Clinical Labs: Working with planetary health for patient health.

Safeguarding planetary health for southeast Asia's future children

Integrating planetary health into clinical guidelines to sustainably transform health care

Health professionals must be prepared to address the health risks and impacts of climate change Between 2030 and 2050, climate change is expected to cause about 250 000 additional deaths per year.1 This does not include deaths from pollution, mental illness, extreme weather events and resultant migration and conflict, all of which carry significant morbidity and mortality risks. The medical profession has a responsibility to prepare practitioners and the health system for the escalating challenges of this health crisis. Even though planetary health frameworks, consensus statements, and early teaching experience have begun to be reported,2-10 persistent barriers to the implementation of planetary health concepts, including the health impacts of climate change and the principles of sustainable health care, are evident within medical education.11, 12 Consequently, the implementation of this content into predominantly biomedically focused curricula is frequently piecemeal, opportunistic, unidirectional and poorly related to clinical practice.13, 14 Internationally, the emerging curriculum principles to address this challenge align with global health priorities. Specifically, addressing the socio-economic and environmental determinants of health under the United Nations Sustainable Development Goals framework (https://sdgs.un.org/goals), indigenous eco-health-centric leadership, promotion of systems thinking and change, and experiential, practice-based learning that cultivates interprofessional teamwork, advocacy and leadership development.3-7, 9, 10, 15 A 2019 interactive perspective provides a useful open access resource in this direction.16 More recently, Emory University students and staff reported their experience in the incorporation of climate content into selected aspects of the pre-clinical curriculum.17 In Australia, Medical Deans of Australia and New Zealand (MDANZ) established a Climate Change and Health Working Group, which has proposed graduate outcome statements and learning objectives that incorporate the environment as a health determinant, health care sustainability, and the health effects of climate change.18, 19 At the time of publication, the Australian Medical Council is reviewing the accreditation standards of primary medical programs and has released updates to the National Framework for Prevocational Medical Training, strengthening a top-down national approach to producing climate-aware and prepared practitioners. There are many steps between developing new accreditation standards and actual delivery to learners. The three key strategies are: i) integrate climate change as a cross-cutting core theme, ii) facilitate educators and students sharing knowledge and teaching one another in this emerging field, and iii) relate learning to clinical practice.11 An intermediate step is to link existing organ systems focused preclinical studies with the impacts of climate change on the health of individual patients. In response to these challenges, students and faculty volunteers, all members of the Doctors for the Environment Australia at the University of Melbourne, collaborated to form the Planetary Health Curriculum Taskforce. This group was driven by student advocacy seeking to address a perceived gap in their curriculum. We contend that such cocreation is essential to accelerate the integration of such urgently needed curriculum content by adopting the highest level of pedagogical methods and to model the intergenerational collaboration required to address this "wicked" challenge. We sought to achieve three objectives (Box 1) and conducted our work in three phases (Box 2). First, student focus groups from all years of the medical school identified planetary health learning opportunities within the existing curriculum structure. DEA = Doctors for the Environment Australia. Second, we did a structured literature review, via two student and faculty workshops, to map climate change and health literature content and themes to the classical organ systems framework of first year medicine (Box 3). We incorporated the principles of sustainable health care, such as environmental footprint assessment and valuing the health cobenefits of decarbonisation, as well as the opportunities for medical students to learn applied skills and behaviour. Engagement with the First Nations health team helped us to incorporate Indigenous-led content, an identified area for further action by Australian and New Zealand public health and medical educators.12 WHO = World Health Organization. Source: Reproduced with permission from Burch et al.20 Phase three consisted of expert peer review by seven specialist, generalist and public health clinicians with teaching and research experience in climate change and health. Each clinician was allocated two organ system blocks and instructed to review and edit content for clinical relevance, strength of evidence, and quality of writing. The final synthesis, inclusion of images, figures and executive summaries were completed by the Curriculum Taskforce student members, with design support from Doctors for the Environment Australia. The outcome was an infographic-rich curriculum resource, a planetary health–organ system map,20 which is being used as a resource in first year medical teaching. Our systematic, student and faculty codeveloped process and clinical focus are an example to others seeking successful integration of planetary health into their curricula. Central to our approach was the application of the three selected models (Box 3). This process identified and explored the multidirectional relationships between broad public and planetary health content and person-centred biophysiological mechanisms. We achieved this by connecting literature content using Model 1 headings (eg, cardiovascular organ system) and Model 2 (relevant social determinants of health) and Model 3 content (relevant major consequences of climate change). As an example, Box 4 shows a mechanism for heatwave-associated acute myocardial infarction from the planetary health–organ system map. Source: Reproduced with permission from Burch et al.20 There is clear recognition by peak Australian medical bodies of the importance of climate change and our professions' role not just in preparing practitioners, but in advocating for climate-conscious health care and broader mitigation policies.21, 22 This has led to an emergent discussion about planetary health at all levels of Australian medical education. Our methodology and output may assist medical educators in addressing the challenges of integrating climate change education into their own teaching.11 For example, as this approach enables students to share their knowledge and experiences with teachers outside of formal classroom boundaries, it may support the evident lack of medical educators proficient in planetary health teaching. Empowering students as leaders and partners in learning and developing education material is known to improve their effectiveness as learners and confidence in teaching.23 It also explicitly promotes higher order relational and extended abstract reasoning by students (Blooms' revised taxonomy levels 4–6) — the ultimate task of any curriculum.24 Despite not being formally evaluated, we observed that the students involved in this project achieved the Association for Medical Education in Europe (AMEE) planetary health and education for sustainable health care consensus statement aims of "knowledge, skills, values, competence and confidence".9 Our mapping output also addresses the need for learning resources that are centralised, accessible and frequently peer reviewed. Our focus on clinical relevance helped narrow the scope of literature and developed the curriculum resource towards use in practice. This strategy connected theory with patient care in a way that ensured concepts could be translated into clinical skills. Even though it was designed for one context, the organ systems structure and clinical relevance also allow learning points to be drawn from this resource for prevocational, vocational and continuing professional development teaching. Our approach also aligns with recent understanding that planetary health is a theme akin to ethics or leadership that should spiral through the core curriculum.11 In this context, biomedical planetary health learning primes students for subsequent clinical training. Our initial successes, including deriving a climate change-themed tutorial from the map and precipitating a review of planetary health curriculum opportunities within the Doctor of Medicine (MD) program redesign, parallel those of the Emory student–staff collaboration.17 The process of expanding the map to cover more of the MD curriculum, regular peer review of emerging evidence and increasing interprofessional collaboration is ongoing and has garnered formal support through seed grant funding.25 We encourage the formal recognition of planetary health as core to any medical curriculum, with dedicated resourcing from the top-down and codesign from the bottom-up. We recognise and value the concurrent higher level advocacy of the MDANZ Climate Change and Health Working Group in supporting our grassroots project,18, 19 as well as allyship from our interprofessional and First Nations health colleagues.25 A remaining challenge, given the assessment-driven nature of medicine, is the development of "assessment for learning" inclusive of planetary health. We have not reviewed the assessment blueprint of the University of Melbourne MD program. However, we propose this as a valuable exercise, as assessment often strongly correlates with students' prioritisation of content.26 Ultimately, the role of medical professionals in providing leadership, advocating for sustainable health care and adopting evidence-based strategies for the management of planetary health-related risks has been widely acknowledged.9, 21, 22 Our methodology to generate the planetary health–organ system map presents a model for engaging learners through codevelopment of a novel learning resource. Our infographic-rich map also provides an example of systematic integration with existing curricula and an opportunity for strengthening planetary health leadership in medical education. We thank the members of Doctors for the Environment Australia (DEA) for their clinical and research expertise, and the organisation for its graphic support to produce our final curriculum mapping resource. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

Planetary health: from concept to decisive action

Sustainable healthcare education: integrating planetary health into clinical education

Beyond tokenism: meaningful youth engagement in planetary health

Non-technical summaryHealthcare systems significantly impact the environment, which in turn affects human health. To address this, we propose to revise a popular framework for healthcare improvement, by introducing the advancement of planetary health (the health of both humans and the natural systems) among the aims that health systems should pursue. This approach suggests reducing medical service needs through disease prevention, minimizing environmental impacts, and supporting global efforts to protect planetary health. Practical applications to bring about these pathways are documented in the literature.Technical summaryRestoring the health of the planet, with concurrent benefits for human civilization, is paramount. Healthcare systems play a crucial role in this regard, considering the environmental impact of health services. Widely recognized approaches to designing healthcare systems for the optimization of their performance are based on the pursuit of multiple aims, such as the Triple Aim and Quadruple Aim frameworks. The objective of this work is to revise the latter by substituting ‘Advance Planetary Health’ for ‘Improve Population Health’.The objective of advancing planetary health supports all other pre-existing objectives: lowering costs, enhancing patient experience, team wellbeing, and population health, which directly relates to planetary health. Health systems promoting planetary health reduce the need for medical services through disease prevention and health promotion, pursue the provision of appropriate care, minimize the overall environmental impact of medical services, and support planetary health initiatives across all sectors and society. Multiple interconnected pathways exist to operationalize the above components.A revised quadruple aim for healthcare improvement, aligned with social and economic goals of sustainable prosperity and wellbeing, may be a desirable step toward constructing planetary health systems capable of maximizing the health of humans and natural systems.Social media summaryIt's time for new ‘planetary health systems’: focusing on planetary health to enhance healthcare performance. #PlanetaryHealth #ClimateCrisis #HealthcareImprovement.

Planetary health movements have advanced substantially within the last ten years with new frameworks and models being considered within health systems in varied contexts. Despite advancements, there continues to be an overall lack of accessible and regional- or field-specific planetary health frameworks to inform health systems. We therefore set out to conduct a scoping review to identify current planetary health-related frameworks that have been developed for health systems. We systematically searched the following electronic databases up to November 2023: Medline, CAB s, and Scopus; and carried out manual searches in Overton, Policy Commons, Google, and Google Scholar. We engaged a two-stage article review process, then used content analysis to identify the different domains. We identified six overarching categories within the planetary health-related frameworks including: 1) health system and environmental impacts; 2) vision, advocacy, leadership, and communication elements; 3) key structural components for environmentally sustainable health systems; 4) climate resiliency and environmental sustainability of healthcare facilities and systems; 5) climate-resilient and sustainable technologies and infrastructure; and 6) evaluation and accountability mechanisms. Regional, national, and international governments, funding agencies, and organizations are called to support greater research and implementation work around planetary health-informed health systems change while considering existing frameworks. Better inclusion of all facets of planetary health (e.g., biodiversity), as well as key acknowledgement and work with other knowledge systems (e.g., Indigenous Peoples and their knowledge systems) are needed to ensure planetary health-related frameworks are grounded in what we are trying to protect—the planet itself.

The escalating climate crisis necessitates that health care and medical education adapt to the increasing health impacts of extreme weather events, rising temperatures, and shifting ecosystems. Patients and medical trainees are already confronting the health consequences of climate change, pollution, and environmental degradation, while health care systems grapple with effects on service delivery. These environmental challenges underscore the need for health care and medical education that is resilient and proactive in addressing emerging threats.Planetary health is a field inclusive of the effects of climate change and environmental degradation on human health and the broader systems that sustain life. Many U.S. medical schools have begun integrating planetary health into their curricula. However, without deliberate and scaffolded inclusion of planetary health education throughout graduate medical education, trainees may lack the ability to translate environmental determinants of health into actionable clinical strategies that improve patient outcomes and health care system resilience, as graduate medical education plays a pivotal role in shaping physicians' practice patterns. The Accreditation Council for Graduate Medical Education (ACGME), which sets the standard for routine graduate medical education, has the opportunity to help prepare trainees to meet societal needs and equip them for the challenges they will encounter in their medical practice.Incorporating planetary health into the Common Program Requirements would establish a training standard for planetary health, now widely recognized as fundamental to human health. Existing ACGME priorities, such as health equity, quality improvement, systems-based practice, and interdisciplinary collaboration, align with planetary health approaches. The ACGME's endorsement of planetary health education would ensure all residents acquire the skills and knowledge necessary to address the health consequences of climate change and are prepared to practice sustainable health care, thus fostering a health care workforce capable of meeting the needs of patients and delivering resilient, sustainable, and equitable care.

Promoting sustainability in nursing and midwifery clinical laboratories: Strategies for resource reduction, reuse, and recycling

This study aimed to:Highlight synergies between health professionals' leadership competencies and planetary health principles.Elucidate how health professionals can meet their leadership competencies while simultaneously learning about and promoting planetary health. Health professionals representing multiple professions engaged in discussions exploring how health leadership impacts planetary health. Discussants selected competencies from the Faculty of Medical Leadership and Management that align with the United Nations' Sustainable Development Goals and pertain to planetary health. The selected competencies were reworded to explicitly reference planetary health. Two competencies in each of seven leadership domains were reworded to explicitly reference planetary health. Practical examples of how these competencies could be achieved while promoting planetary health were developed to guide learners, educators and those developing professional standards to incorporate a planetary health perspective. A multiprofessional group identified how health leadership competencies and planetary health priorities can be addressed simultaneously in lifelong learning across all health professions, disciplines and levels of training.

A framework to guide planetary health education

In their 2024 editorial, Yassaie and Garman called on health professionals to be planetary health leaders. Responding to their call for articles, this submission reflects my COVID-19 'planetary health' epiphany during the Australian lockdowns while curating sustainable healthcare and climate change education submissions. COLLECTIVE COVID-19 LEARNINGS: As a global collective, we could have learnt much from the pandemic. Despite our broken relationship with Nature, during lockdown, most of us spent considerable time in Nature. This should have heightened our awareness of our interdependence with our natural environment. The United Nations has asked us to Make Peace with Nature and be the #GenerationRestoration in the 2021-2030 Decade of Restoration. A PERSONAL COVID-19 EPIPHANY: My COVID-19 epiphany happened while curating sustainable healthcare education articles for a medical education journal. An article reflecting Indigenous perspectives introduced me to Natural and First Laws. My newfound awareness of Indigenous communities' deep spiritual connection to and stewardship of Country or Land changed the lens with which Planetary Health was integrated across our curriculum. This 'epiphany' also led to advocacy for advancing planetary stewardship in health professions education, such as the development of a Consensus Statement on Planetary Health and Education for Sustainable Healthcare, and contributing to the revision of the Australian Medical Council's Accreditation Standards. Individually and collectively, as health professionals and health professions educators and as #GenerationRestoration, current and yet unborn generations of all 'beings' are relying on us to be inclusive eco-ethical leaders and planetary stewards.

BackgroundPlanetary Health studies the impact of the global environmental crisis on health. Urgent transdisciplinary, intersectoral, and holistic solutions adapted to local realities are needed. Designing training programs attuned to contextual needs of diverse groups and geographical areas is crucial. Planetary health programs are emerging worldwide, but little is known about their scope and learning outcomes. A systematic scoping review is needed to shed light on the state of planetary health education.ObjectivesThis review aims to identify existing frameworks, competencies, content, and teaching methods in planetary health education.MethodsFollowing PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines, we included studies targeting undergraduate and postgraduate students, focusing on skills, knowledge, and abilities related to planetary health, published in English or Spanish. No exclusions were made based on geographic area, study design, or publication period. Databases consulted were MEDLINE via PubMed, Scopus, Web of Science, and ProQuest. Selection and data extraction processes were conducted systematically.ResultsWe included 73 articles, with 88% from high-income countries and 49% focused on health professionals. Conceptual frameworks identified include "One Health," "Sustainable Development Goals," and the "Planetary Health Education Framework." Transversal skills (complex problem-solving, systemic thinking, collaboration, interdisciplinary) and specific competencies (understanding health interactions with climate change, pollution) were outlined in 45% of studies. Half of the studies described 23 general topics and 93 specific content areas. Teaching methods included in-person (59%), virtual (12%), and hybrid models (29%).ConclusionsThis review highlights the heterogeneity in conceptual frameworks, competencies, content, and teaching methods in planetary health education for health professionals. Future research should focus on developing and evaluating evidence-based educational models to address the evolving challenges of planetary health. Recommendations include enhancing collaboration among stakeholders and integrating innovative teaching methods to improve planetary health education.Trial registrationThe protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).Clinical trial number: not applicable.

Global environmental change and planetary health in the curriculum of undergraduate health professionals in Latin America: a review