Planetary Health: Educating the Current and Future Health Workforce

Abstract

Human health and well-being are inextricably linked to the environment, but human development in Western countries has been at the expense of the natural environment, largely through our reliance on fossil fuels. As we may have already reached “tipping points” in terms of some global environmental changes (e.g., climate change, biodiversity loss, air pollution), threatening human health and well-being, health professionals must respond urgently through mitigation, adaptation, and advocacy. Many are, however, not sufficiently informed to feel confident to do so. There is thus an imperative to upskill and educate practicing health professionals and current health professional students to practice environmentally sustainable health care and to take action to protect the environment to ensure human health. This chapter sets the scene in terms of the importance of the environmental determinants of health for individuals and for populations. It also provides health professionals and health professions educators with a resource list and case studies to guide the integration of planetary health and sustainable health care into the curriculum.

Health professionals have leading roles to play in addressing climate change … The pervasive threats to health posed by climate change demand decisive actions from health professionals and governments to protect the health of current and future generations.

Haines and Ebi (2019, p. 271)

Appendices

Appendix 1. Position Statements and Declarations From National Health Professional Organizations and Postgraduate Medical Colleges

National Professional Bodies

Australian Medical Association (AMA): Recently published several position statements addressing climate change, resource stewardship, and sustainability include:

• Health Care and Climate Change (2015): https://ama.com.au/position-statement/ama-position-statement-climate-change-and-human-health-2004-revised-2015

• Doctor’s Role in Stewardship of Health Care Resources (2016): https://ama.com.au/position-statement/doctors-role-stewardship-health-care-resources-2016

• Environmental Sustainability in Health Care (2019): https://ama.com.au/position-statement/environmental-sustainability-health-care-2019

Postgraduate Medical Colleges

Academy of Medical Royal Colleges (AMRC, UK): The UK’s AMRC is a good example of how collectively medical colleges are promoting sustainability, not just in terms of travel, procurement, building, and divestment from fossil fuel companies, but also in terms of community engagement (AMRC 2014). Relevant AMRC documents include:

• Facing the Future: Sustainability for Medical Royal Colleges: https://www.aomrc.org.uk/wp-content/uploads/2016/05/Facing_the_Future_Sustainabilty_for_MRC_1014.pdf

• Protecting Resources Promoting Value. A Doctor’s Guide to Cutting Waste in Clinical Care: https://www.aomrc.org.uk/reports-guidance/protecting-resources-promoting-value-1114/

Council of College Presidents (CPMC, Australia): Following a Roundtable Forum on climate change and health, the CPMC released a 2018 Communique recognizing the need for more sustainable health care and evidenced-based strategies for the management of climate change and extreme weather-related risks to health and health care infrastructure, operations, and personnel: https://cpmc.edu.au/communique/managing-and-responding-to-climate-risks-in-healthcare/

Royal College of Physicians (RCP, UK): Has a health care sustainability program that aims to reduce the environmental, social, and financial impacts of the health service. The College has produced a series of policy position papers:

• Every Breath We Take: The Lifelong Impact of Air Pollution (2016): https://www.rcplondon.ac.uk/projects/outputs/every-breath-we-take-lifelong-impact-air-pollution

• Breaking the Fever: Sustainability and Climate Change in the NHS (2017): https://www.rcplondon.ac.uk/projects/outputs/breaking-fever-sustainability-and-climate-change-nhs

• Less Waste, More Health: A Health Professional’s Guide to Reducing Waste (2018): https://www.rcplondon.ac.uk/projects/outputs/less-waste-more-health-health-professionals-guide-reducing-waste

Royal Australasian College of Physicians (RACP): In June 2015, the RACP announced that it would divest from fossil fuels due to the health impacts of climate change. At the same time and in the lead up to COP21, the RACP mobilized health professional organizations and health professionals around the world in Doctors for Climate Action, a petition calling for strong commitments for global action in Paris. In 2016, a series of position papers were published that have informed policy and advocacy initiatives:

• Climate change and health (2016): https://www.racp.edu.au/docs/default-source/advocacy-library/climate-change-and-health-position-statement.pdf

• Environmentally sustainable health care (2016): https://www.racp.edu.au/docs/default-source/advocacy-library/environmentally-sustainable-healthcare-position-statement.pdf

• Health benefits of mitigating climate change (2016): https://www.racp.edu.au/docs/default-source/advocacy-library/health-benefits-of-mitigating-climate-change-position-statement.pdf

Royal Australasian College of General Practitioners (RACGP):

• Climate change and human health Position Statement (2019): https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Position%20statements/Climate-change-and-human-health.pdf

American College of Physicians (ACP): In addition to a position statement, the ACP website provides several resources for physicians:

• Position statement on climate change and health: https://annals.org/aim/fullarticle/2513976/climate-change-health-position-paper-american-college-physicians?resultClick=3&_ga=2.114596612.2038160052.1556863397-358539027.1556863397.

• A Climate Change Toolkit: https://www.acponline.org/advocacy/advocacy-in-action/climate-change-toolkit

• Medical Society Consortium (physicians in medical societies representing over half of the nation’s doctors) member report on the health impacts of climate change: https://medsocietiesforclimatehealth.org/reports/medical-alert/

Royal Australasian College of Surgeons (RACS): Recommends that surgeons and hospitals reduce the impact of surgery on the environment.

• Environmental Impact of Surgical Practice Position Paper (2018): https://www.surgeons.org/news/advocacy/2018-06-18-environmental-impact-of-surgical-practice.

Appendix 2. International and Country-Based Organizations Providing Resources and/or Case Studies Relating to Sustainability in Health Care and Health Care Education (Alphabetical)

Alliance of Nurses for Healthy Environments: https://envirn.org/

A wealth of resources available from this US-based Alliance with a range of work group offering free resources: Education, research, practice, policy and advocacy, climate change, safer chemicals, food sustainability, and energy and health.

Canadian Association of Physicians for the Environment (CAPE): https://cape.ca/

CAPE works to better human health by protecting the planet. The Guiding Principles relate to evidence-based and ethics-driven education, collaboration, advancement off human health by addressing environmental issues, and advocacy in terms of healthier environments and ecosystems. A toolkit is available: https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-for-health-professionals/

Centre for Disease Control (CDC): https://www.cdc.gov/climateandhealth/default.htm. A range of resources available, including the BRACE – Building Resistance Against Climate Effects – framework.

Centre for Sustainable Healthcare Education (CHE): https://networks.sustainablehealthcare.org.uk/network/sustainable-healthcare-education

A network for those interested in educating health professionals for planetary health in terms of understanding the links between human health and the environment and developing skills for creating a sustainable health service. An example of an available case study is Driving sustainable healthcare education through the development of assessment practices: https://networks.sustainablehealthcare.org.uk/networks/sustainable-healthcare-education/driving-sustainable-healthcare-education-through

Climate and Health Alliance (CAHA): https://www.caha.org.au/

A coalition of health care stakeholders advocating for strong policy action to reduce the threat climate change poses to human health. Offers an opportunity for different health professions to collaborate and collectively advocate. CAHA further strengthens Australian campaigns by building on global initiatives, for example, CAHA’s Healthcare Climate Challenge represents the Australian arm of Global Green and Healthy Hospitals. CAHA endeavors to link its energy projects with the international Healthy Energy Initiative. The CAHA campaign for a National Strategy on Climate Health and Wellbeing has developed a framework for the federal government to take leadership on climate change and to meet its Paris Agreement obligations.

Doctors for the Environment, Australia (DEA): https://www.dea.org.au/

Represents medical professionals, researchers, and students. Aims to promote human health through environmental health. Has a broad national network with each state liaising with local and state governments, and universities, providing climate change and health presentations, political briefings and making policy submissions. DEA convenes an annual national conference which is a crucial opportunity for health professional education. The conference regularly includes workshops to upskill health professionals and students in media, public speaking, policy submissions, and practice sustainability. DEA encourages students to join state committees and regularly supports students to provide further education for their university peers. DEA works closely with medical associations such as the AMA and AMSA, medical training colleges and state and local government.

Environmental Justice Australia: https://www.envirojustice.org.au/

Nature’s legal team. Uses technical expertise and practical understanding of the law to protect nature and defend communities’ rights to a healthy environment. For cases and publications: https://www.envirojustice.org.au/publications/

Global Consortium on Climate and Health Education: https://www.mailman.columbia.edu/research/global-consortium-climate-and-health-education

Hosted by Columbia University School of Public Health, the mission of this Consortium is to advance global health security and educate professionals on the effects of climate change. A range of resources, online courses and MOOCs as well as learning outcomes are available.

Global Green and Healthy Hospitals Network: https://www.greenhospitals.net/

Comprises health organizations dedicated to reducing their ecological footprint and promoting public and environmental health, with sharing of best practice models and strategies such as operating theatre waste reduction, anesthetic GHG reductions, parking lot lighting energy savings and transport action plans. A Green Challenge award recognizes innovation in meeting environmental challenges: https://www.greenhospitals.net/case-studies/#clima.

Healthcare without Harm: https://noharm.org/

Works to transform health care worldwide to reduce its environmental footprint, becoming a community anchor for sustainability and a leader in the global movement for environmental health and justice. Programs include medical waste, toxic materials, safer chemicals, green building and energy, healthy food, pharmaceuticals, green purchasing, climate and health, transportation, and water.

Healthcare Environmental Resource Center: http://www.hercenter.org/

A US-based center with the website maintained by the National Center of Manufacturing and funded by the Environmental Protection Services. Provides pollution prevention and environmental compliance assistance information for the healthcare sector. Intended to be a comprehensive resource, covering all the varieties of hospital wastes and the rules that apply, including both federal regulations and the specific rules that apply in different states. HERC also includes environmental compliance information for dental offices and assisted living/nursing care communities.

MedAct (UK): https://www.medact.org/project/divestment/

The Mission is to support health professionals from all disciplines to work together towards a world in which everyone can truly achieve and exercise their human right to health. The Organization’s campaigns include Fossil Fuel Divestment, Healthy Planet Healthy World, Hospital Food, Sustainable Food Systems, Diets & Health.

Menus of Change Initiative: http://www.menusofchange.org/

Initiative from The Culinary Institute of America and Harvard T.H. Chan School of Public Health that strives to realize a long-term, practical vision integrating optimal nutrition and public health, environmental stewardship and restoration as well as social responsibility concerns within the foodservice industry and the culinary profession. Resources and case studies are available.

Pharmacists for the Environment, Australia: https://www.facebook.com/PharmEnviroAus/?ref=br_rs

Pharmacists for the Environment Australia (PEA) is committed to advocacy and promotion of sustainable pharmacy practices for better human and planet health. The website is currently under construction: http://www.pea.org.au/?fbclid=IwAR1Inp-P_bX3ndnuIGwmE8s8ctO8KhAjzsjukGT3OTfHkGeZ_SYpuAeh7OM

Planetary Health Alliance: https://planetaryhealthalliance.org/planetary-health; https://planetaryhealthalliance.org/education

Consortium of universities, NGOs, and partners committed to advancing planetary health. Educational resources include planetary health syllabi, workshops, videos, etc.

Practice Greenhealth: https://practicegreenhealth.org/

The leading US membership and networking organization for sustainable health care, delivering environmental solutions to hospitals and health systems across the United States. A range of toolkits are on offer, for example, anesthetic gas toolkit, greenhouse gas reduction toolkit.

Sustainable Development Unit (UK): https://www.sduhealth.org.uk/

Funded by and accountable to NHS England and Public Health England to work across the NHS, public health and social care system. Supports the NHS, public health, and social care to embed and promote the three elements of sustainable development: Environmental, social, and financial. Helps organizations across health and care embed and promotes sustainable development in order to reduce emissions, save money, and improve the health of people and communities. Involved in the long-term needs of the health system including adaptation of health service delivery, health promotion, tackling the wider determinants of health, corporate social responsibility, and developing new sustainable models of care.

• Case studies from various NHS units and hospitals: https://www.sduhealth.org.uk/resources/case-studies.aspx

• Tool for sustainable planning: https://srp.digital/

• 2018 Sustainable Development Report: https://www.sduhealth.org.uk/policy-strategy/reporting/natural-resource-footprint-2018.aspx

World Bank: https://www.worldbank.org/en/topic/climatechange

Keeping global temperature rise to below 2 °C will require co-ordinated global action at an unprecedented scale and speed. The World Bank Group is committed to helping countries meet their national climate targets. Three relevant links are:

• Climate change and health: http://www.worldbank.org/en/topic/climatechangeandhealth

One of the resources includes a document entitled Climate-Smart Healthcare: Low-Carbon and Resilience Strategies for the Health: https://openknowledge.worldbank.org/handle/10986/27809

• Climate-smart agriculture: http://www.worldbank.org/en/topic/climate-smart-agriculture

• Disaster risk management: http://www.worldbank.org/en/topic/disasterriskmanagement

World Health Organization (WHO)

More than 7000 people working in 150 country offices in six regional offices, with headquarters in Geneva. The World Health Assembly is the governing body. Its list of programs is long, from Accountability for women’s and children’s health to Zoonoses and Veterinary public health. Some useful resources include:

• Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings: https://www.who.int/globalchange/publications/healthcare_settings/en/

• Operational framework for building climate resilient health systems:https://en.unesco.org/themes/education-sustainable-development

• 2030 Sustainable Development Goals (SDGs), Global Action Plan: https://www.who.int/sdg/en/

Appendix 3. Features of an Environmentally Accountable Medical School (Applicable to All Health Professions) (Boelen et al. 2016)

An environmentally accountable medical school or HP college should be:

• 1. Environmentally responsible: Aware of GECs facing society and recognizes its impact on future students, staff, and populations served by the school. Responsibility includes tracking the school’s carbon footprint and other resource usage such as water.

• 2. Environmentally responsive: Aware of requirements to reduce the school’s impact on local and global environment, having policies and priorities for saving water, raw materials and energy, for example, through amending building and travel policies, reducing, recycling, encouraging sustainability initiatives, and individual champions.

• 3. Environmentally accountable: Has clear, effective policies to reduce the school’s environmental impact and through education, research and service to ensure health systems are sustainable for future generations. Includes linking awareness and responsiveness to challenges with clear, evidence-based action plans, working with local communities so the school and the communities it serves can reduce their environmental impact and minimize damage where impact is unavoidable. Has measurable outcomes.

Appendix 4. Ethical Framework (With Questions) Relating to Large Infrastructural Projects

Ecological consequences

• What ecosystems will be affected? What flora and fauna will be affected?

• What are the potential impacts on water (e.g., usage, pollution, run-off)?

• What are the potential pollutants? What measures are required to prevent or minimize them?

• In the event of an accident, what species will be affected by the failure?

• Are measures in place to ensure that a clean-up happens in the event of bankruptcy, abandonment or at the end of the life of the project?

Health consequences

• Whose health and well-being are likely to be negatively affected?

• What specific physical and mental health impacts are foreseeable?

• In the event of an accident, which communities will be affected?

Cultural consequences

• What happens to burial grounds, ceremonial places and other spiritual locations and other cultural centers?

• In the event of a disruption, what are the physical and mental health consequences?

Legal considerations

• What are the health and other consequences of undermining the laws of a local community?

Gender and age considerations

• How might the establishment of the project increase the suffering and poor health of impacted women, children, and the elderly?

Economic considerations

• Which communities and individuals benefit from the mine and which are harmed?

• Within those communities, how are benefits and harms distributed?

• Who bears the costs of damage to personal property or impacts on physical and mental well-being as a result of the project’s activities?