Preparing for the future of public health: ecological determinants of health and the call for an eco-social approach to public health education

Social Justice, Community Engagement, and Undergraduate STEM Education: Participatory Science as a Teaching Tool

Social justice is increasingly being seen as relevant to the science curriculum. We examine the intersection of participatory science, social justice, and higher education in the United States to investigate how instructors can teach about social justice and enhance collaborations to work toward enacting social justice. Participatory science approaches, like those that collect data over large geographic areas, can be particularly useful for teaching students about social justice. Conversely, local-scale approaches that integrate students into community efforts can create powerful collaborations to help facilitate social justice. We suggest a variety of large-scale databases, platforms, and portals that could be used as starting points to address a set of learning objectives about social justice. We also describe local-scale participatory science approaches with a social justice focus, developed through academic and community partnerships. Considerations for implementing participatory science with undergraduates are discussed, including cautions about the necessary time investment, cultural competence, and institutional support. These approaches are not always appropriate but can provide compelling learning experiences in the correct circumstances.

Promoting community health and climate justice co-benefits: insights from a rural and remote island climate planning process

Climate change is an environmental crisis, a health crisis, a socio-political and an economic crisis that illuminates the ways in which our human-environment relationships are arriving at crucial tipping points. Through these relational axes, social structures, and institutional practices, patterns of inequity are produced, wherein climate change disproportionately impacts several priority populations, including rural and remote communities. To make evidence-based change, it is important that engagements with climate change are informed by data that convey the nuance of various living realities and forms of knowledge; decisions are rooted in the social, structural, and ecological determinants of health; and an intersectional lens informs the research to action cycle. Our team applied theory- and equity-driven conceptualizations of data to our work with the community on Cortes Island-a remote island in the northern end of the Salish Sea in British Columbia, Canada-to aid their climate change adaptation and mitigation planning. This work was completed in five iterative stages which were informed by community-identified needs and preferences, including: An environmental scan, informal scoping interviews, attending a community forum, a scoping review, and co-development of questions for a community survey to guide the development of the Island's climate change adaptation and mitigation plan. Through this community-led collaboration we learned about the importance of ground truthing data inaccuracies and quantitative data gaps through community consultation; shifting planning focus from deficit to strengths- and asset-based engagement; responding to the needs of the community when working collaboratively across academic and community contexts; and, foregrounding the importance of, and relationship to, place when doing community engagement work. This suite of practices illuminates the integrative solution-oriented thinking needed to address complex and intersecting issues of climate change and community health.

On the possibility of decolonising planetary health: exploring new geographies for collaboration

Decolonial planetary health aspires to centre the diversity and importance of Indigenous thought and stewardship. In this Viewpoint, we explore research in planetary health across holistic worldviews and western scientific approaches. We base our examination of decolonising interventions in planetary health by exploring how global trajectories play out in British Columbia, Canada. A central part of this analysis is highlighting intercultural thinking to promote an anti-colonial, anti-racist, and reciprocal approach to climate change and global health inequities across geographical space and within planetary health discourse. Our perspective encompasses an asset-based examination, which focuses on the Indigenous scholarship in planetary health that is already underway and considers how rigorous engagement with epistemic and geographical diversity can strengthen and advance planetary health. This is a place-based response to planetary health, as British Columbia experiences climate catastrophes that are impacting whole communities, cutting through major transportation systems, disrupting supply chains, and creating a further burden on public health agencies and authorities that are spread thin by COVID-19 response. We argue for a progressive acknowledgment of decolonising work that is pushing research and practice in planetary health forward.

Climate and health education: A critical review at one medical school

Introduction

As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy.

Objective and methods

In the present study, we assessed the "climate and health" content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign. We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign.

Results and discussion

Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school's new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.

Creating Environmental Health Leaders When Educators Are Learning Too

The climate crisis is upon us, already exacting a health cost, with likely acceleration over our lifetimes. Our existing medical curricula do not adequately prepare medical students to deal with climate health nor to be leaders in the public health sphere. Current faculty have themselves not often been exposed to climate health training nor often to leadership training. This affords a unique opportunity for creative implementation of strategies to educate both faculty and students on how leadership skill building can complement the science and policy of climate health.

Towards an educational praxis for planetary health: a call for transformative, inclusive, and integrative approaches for learning and relearning in the Anthropocene

Fuelled by the intersecting challenges of climate change, biodiversity loss, pollution, and profound social, economic, and environmental injustices, calls for new ways to work together for a healthy, just, and sustainable future are burgeoning. Consequently, there is a growing imperative and mandate across the higher education space for transformative, inclusive, integrative-and sometimes disruptive-approaches to learning that strengthen our capacity to work towards the goals and imperatives of planetary health. This educational transformation requires attention to pathways of societal, policy, and system change, prioritising different voices and perspectives across jurisdictions, cultures, and learning contexts. This Viewpoint seeks to explore the developing areas of education for planetary health, while additionally reflecting on a praxis for education in the Anthropocene that is rooted within the confluence of diverse knowledges and practice legacies that have paved the way to learning and relearning for planetary health.

Strengthening a One Health approach to emerging zoonoses

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all.

Transformative learning for a sustainable and healthy future through ecosystem approaches to health: insights from 15 years of co-designed ecohealth teaching and learning experiences

This paper presents insights from the work of the Canadian Community of Practice in Ecosystem Approaches to Health (CoPEH-Canada) and 15 years (2008-2022) of land-based, transdisciplinary, learner-centred, transformative learning and training. We have oriented our learning approaches to Head, Hands, and Heart, which symbolise cognitive, psychomotor, and affective learning, respectively. Psychomotor and affective learning are necessary to grapple with and enact far-reaching structural changes (eg, decolonisation) needed to rekindle healthier, reciprocal relationships with nature and each other. We acknowledge that these approaches have been long understood by Indigenous colleagues and communities. We have developed a suite of teaching techniques and resources through an iterative and evolving pedagogy based on participatory approaches and operating reciprocal, research-pedagogical cycles; integrated different approaches and ways of knowing into our pedagogy; and built a networked Community of Practice for continued learning. Planetary health has become a dominant framing for health-ecosystem interactions. This Viewpoint underscores the depth of existing scholarship, collaboration, and pedagogical expertise in ecohealth teaching and learning that can inform planetary health education approaches.

Putting global health high on the agenda of medical schools

In this opinion paper, we reflect on global health and global health education as well as challenges that the coming generation are likely to face. As the field is rapidly changing, it is vital to critically reflect categories of “global south” and “global north” as geographical boundaries, and rather think in terms of inequalities that are present in all countries. Global perspectives on health are useful to analyze structural challenges faced in all health care systems and help understand the diversity of cultures and patients’ concepts of disease. We first discuss burning questions and important challenges in the field and how those challenges are tackled. Rather than going into detail on topical issues, we reflect on approaches and attitudes that we think are important in global health education and present opportunities and challenges for young scholars who are interested in working in this field.

Planetary health pedagogy: Preparing health promoters for 21st-century environmental challenges

ISSUE ADDRESSED

Multiple interconnected drivers threaten the health and wellbeing of humans and the environment, including biodiversity loss, climate change, pollution, rapid urbanisation and displacement. This requires enhanced literacy on health of the environment and innovation in problem conceptualisation and cross-sectoral solutions. Contemporary mandates (eg, Ottawa Charter) task health promoters to tackle the human and environmental health crisis. To address the complex determinants across multiple settings, health promotion graduates require competencies in interdisciplinary collaboration grounded in systems thinking. They also require knowledge and agility to leverage multiple gains from health promotion action that benefits people and planet. Similarly, health promotion practitioners are currently aware of the need for skills to deliver co-benefits to people and planet. Planetary health, as theory and framework, provides a socio-ecological focus, systems thinking approach, co-benefits framework for action and foundational basis to enhance health promotion graduates' skills and competencies to address multiple health and planetary challenges. To date, there have been limited practical attempts to address these challenges.

METHOD

A desktop review and synthesis of teaching and learning scholarship in planetary health were coupled with iterative critical reflections of teaching practice, and the use of two case studies, to illuminate innovations in health promotion competencies.

RESULTS

Two examples of how planetary health promotion challenges are addressed through teaching and learning scholarship are presented to illustrate the use of a tailored sustainability tool and a deliberative interdisciplinary approach to collaboration, delivered within a course that constructively aligns curriculum content and assessment.

CONCLUSION

A bespoke model, the Sustainability Wheel of Fortune, combined with constructive interactive teaching approaches, adds interdisciplinary collaboration and systems thinking approaches to the knowledge and practice of planetary health. A postgraduate microcredential fast-tracks knowledge and skills acquisition for recent graduates and established practitioners interested in upskilling for planning planet and population health co-benefits. SO WHAT?: The Sustainability Wheel of Fortune provides health promotion students with a model for understanding, and addressing, complex global and local challenges. The microcredential builds on health promotion competencies to develop interdisciplinary and systems-based approaches to planetary health challenges.

Health-promoting pedagogy: Using reflexivity to support learning and action in planetary health education

ISSUE ADDRESSED

International competencies for health promotion education require ethical practice that is supported by reflexive health promotion practitioners, yet professional bodies do not codify how health promotion curriculum should support students' skill development in reflexive practice.

METHODS

Reflexivity in teaching and learning was scaffolded through short, progressive reflective blogs assessments, supportive feedback/feedforward mechanisms, and nested assessment design.

RESULTS

Student feedback is offered to demonstrate the impact of reflexive pedagogy in health promotion education.

CONCLUSION

Reflexivity in teaching and learning supports students in learning the role of health promotion in planetary health and developing skills in planetary health advocacy.

SO WHAT

Explicitly teaching the practice and process of critical reflexivity can help students develop personal insight, support professional practice, and promote positive change in the health of people and our planet.

Exploration and Analysis of Educational History from the Perspective of Educational Environmental History and Environmental History

The emergence of environmental historiography, for the first time, organically combined the history of the environment and human history and began to pay attention to the close relationship between human social changes and environmental changes. This paper explores the impact of environmental history on education from the perspective of environmental history. This paper explores and analyzes the history of the educational environment from the perspective of environmental history and studies the laws and characteristics behind the evolution of the relationship between education and environment. This paper analyzes the influence of environmental history on the three views of college students under environmental education. Further analysis of educational environmental history is improved to improve the three views of college students and promote the social development of research significance. The study of educational environmental history is of great significance to enlarge the field of educational history research, enrich the content of educational history research, and perfect the discipline construction of educational history. At the same time, the environmental perspective and ecological consciousness of educational environmental history research are the embodiment and adherence of Marxist historical materialism and environmental view.

Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis

Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.

Exploring Cross-Sectoral Implications of the Sustainable Development Goals: Towards a Framework for Integrating Health Equity Perspectives With the Land-Water-Energy Nexus

Objectives: To assess existing evidence and identify gaps in the integrative framework of the Sustainable Development Goals (SDGs) for their potential to advance cross-sectoral perspectives and actions that connect health equity with the land-water-energy nexus in a watershed context.

Methods: Five bibliographic databases were searched from 2016 to 2021. This yielded an initial 226 publications, which were screened for titles, abstracts, and full texts on DistillerSR; resulting in a final 30 publications that were studied. These keywords defined the search terms: “health equity,” “SDGs,” “watershed,” “resource nexus,” and “cross-sectoral.”

Results: Thematic syntheses of debates and gaps point to the relevance of the SDGs as a cross-sectoral, integrative platform for place-based programming of the land-water-energy nexus, and to account for negative externalities and cascaded impacts on human and environmental health.

Conclusion: For the purpose of monitoring health equity in the contexts of interactions of land, water, and energy in rural, remote, and Indigenous contexts, and on the basis of the SDGs, this paper generates evidence to inform health equity-oriented policies, programs and practices, and to enhance health for equity-seeking populations.

Waiora: the importance of Indigenous worldviews and spirituality to inspire and inform Planetary Health Promotion in the Anthropocene

We now live in a new geological age, the Anthropocene – the age of humans – the start of which coincides with the founding of the International Union for Health Promotion and Education (IUHPE) 70 years ago. In this article, we address the fundamental challenge facing health promotion in its next 70 years, which takes us almost to 2100: how do we achieve planetary health? We begin with a brief overview of the massive and rapid global ecological changes we face, the social, economic and technological driving forces behind those changes, and their health implications. At the heart of these driving forces lie a set of core values that are incompatible with planetary health. Central to our argument is the need for a new set of values, which heed and privilege the wisdom of Indigenous worldviews, as well as a renewed sense of spirituality that can re-establish a reverence for nature. We propose an Indigenous-informed framing to inspire and inform what we call planetary health promotion so that, as the United Nations Secretary General wrote recently, we can make peace with nature.

A bolder One Health: expanding the moral circle to optimize health for all

One Health is a ground-breaking philosophy for improving health. It imaginatively challenges centuries-old assumptions about wellbeing and is now widely regarded as the 'best solution' for mitigating human health problems, including pandemic zoonotic diseases. One Health's success is imperative because without big changes to the status quo, great suffering and ill-health will follow. However, even in its more ambitious guises, One Health is not radical enough. For example, it has not embraced the emerging philosophical view that historical anthropocentrism is an unfounded ethical prejudice against other animals. This paper argues that One Health should be more imaginative and adventurous in its core philosophy and ultimately in its recommendations and activities. It must expand the circle of moral concern beyond a narrow focus on human interests to include nonhuman beings and the environment. On this bolder agenda, progressive ethical and practical thinking converge for the benefit of the planet and its diverse inhabitants-human and nonhuman.

Universal depression prevention: An umbrella review of meta-analyses

Depression is a disabling, highly prevalent, frequently chronic, and difficult-to-treat disorder with an immense cognitive, social, and economic burden. Given that many of the advances in other non-communicable disorders like cancer have been in prevention rather than treatment, the prevention of depression is currently an unmet public health priority. We sought to provide an overview of the meta-analytic literature through conducting a systematic umbrella review of universally delivered preventive interventions for depression. The search was conducted on March 18, 2021 utilising the following databases (all accessed through EBSCOHost); Allied and Complementary Medicine Database, CINAHL Complete, Global Health, Health Source: Nursing/Academic Edition, MEDLINE Complete and APA PsychArticles. The following search terms related to depression, prevention, and trial study design. Two authors independently screened articles and a third resolved discrepancies. Eligibility criteria sought to identify meta-analyses that investigated the prevention of depression (i.e., reduced incidence) through intervention studies that were universal, in that they were designed to be delivered to entire populations Six meta-analyses on psychological interventions, two school-based meta-analyses, and one eHealth meta-analysis were included in this umbrella review. Findings indicated that all identified studies were of good quality and one was of fair quality. One previous meta-review that examined physical activity to prevent depression was included in results, comprising eight meta-analyses. Preventive interventions have primarily and successfully utilized psychological therapeutic components, delivered at the school, community, and workplace settings. Both school- and eHealth-based interventions hold some utility for depression prevention. There is meta-analytic evidence that physical activity is efficacious for depression prevention. However, universal prevention is inconsistently defined. There is a pressing need for well-designed randomized controlled preventative interventions for depression before recommendations can be universally accepted with convincing level of evidence.

Health promotion and harm reduction attributes in One Health literature: A scoping review

One Health faces enormous pressure and challenges as it attempts to mitigate dynamic, surprising and complex global events that threaten the health and sustainability of human and animal populations and the biosphere. One Health practitioners and researchers need every advantage to developing working solutions to the world's imminent complex issues. Heath promotion and harm reduction, interrelated approaches that have seen much success over decades of use in global public health, may be important models to consider. Both use an upstream socioecological determinant of health approach to reach beyond the health sector in all health efforts, and encourage active community participation and empowerment to attain and sustain human and ecological health. This scoping review of 411 documents, believed to be the first to relate health promotion and harm reduction to One Health, searched self-declared One Health research literature for evidence of health promotion and harm reduction policies, principles and methodologies. It sought to answer the questions: "What is the scope of practice of One Health in self-declared One Health publications?" and "Are attributes of health promotion and harm reduction found in self-declared One Health-reviewed research literature?" Over half of the papers revealed no health promotion or harm reduction attributes while 7% were well-endowed with these attributes. These 7% of papers focused on deep-seated, complex health issues with systemic knowledge gaps and decision-making issues revolving around specific population vulnerabilities, social inequities and competing stakeholders. Implementing 'on the ground change' was a common theme in the strongest health promotion/harm reduction papers we identified. Alternatively, papers lacking health promotion or harm reduction attributes focused on managing proximate risks, primarily for infectious diseases. The addition of health promotion and harm reduction to One Health practices may help the field rise to the growing expectations for its involvement in complex global issues like pandemics and climate change.

The National Collaborating Centre for Healthy Public Policy in times of COVID-19: Building skills to "Build Back Better"

This article, the second in a series on the six National Collaborating Centres for Public Health, focuses on the National Collaborating Centre for Healthy Public Policy (NCCHPP), a centre of expertise, and knowledge synthesis and sharing that supports public health actors in Canada in their efforts to develop and promote healthy public policy. The article briefly describes the NCCHPP's mandate and programming, noting some of the resources that are particularly relevant in the current coronavirus disease 2019 (COVID-19) context. It then discusses how the NCCHPP's programming has been adapted to meet the changing needs of public health actors throughout the pandemic. These needs have been strongly tied to decisions aimed at containing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and mitigating its immediate impacts in various societal sectors since the beginning of the crisis. Needs have also gradually emerged related to how public health is expected to help inform the development of public policies that will allow us to "build back better" societies as we recover from the pandemic. The article concludes by discussing the orientation of the NCCHPP's future work as we emerge from the COVID-19 crisis.

Why is repositioning public health innovation towards a social paradigm necessary? A reflection on the field of public health through the examples of Ebola and Covid-19

Health innovations are generally oriented on a techno-economic vision. In this perspective, technologies are seen as an end in themselves, and there is no arrangement between the technical and the social values of innovation. This vision prevails in sanitary crises, in which management is carried out based on the search for punctual, reactive, and technical solutions to remedy a specific problem without a systemic/holistic, sustainable, or proactive approach. This paper attempts to contribute to the literature on the epistemological orientation of innovations in the field of public health. Taking the Covid-19 and Ebola crises as examples, the primary objective is to show how innovation in health is oriented towards a techno-economic paradigm. Second, we propose a repositioning of public health innovation towards a social paradigm that will put more emphasis on the interaction between social and health dimensions in the perspective of social change. We will conclude by highlighting the roles that public health could play in allowing innovations to have more social value, especially during sanitary crises.

Storylines of research on resource extraction and health in Canada: A modified metanarrative synthesis

Patterns of research on resource extraction's health effects display problematic gaps and underlying assumptions, indicating a need to situate health knowledge production in the context of disciplinary, corporate and neocolonial influences and structures. This paper reports on a modified metanarrative synthesis of 'storylines' of research on resource extraction and health in the Canadian context. Peer-reviewed articles on mining or petroleum extraction and health published between 2000 and 2018 and dealing with Canadian populations or policies (n = 87) were identified through a systematic literature search. Coding identified main disciplinary traditions, methodologies and approaches for judging high-quality research. Underlying assumptions were analyzed in terms of models of health and well-being; resource extraction's political economic drivers; and representations of Indigenous peoples, territories and concerns. Findings included a preponderance of occupational and environmental health studies; frequent presentation of resource extraction without political economic antecedents, and as a major contributor to Canadian society; sustainable development aspirations to mitigate health impacts through voluntary private-sector governance activities; representations of Indigenous peoples and concerns ranging from complete absence to engagement with legacies of historical trauma and environmental dispossession; and indictment of corporate (especially asbestos industry) and government malfeasance in a subset of studies. Canada's world-leading mining sector, petroleum reserves and population health traditions, coupled with colonial legacies in both domestic and overseas mining and petroleum development, make these insights relevant to broader efforts for health equity in relation to resource extraction. They suggest a need for strengthened application of the precautionary principle in relation to resource extraction; nuanced attention to corporate influences on the production of health science; more profound challenges to dominant economic development models; and extension of well-intentioned efforts of researchers and policymakers working within flawed institutions.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Emergence of zoonoses such as COVID-19 reveals the need for health sciences to embrace an explicit eco-social conceptual framework of health and disease

An accurate understanding of why zoonoses such as SARS-CoV-2 are emerging at an increased rate, is vital to prevent future pandemics from the approximately 700,000 viruses with zoonotic potential. Certain authors have argued that the consumption of wildlife, or human contact with bats was responsible for the emergence of SARS-CoV-2. Others argue that a range of anthropogenic environmental degradations have played a vital role in the emergence of SARS-CoV-2 and other zoonoses. In this opinion piece, I argue that these divergent viewpoints stem, in part, from different foundational conceptual frameworks - biomedical individualist and eco-social frameworks, respectively. Based on the fact that the eco-social framework provides a more complete account of the different types of causal factors underpinning the emergence of zoonoses, I propose that the COVID-19 pandemic provides an additional reason for the health sciences to ground its theory of health and disease in an eco-social conceptual framework.

Strengthening collaborations at the public health system-academic interface: a call to action

In Canada and globally, the COVID-19 pandemic has highlighted the importance of reliable and responsive public health systems. The pandemic has required decisive leadership and collaboration across all sectors of society informed by the best available evidence. In this commentary, we argue that in order to create a robust public health system equipped to address current and future public health challenges, we must prioritize and invest in stronger relationships between public health practice and academia. We briefly review key recommendations following the SARS outbreak, particularly those calling for stronger linkages between public health academia and practice settings in Canada. We then propose key actions for strengthening these linkages. Echoing other COVID-19-related calls, which request long-term reinvestment in public health education and training, we recommend the following actions: (1) Improve collaboration between education programs and public health agencies to address system needs (e.g., surge capacity) and persisting health inequities; (2) Fund a pan-Canadian public health training initiative that builds on a renewed set of public health competencies to address priority training needs (e.g., equity-oriented leadership); and (3) Prepare a cadre of certified public health leaders who can progress along public health career pathways, including those already in practice.

Many lenses for planetary health: seeding citizen engagement for sustainable futures visioning with new ways of seeing

OBJECTIVES

This pilot project sought to seed citizen engagement processes for sustainable futures visioning with ideas, perspectives, and processes informed by Indigenous ways of knowing.

METHODS

Five circle dialogues were convened with students, faculty, and members of the public, in the spring of 2019, using Indigenous talking circle methodology and intentionally seeded with "disruptive" ideas to encourage reflexivity and open space for "out-of-the-box" thinking. These were complemented by a series of one-on-one dialogues with members of the pan-Canadian research team. Pre- and post-dialogue surveys, notes taken by participants, team members, and co-facilitators, as well as notes from one-on-one interviews, constituted the data drawn upon for this paper.

RESULTS

Participants were overwhelmingly positive about their experience, noting they were able to go further and deeper in their thinking and listening, and that they valued the Indigenous talking circle methodology, even if they stopped short of claiming the experience had transformed their way of seeing the world. Key points raised in the dialogues included the need for a more relational worldview, the need to repair severed relations with the land and nature, the importance of Indigenous ways of knowing, the importance of community building, and the need to question the fundamental assumptions undergirding contemporary Western societies.

CONCLUSIONS

While caution must be exercised in drawing conclusions and extrapolating from this modest pilot project, our experience underscores the value of processes that intentionally catalyze critical reflexivity and openness to other ways of seeing, informed by Indigenous ways of knowing and talking circle methodology.

Education for the Anthropocene: Planetary health, sustainable health care, and the health workforce

Over the past few centuries, human activity has wrought dramatic changes in the natural systems that support human life. Planetary health is a useful concept for health profession education (HPE) teaching and practice because it situates health within a broader understanding of the interdependent socio-ecological drivers of human and planetary health. It facilitates novel ways of protecting both population health and the natural environment on which human health and well-being depends. This paper focuses on the climate crisis as an example of the relationship between environmental change, healthcare, and education. We analyze how HPE can help decarbonize the healthcare sector to address both climate change and inequity in health outcomes. Based on the healthcare practitioner's mandate of beneficence, we propose simple learning objectives to equip HPE graduates with the knowledge, skills, and values to create a sustainable health system, using carbon emission reductions as an example. These learning objectives can be integrated into HPE without adding unduly to the curriculum load.

Education for sustainable healthcare: Leadership to get from here to there

The current global crises, including climate, COVID-19, and environmental change, requires global collective action at all scales. These broad socio-ecological challenges require the engagement of diverse perspectives and ways of knowing and the meaningful engagement of all generations and stages of personal and professional development. The combination of systems thinking, change management, quality improvement approaches and models, appreciative/strength-based approaches, narratives, storytelling and the strengths of Indigenous knowledges, offer synergies and potential that can set the stage for transformative, strengths-based education for sustainable healthcare (ESH). The need for strong leadership to enact a vision for ESH is outlined here with the intent to enable and nurture the conditions for change, ultimately improving health and well-being across generations.

Envisioning planetary health in every medical curriculum: An international medical student organization's perspective

BACKGROUND

With deteriorating ecosystems, the health of mankind is at risk. Future health care professionals must be trained to recognize the interdependence of health and ecosystems to address the needs of their patients and communities. Health issues related to, e.g. climate change and air pollution, are not, however, generally included in medical education.

OBJECTIVES

To assess the inclusion of climate change and air pollution in medical curricula and to guide the International Federation of Medical Students' Associations' (IFMSA) Vision of Climate Change in the Medical Curriculum.

METHODS

A study comprising three surveys (March 2019, August 2019, March 2020) explored medical students' perceptions of the current status of formal and non-formal elements of climate change and air pollution and health in their medical programs.

RESULTS

Respondents originated from 2817 medical schools in 112 countries. Only 15% of medical schools have incorporated climate change and health into the curriculum. Students led climate-related activities in an additional 12% of medical schools. With regard to air pollution and health, only 11% of medical schools have formal education on the topic.

CONCLUSIONS

It is crucial to acknowledge the current omissions from medical curricula and the importance of meaningful student involvement in curriculum transformation.

Public health for the hunter-gatherer in us all

In evolutionary terms, the transformations which humans have engendered in social, ecological and built environments are increasingly out of step with their biological makeup. We briefly review the evidence on health-relevant practices and status of our Paleolithic ancestors and contrast these with current food, transportation, work and governance systems with their associated impacts on human health. As public health and planning practitioners engaged in the EcoHealth Ontario Collaborative, we argue for recognition of our hunter-gatherer nature to promote joint efforts in building sustainable and equitable community infrastructures, both built and green. Although such efforts are underway at multiple jurisdictional levels across Canada, the pace is frustratingly slow for the burden of endemic chronic diseases and global environmental change which humans face. Reminding reluctant stakeholders of the hunter-gatherers in us all could bring about deeper reflection on the urgent work in redirecting community planning.