Findings:
Health care production and consumption can be broadly divided into that which is beneficial (i.e. improves human health) and that which is not beneficial (either yields little or no benefit, or causes harms to human health). Growing evidence suggests that a significant proportion of health care utilisation and expenditure yields no benefit to patients, while potentially exposing them to harm. At the same time, all health care production potentially has negative ecological impacts – through use of non-renewable natural resources, release of CO2 and other greenhouse gases, direct waste disposal, and indirect release of pharmaceutical and other waste products (e.g. via excretion) that may damage natural systems.

Interpretation:
Even while “right care” brings great benefits to human health, health care also displays the characteristics of overconsumption (individual consumption choices that are not compatible with maintaining a society or species’ life support systems in aggregate) and of misconsumption (consuming in a way that undermines an individuals own well-being), through the well-documented problem of overuse of health care. Health care thus contributes to the problem of uneconomic growth – increased production and consumption whose social and ecological costs outweigh their benefits. The elimination or minimisation of overdiagnosis, overtreatment and overuse would allow the elimination of a significant portion of the adverse ecological consequences of modern health care, with no negative impact on human health. Policy attention could then focus more closely on minimising the negative ecological impacts of beneficial health care.

Transitioning from Public Health to Planetary Health in the Caribbean- Directors of Public Health Programmes and Schools Perspective

Authors: Sandeep Maharaj1, Celeste Bhagwat1, Srikar Bhati1, Srilekha Bhati1, Sanjay Bhagoutie1, O’Neele Bhola1, Amrita Birbal1, Eleanor Bissoon1, Shaquille Blanche1
Author Affiliations: 1The University of the West Indies

Background
Horton R. et. al in their publication “From Public to Planetary Health: a manifesto” called for the transformation of public health at all levels to respond to the threats of human health, the threats to civilization sustainability and threat to natural and human systems that support mankind. This article seeks to gain the perspective of the directors of public health schools and programmes as to how this transition can be done in the Small Island Developing States in the English Speaking Caribbean. These islands although not major contributors to climate change, feel the major effects of it through the El Nino & La Nina effect and most recently hurricanes.

Methods
The study population comprised the directors of public health organisations and directors/professors of public health programs of universities and other schools. A descriptive study, also called a co relational or observational study, was conducted which involved using a convenience sample to select 140 directors/professors to be surveyed using self-completed questionnaires.

Ethical approval for this study was received and the study was then conducted between February 2nd 2015 and May 29th 2015.

The survey instrument used obtained data to determine the impact of transitioning from public health to planetary health and parameters for health success in the Caribbean. There were four (4) demographic questions. The other questions were constructed with the guidance of existing literature on public health and planetary health. This instrument was revised after consulting individual, authors of “A Manifesto: From public to planetary health” which was published in The Lancet .

Quantitative data was analyzed using survey monkey for data summary and presentation. Qualitative data was analyzed using descriptive methods.

All soft copy data collected was stored on a password-protected document on the computer of the Principal Investigator for the duration of one year.

Findings
In identifying the steps for a successful transition respondents were predominantly inclined (n=16, 34%) to mention increased public awareness and education as the requisite steps. To ensure Caribbean governments place planetary health at the top of the agenda the vast majority of respondents (n=33, 79%) supported comprehensive research into the benefits and drawbacks is required. It was believed international dialogue among heads of government would be crucial for success and devising tailored plans for each country would lead to better success than a plan for the region as a whole.

The major challenge seen however was funding, having been selected by 82% of respondents. Thirty-four of 44 respondents, or 77%, believed a lack of political leadership to be another potential challenge. Sixty-eight (68) percent agreed that limited knowledge of planetary health initiatives could prove to be a hindrance.

Interpretation
There is a clear need to Transition the public health system in the Caribbean, it region continues to feel the effects of climate change. However, given the systemic weaknesses of these states world-governing bodies are, need to assist.

Health Impacts of Climate Change Should and Can Be Integrated Into University Programs

Authors: Warren Lavey1
Author Affiliations: 1University of Illinois at Urbana-Champaign

Background
The health impacts of climate change have moved from a field for a few researchers to a core competency for hundreds of thousands of professionals. Many university students in health and other disciplines graduate without courses or even lectures on the rising deaths and illnesses from climate change. Consequently, practitioners are underprepared for providing professional services in a world affected by climate change. They also lack the training to communicate this transformative development effectively to community groups, public decision-makers, and future students.

Leading professional associations called for educating students on climate-related health effects (CRHE), in the health sector (including World Health Organization, American Medical Association, and American Public Health Association) and other fields. However, accreditation criteria fail to specify climate-related training.

Methods
In 2016 and 2017, four approaches to teaching CRHE were offered at the University of Illinois at Urbana-Champaign: one semester-long course on climate change and community health; an environmental clinic; a half-semester, online course on nature conservation; and individual health lectures with customized, localized content. Participants included medical, medical residency, public health, environmental sciences, geography, urban planning, and law students.

Each offering used innovative content, integrating active learning, expert presenters, and interdisciplinary studies. The courses assigned research papers and connected students with environmental and health researchers, government agencies, and non-governmental organizations. Participants completed surveys and evaluations.

Findings
Each approach improved students’ knowledge of CRHE and advanced fundamental program educational objectives, including competencies in environmental health determinants, ecosystem services and protection, socioeconomic disparities, systems thinking, problem solving, advocacy, local and global burdens of illnesses, and quantitative methods.

Research projects increased the students’ depth of knowledge of CRHE, critical thinking, and commitment to mitigation, adaptation and communication efforts. Organizations used the students’ work in submissions to regulators, sustainability plans, health impact assessments, legislation, and advocacy.

The nature-based course taught CRHE and ecosystem solutions to students who would not have enrolled in a health course. The lectures and online course overcame students’ crowded schedules.

Interpretation
CRHE instruction at universities would promote career training and core program objectives. Various instructional approaches can make CRHE competency engaging and educational for many diverse students. Along with dedicated offerings, CRHE could be integrated into standard courses as case studies and classroom exercises. Faculty could choose an approach which best fits with their expertise, course offerings, and schedules. Learning from these offerings can help spur more efforts and further innovations in teaching CRHE at universities.

Embedding climate change and sustainability into nursing curricula -The NurSusTOOLKIT

Authors: Norma Huss1, Janet Richardson2, Carmen Álvarez-Nieto3, Maud Huynen4
Author Affiliations: 1Esslingen University; 2Plymouth University; 3University of Jaén; 4Universiteit Maastricht

Sustainable development is a concept vital to healthcare, as healthcare is often provided to the detriment of others, for example:

  • profits from social inequality and inequity
  • produces vast amounts of waste
  • emits relatively large amounts of carbon dioxide, (at least 5% of total CO2 emissions in the EU)
  • uses and produces toxic materials

Therefore, healthcare is ultimately compromising public health and damaging the ability of future generations to meet their needs. Improving energy and resource efficiency, procurement policies and waste management are vital for a more sustainable health sector.

Nursing is one of the largest professions in Europe. Nurses are agents of change, they have a remit to promote health and control the use of health resources. Embedding climate change and sustainability into nursing curricula will have a qualitative impact on how health care is delivered, allowing for a holistic approach to nurses‘ training to take non-medical issues into account. Although the concept of sustainability has been explored in the literature, inclusion of sustainability topics in nursing and healthcare curricula is limited.

The aim of the Erasmus+ funded European NurSusTOOLKIT project is to enhance the availability of an evidence-based, learning offer in Sustainability Literacy and Competency (SLC) in nurse education by developing innovative teaching and learning approaches and materials.

Process

Evidence for topic inclusion was based on:

  • a systematic literature review
  • a scoping activity focused on the nursing curriculum in partner organisations
  • a broader participatory Delphi survey of curriculum opportunities was conducted with stakeholders across Europe in order to identify how to integrate key sustainability issues and find examples of good practice in nurse education.

Students were engaged in this process through social media and focus groups.

Findings

Data from the systematic review and curricula scoping were used to design the Delphi study for nurse education experts across Europe.

A total of 52 experts from different European regions participated in the first round of the Delphi survey, with 80% completing round 2. The participating experts were also asked to prioritise sustainability topics for inclusion in nursing curricula.

This paper will present the outcomes of the project: on-line, free materials covering 5 sustainability themes and approximately 60 topics with core topics available in 6 languages.

Themes:

  • Underpinning concepts; sustainability and health
  • Links between providing health care and sustaining the global environment
  • Relationships between health and the environment
  • Healthy (sustainable) communities; including health co-benefits of living sustainably
  • Social and policy context

Integrating One Health/Planetary Health into the Training of Health Professionals: Experience from Makerere University, Uganda

Authors: Charles Ssemugabo1,2, Ali Abdullah Halage1, Esther Buregyeya1, William Bazeyo1
Author Affiliations: 1Department of Disease Control and Environmental Health; 2Makerere University

Background: In line with One Health Work Force (OHWF), Makerere University School of Public Health (MakSPH) working with OHWF Project a university network with funding from USAID supported review of the Master of Public Health (MPH), Bachelor of Environmental Health Science (BEHS) programmes and short courses in epidemiology, biostatistics and research methods. The objective of the review and revision was to incorporate One Health (OH) competencies in the curriculum and teaching materials. This paper describes how the OH competencies were incorporated into these programs.

Methods: A needs assessment was carried out by a consultant. This involved interviewing graduates of the programmes, employees and other lecturers in the areas of interest. It also involved reviewing the existing curriculum as well as other curricula from universities within the region. Curriculum review committees were formed to ensure findings from the needs assessment and OH competencies were incorporated in the curricula.

Findings: In the review of the old curricula, it was noted that OH competencies were already taught in some courses such as: Principles of Biostatistics; Principles of Epidemiology; Communication for Behaviour Change; Principles of Public Health Microbiology; and Healthy Policy and planning. However, they were strengthened and incorporated in the other courses, for example infection control, bio risk assessment and detection, bio risk management and response were incorporated into Health Laboratory Management in the BEHS Curriculum. OH competencies such as: identifying public health problems and the means of solving, applying principles of health promotion and disease control in solving public health problems, investigating an acute disease outbreak and designing appropriate intervention, health surveillance system and evaluation and managing a health system were integrated into the research methods course under the MPH Programme. For the short courses, students will be given OH case studies in the practical sessions to enable them appreciate the OH perspective. In addition, ethical issues in OH were also incorporated in the research methods and ethics course.

Interpretation: Planetary health competencies were strengthened and incorporated in the BEHS, MPH and short courses taught at Makerere University School of Public Health. Training environmental / public health professionals with a good understanding of planetary health challenges we are faced with today is important, as it promotes development of innovative and noble interventions that can change policy and practice.

Student engagement in the process of topic inclusion for the NurSusTOOLKIT

Authors: Ecker Patrick1, Norma Huss1
Author Affiliations: 1Esslingen University

The International Council of Nurses’ Code of Ethics states among other things that ‘the nurse practices to sustain and protect the natural environment and is aware of its consequences on health’. As nursing is one of the largest professions in Europe nurses are not only valuable multipliers in promoting health but also in sustainability by controlling the use of resources and waste.
Although the concept of sustainability has been explored in the literature, inclusion of sustainability topics in nursing and healthcare curricula is limited. The aim of the Erasmus+ funded European NurSusTOOLKIT project is to enhance the availability of an online, free, evidence-based, learning offer in Sustainability Literacy and Competency in nurse education by developing innovative teaching and learning approaches and materials.

12 students of nurse education and nursing science from Esslingen University actively supported this project from October 2014 until June 2017. It was deemed by the group as important to raise the awareness of this topic in the nurses of the future. The students were engaged in the process of topic inclusion for the NurSusTOOLKIT through social media and focus groups, presentations and discussions. Many activities and topics such as climate change, sustainable travel, nutrition, pollution and health resource management and implementation were discussed and presented based on literature researched. Various actions were undertaken to raise awareness of sustainability within the university and to stimulate reflection regarding what it is possible to do as an individual and as a professional nurse without raising the moral index finger. This process also highlighted to the students the health co-benefits of living sustainably.

Catalyzing Planetary Health Engagement at a University

Authors: Jennifer Gunderman-King1, Holly Parker1
Author Affiliations: 1University of New England

Background: The University of New England (UNE) is Maine’s largest private university and includes the College of Arts and Science, The Westbrook College of Health Professions, College of Medicine, College of Dental Medicine, College of Pharmacy, and the College of Graduate and Professional Studies. With the tagline, “Innovation for a Healthier Planet”, UNE is committed to finding solutions to global issues through curriculum, research, and community engagement. UNE seeks to integrate the Planetary Health Alliance model.

Methods: With the support of UNE’s Office of Strategic Initiatives and the Office of the Provost, UNE participated in and implemented activities to become grounded in PHA and identify ways to integrate it across the university. A delegation of faculty, staff, and students attended the first PHA conference and shared lessons learned to a UNE core group. This evolved into a faculty, staff, and student led steering committee representing all colleges at UNE. The committee’s goals include: identify existing UNE planetary health initiatives (research, education, community action), build collaboration across colleges and units, and engage with the larger UNE community on PHA related issues. By utilizing design thinking strategies, such as a community wide World Cafe event, strategic planning was conducted. The result of this planning was coordination of PHA related activities. As a means of communication, digital identity was established via webpages and social media.

Findings: To establish PHA at a university, five core activities could assist in laying a good foundation. First, principles should be identified to guide and help create a path. At UNE, guiding principles included such things as ensuring that the process prioritizes student involvement, builds upon an interdisciplinary approach, and provides ongoing opportunities for sharing information and ideas. Second, a Steering Committee representing all colleges is essential for collaborative investment, engagement, and participation across the university. Third, strategic planning should be inclusive, student focused, and interactive. Fourth, having basic communication tools, such as but not limited to a web site and presence on social media, provides legitimacy and method for raising awareness. Fifth, starting with an inventory of curriculum, research, and community action that is currently aligned with PHA can identify high impact, low resource activities to jump start PHA at the university.

Interpretation: UNE’s story demonstrates that an institution with diverse constituencies and interests can be quickly mobilized through a faculty and student grassroots initiative supported by innovation strategies.

One-Health Research Fellowship Program in Pakistan

Authors: Lida Anestidou1, Audrey Thevenon1
Author Affiliations: 1US National Academies of Sciences, Engineering and Medicine

Background:
Recent infectious disease outbreaks are a sobering reminder that the health of humans is inescapably linked to the health of animals and our shared environment. Innovative initiatives based on the One-Health approach recognize the importance of this delicate equilibrium by promoting a collective attempt to preserve it. Transnational, collaborative and multidisciplinary efforts to solve global health issues and reach the UN’s Sustainable Development Goals are necessary.

Methods:
To nurture these connections among countries and build inter-disciplinary cadres of skilled and trained individuals, the US National Academy of Sciences (NAS), in partnership with the Pakistan Academy of Sciences, is supporting a fellowship program to build capacity of early to mid-career Pakistani scientists whose research projects follow the One-Health approach. This program, adaptable to different country settings, creates a model for fostering enduring international and national research collaborations and cooperation in preparedness and response to zoonotic diseases and other shared environmental health risks. For the pilot phase of this 12-month fellowship, five Pakistani researchers mentored by international One-Health experts, participated in 2 NAS-sponsored scientific symposia, and spent up to 5 months at host research laboratories in Kenya, Thailand and Singapore. The fellows were integrated in the hosts’ research teams and participated in on-going studies, while also receiving training relevant to their own Pakistan-relevant One Health research. All fellows’ findings were presented at international research conferences.

Findings:
The careful design of the program enabled the initiation of a One-Health research network in Pakistan by facilitating discussion and debate between young researchers and their senior counterparts regarding One-health issues.

Interpretation:
The unique elements of this program are designed to assist a country in which human, animal, and environmental health scientists and professionals work together in advance of a public health threat, to become resilient in the face of an actual outbreak. It also highlights the mutual benefits and ease for researchers from diverse countries to work toward a common goal. This presentation will focus on the strengths of the fellowship, describe the goals, success stories and outcomes of the pilot and the current second rounds, and provide a concept for global inter-connectedness through education and training in One-Health pillars.

An EURACT-standard lecture of Planetary Health for Brazilian medical students

Authors: Enrique Barros1, Tatiana Camargo2, Diogo S. Onofre2, Luciana Calabro2, Ediane Gheno2, Maria Paz2

Author Affiliations: 1Universidade de Caxias do Sul; 2Universidade Federal do Rio Grande do Sul

Background- The Rockefeller–Lancet Commission on PH has identified the imagination gap as a fundamental challenge. Despite the recent general acceptance for the introduction of PH in the medical curriculum, little has been published on how to effectively teach this. We have introduced the PH subject for medical students in Brazil, trying to expose learners to the challenges of knowledge and governance, ultimately aiming to capture their imaginations, in order to stimulate medical leaders for PH.

Method-
Utilizing the EURACT model (from the European Academy of Teachers in Family Medicine/GP) we developed an interactive lecture to introduce PH to medical students of the first semester in a University in Brazil. We applied a pre and a post questionnaire to investigate negative and positive aspects of this educational intervention.

Findings- Our questionnaire was applied to two semesters in 2017 totalling over 80 medical students. Our Preliminary findings show approval of the EURACT model and general student concordance in the formalization of the subject as part of the medical curriculum. Further analysis are still pending.

Interpretation- Our preliminary experience shows that it is challenging to introduce PH to medical students. An extra effort must be done in order to overcome the medical school fragmented approach to health and its general avoidance of integrated approaches between environment and human health and its systemic complexities. However, with innovative educational methodologies such as EURACT, we have seen students grow very fond of this new field.

 

%d bloggers like this: