What Does the Sustainable Healthcare field bring to planetary health progress?: A UK perspective

By: Sarah Walpole

To address health issues as important and as wide reaching as those in the planetary health sphere, we do well to draw on as wide a pool of resources as we can muster. Important knowledge and resources include the lessons learnt, networks of individuals and motivation that have been built by existing initiatives. In the UK two such existing initiatives are the Centre for Sustainable Healthcare (CSH), has been working since 2008 with goals in
line with the planetary health agenda, and the Sustainable Healthcare Education network, a subsidiary of CSH which has been promoting education about planetary health since 2009.

Getting the wording right is important for the PHA’s aim of bringing new parties onboard into a global community of practice for planetary health. An opening panel at the PHA meeting in Edinburgh this year discussed ‘different lenses towards one overarching goal’, and concluded that EcoHealth, One Health, GeoHealth and Planetary Health can effectively be used interchangeably (see (Buse et al., 2018) ).

The term ‘sustainability’ did not feature, yet it is an important word in the UK’s health service. The NHS has a Sustainable Development Unit (NHS Sustainable Development Unit;, 2016) . The UK’s Centre for Sustainable Healthcare started life as ‘Centre for Greener Healthcare’, until its core team recognised that sustainability is a better understood and more applicable term in the UK NHS.

Sustainability, meeting the needs of today without compromising the needs of tomorrow, is in line with the NHS’s principles of equity of access and quality of care (UK Department of Health, 2015) . In a small group session at the PHA meeting, many participants were averse to the term sustainability for planetary health discussions, preferring a term that focuses on environmental issues over and above financial and social sustainability. However, the meshing of social, environmental and economic goals — addressing the triple bottom line — is seen as a strength and not a weakness; enabling a wide range of individuals and employees to identify with the importance of the agenda and collaborate for this aim.

The Centre for Sustainable Healthcare works with clinicians and NHS organisations to develop innovations, campaigns and strategies that reduce the environmental footprint of healthcare, while maintaining or improving the quality of care and health promotion that patients and the public receive. ‘Sustainable specialty’ programmes explore patient care pathways, from presentation to diagnosis to treatment and follow up of patients, and identify approaches to reducing the environmental footprint of care within the specialty. A project to promote tree planting on NHS sites is called ‘NHS Forest’. Apart from planting trees at 170 sites, it has explored the health and wellbeing benefits of green space on NHS sites.

The Sustainable Healthcare Education network, another CSH project, has a specific contribution to make towards PHA’s goal of integrating planetary health into education across all disciplines and all levels of study. The Sustainable Healthcare Education network has ten years of experience of supporting health professional educators to develop and deliver teaching about planetary health topics. It has developed approaches to engaging medical school faculty and building their confidence to teach about environmental sustainability, session outlines and slide sets for learning events, project ideas for student directed work, and case studies with discussion of lessons learnt during teaching development and delivery (Braithwaite et al., 2012).

Network members developed three ‘priority learning objectives’ for medical students, which demand attention to (1) the relationship between environmental change and health, (2) the environmental footprint of healthcare and interaction between healthcare and the environment, and (3) the ethical dimensions of environmental issues relating to health (Thompson et al., 2014).

PHA’s published principles for planetary health education across all disciplines (Stone et al. 2018).

In an education side-session at the 2018 PHA meeting, a group focusing on medical education comprised about 20 people from at least five continents and identified four challenges: faculty development, the need to link learning to practice (i.e. we need to develop PH in practice if we are to teach it successfully and thus teach solutions and not just problems), how to generate interprofessional learning, how to make courses accessible (including open access for download) to avoid only preaching to the converted.

The group also identified three aims: (1) share existing teaching on planetary health through an online platform, (2) develop one internationally applicable online or outline learning event for use in diverse settings (any health professional), and (3) develop approaches, pedagogies and assessments for embedding PH across the curriculum. Towards the first aim, the PHA have created an online, open-access platform where they plan to collate materials for planetary health education: https://planetaryhealthalliance.org/education. The Sustainable Healthcare Education network has already contributed some teaching materials. Work will need to be done to disseminate information about this platform and ensure that it is accessible and user friendly. The second is already underway, with at least two groups working on MOOCs on planetary health for global audiences. The third aim requires ongoing collaboration to build on existing efforts.

PHA has suggested that it will function as an umbrella organisation, or in the words of one member as a tree that supports the growth of leaves and fruit, its members and affiliates. Bringing a ‘planetary health lens’ to education in a range of disciplines will doubtless be an important aspect of the PHA’s work, and the fruits of this endeavour will be created through collaboration with educational institutions and other partners. The twenty ‘planetary health clubs’ that have already been established and those that are developed in future by and for students and emerging researchers may build the local connections and collaborations not only to develop research, but also to facilitate teaching. An excellent example of building on existing experience and resources, may be collaboration between Sustainable Healthcare Education network teams (which already exist in many UK medical schools) and newer Planetary Health Clubs to catalyse planetary health research and education.

Braithwaite, I., Mortimer, F., Thompson, T., Walpole, S. C., Barna, S., Gillam, S., … Hastings, A. (2012). Case Studies: UK Medical school teaching on Sustainability, Climate and Health. Oxford. Retrieved from http://sustainablehealthcare.org.uk/sustainable-healthcare-

Buse, C. G., Oestreicher, J. S., Ellis, N. R., Patrick, R., Brisbois, B., Jenkins, A. P., … Parkes, M. (2018). Public health guide to field developments linking ecosystems, environments and health in the Anthropocene. Journal of Epidemiology and Community Health, jech-2017–210082. https://doi.org/10.1136/jech-2017-210082

NHS Sustainable Development Unit; (2016). Sustainable Health. Retrieved October 25, 2016, from http://www.sduhealth.org.uk/policy-strategy/what-is-sustainable-health.aspx

Thompson, T., Walpole, S., Braithwaite, I., Inman, A., Barna, S., & Mortimer, F. (2014). Learning objectives for sustainable health care. The Lancet, 384(9958), 1924–1925. https://doi.org/10.1016/S0140-6736(14)62274-1

UK Department of Health. (2015). The NHS Constitution for England. Updated October 2015. Retrieved from https://www.gov.uk/government/publications/the-nhs-constitution-for-

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the Planetary Health Alliance or its members.

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