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Planetary Health – Educational Framework

Jennifer Cole, PhD, Department of Health Studies

Royal Holloway University of London

December 2023

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Planetary Health Alliance

https://www.planetaryhealthalliance.org

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Planetary Health Alliance (PHA)

300+ members

60+ countries

Researchers

Practitioners

Policymakers

Activists

The Planetary Health Alliance has more than 300 member institutions in more than 60 countries across the world, including in every continent. Many of these are universities that teach the next generation of students about planetary health so that they can become researchers, policymakers, practitioners, activists, the next generation of academics and make sure that the ideas and concepts of planetary health are disseminated as far and wide as possible so that they can have the most impact. But it’s also important that all these institutions have a consistent vision of what is meant by ‘planetary health’ and what should be taught on courses that claim to be about planetary health. For example, if a university in the USA offers a Bachelor’s degree in Planetary Health, and a university in Tanzania offers one too, students on both courses should gain similar knowledge and understanding – just as they would expect to if they were studying medicine, or mathematics, or music. Students from either university should be able to go on to a Master’s degree in France, or Brazil, or India, or Australia, and know that what they will learn there will drawn on concepts and knowledge gained during their undergraduate course. And the universities should be confident that if they accept students with the Bachelor’s degree to their Master’s courses, those students will understand and know certain things already that won’t need to be taught from scratch again. Organizations involved in sustainability, biodiversity protection, public health or urban greening may want to look for undergraduates with this knowledge when they enter the workforce. The more consistency there is regarding what should be taught as planetary health, the easier this becomes for everyone.

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PHA Educational Framework

“The Planetary Health Education Framework aims to guide the education of global citizens, practitioners, and professionals able and willing to address the complex Planetary Health challenges of our world today.
[It] seeks to inspire all peoples across the globe to create, restore, steward, and conserve healthy ecosystems for a thriving human civilization.
We envisage that the framework will contribute to positive outcomes for the biosphere, overcoming the Planetary Health challenges before us.”

https://www.planetaryhealthalliance.org/education-framework

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Five pillars of PH education

[1] Interconnection with nature

[2] The Anthropocene and health

[3] Equity and social justice

[4] Movement building and systems change

[5] Systems thinking and complexity

https://www.planetaryhealthalliance.org/education-framework

Pictures 1,2,4 from Pixabay

Picture 3 from Interaction Institute for Social Change | Artist: Angus Maguire

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[1] Interconnection with nature

Stewardship of the Earth – humans are its guardians, not its masters
Human evolution and adaptive lag – how well adapted are we to our niche?
Solastalgia – the grief we feel at the loss of the natural world/our heritage
Rewilding – our cities, our diets, our microbiomes and ourselves

Picture from Pixabay

The first pillar, Interconnection with Nature, focuses on the relationship between humans and the natural environment. It stresses that we need to respect and protect nature, making sure we do not cause damage that cannot be repaired, so that future generations have just as much chance to enjoy nature as we have, and our grandparents had. So, for example, if an Architecture course wanted to teach a module on planetary health, they might think about how a new building could be constructed around an old tree or a natural stream, rather than cutting down the tree or rerouting the stream. A town planner may think about how they could incorporate more parks and natural space into a new development.

It’s important within this to remember that humans have only very recently – in evolutionary terms – begun living in cities. We have evolved biologically to live in fields and forests, much more natural environments than we live in now, in temperate climates that are neither too hot nor to cold, and to eat fresh, unprocessed food (though modern humans did evolve after our ancestors developed fire, so cooked food is part of our evolutionary adaptation!). The more different our environment is from where we are ’meant’ to live, the more likely we are to be unhealthy.

As we destroy more and more of the natural world around us, people can often feel a sense of grief and loss that comes with this – called ‘solastalgia’. This is different from ‘nostalgia’ as often we cannot go back: the forest, or lake, or iceberg our ancestors know is gone forever. Understanding and acknowledging this grief can help us to ensure further damage is not repeated.

Recognizing our interconnection with nature, its links with evolution and the grief we feel from its loss can ensure that we think about bringing our environment back in line with what it ’should’ be – more like the natural environment we evolved in.

These are just some of the ideas that can be incorporated into planetary health teaching to help students to understand humans’ interconnection with nature and why it is important.

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[1] Interconnection with nature

https://www.khanacademy.org/humanities/world-history/world-history-beginnings/origin-humans-early-societies/a/where-did-humans-come-from

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[1] Interconnection with nature

Elinor Ostrom

González, J.A., Montes, C., Rodríguez, J. and Tapia, W., 2008. Rethinking the Galapagos Islands as a complex social-ecological system: implications for conservation and management. Ecology and Society, 13(2).

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[1] Interconnection with nature

Some key papers:

The Thousand Names of Gaia: from the Anthropocene to the Age of the Earth

https://thethousandnamesofgaia.wordpress.com

Connectedness as a Core Conservation Concern: An Interdisciplinary Review and a Call for Action

https://link.springer.com/article/10.1007/s40362-014-0021-3

Two-eyed seeing and other lessons learned within a co-learning journey of bringing together indigenous and mainstream knowledge and ways of knowing

https://link.springer.com/article/10.1007/s13412-012-0086-8

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[2] The Anthropocene & health

Climate change
Pollution
Resource extraction/exhaustion
(Global) Urbanisation

Picture from Pixabay

The second pillar of planetary health education is the idea of the Anthropocene and Health. The Anthropocene is the ‘Age of Man(kind)’ – the period of history in which humans have changed the Earth more than natural systems have done, for example by heating the climate through the use of fossil fuels, and chopping down trees so that forest recede. We have extracted many of the world’s natural resources from the ground, and have deposited pollutants – in particular plastic – around the world on land and in the oceans. We have covered the world with nearly 10 billion humans, and with many large, densely populated cities. This has profound effects on not only our own health (e.g. through respiratory disease caused by air pollution, or back pain caused by sitting hunched over a desk all day) but also on the health of the environment.

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[2] The Anthropocene & health

Prüss-Üstün, A., Wolf, J., Corvalán, C., Bos, R. and Neira, M., 2016. Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. World Health Organization.

Pictures from Pixabay

Many health challenges are caused or made worse by environmental conditions. The World Health Organization closely monitors damaging environmental conditions and the impact they have on human health. WHO works with other international organizations, such as the United Nations Environment Programme (UNEP) to promote healthier environment. An important way to teach this concept is to ask people what they think of as a healthy environment, and what sort of environment they would prefer to live in. Show students images such as the ones above and ask them which they would rather live in, and which one they think is more likely to support human health. This also helps to embed ideas of our interconnectedness with nature from Pillar 1 – people feel a sense of awe from nature they rarely do from less natural environments.

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[2] The Anthropocene & health

Some key papers:

The Trajectory of the Anthropocene: The Great Acceleration

https://journals.sagepub.com/doi/full/10.1177/2053019614564785

Defining the Anthropocene

https://www.nature.com/articles/nature14258

Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet commission on planetary health

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60901-1/fulltext?nr_email_referer=1)

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[3] Equity and social justice

Picture credit: Interaction Institute for Social Change | Artist: Angus Maguire

The third Pillar of Planetary Health education is Equity and Social Justice. Equity is not (quite) the same as equality – equality would make something equally available to all (e.g all the people in the top image have an apple each, and all people are at the sports match) but they do not have equity. Their ability to make the most of the opportunity is different and in order for them to get the benefits, they may need more help or support. True equity ensures the outcome is more equal for all people.

These illustrations show the differences between equality and equity. In the images, the apples are all at an equal height, as is the fence around the sports match, but not everyone is able to reach the apples or see over the fence. Some people need additional help; ensuring they get this is equity – equality of opportunity. However, there are still questions to be asked around equality/equity. Who owns the apples that are being picked? Do the people picking them get to eat the apples they pick, or are they workers? Why are some people inside the sports stadium and others outside it trying to look over a fence? Why is there a fence at all? Planetary health teaching should consider these issues and ask students to critque them.

Opinions may be different – some people may think it is perfectly fair to put the fence around the sports field so that people have to pay to go inside the fence to watch and that while it would be fair to put a wheelchair ramp on the stair into the stadium, there is no requirement to help anyone who has not paid to enter to be able to watch. Other people may question why some people can afford to buy a ticket and other can’t – are working wages fair, for instance, or is one ethnic group excluded from certain spaces? What would it take to create a more equitable society?

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[3] Equity and social justice

Picture from Pixabay

The world is, sadly, very unequal. Many people across the world have neither equality nor equity. And often the people who are experiencing inequality and inequity for one domain – e.g. people who have very low incomes, or who live in regions more at risk from climate change – also suffer challenges in others, such as difficulty in obtaining a good education or accessing healthcare.

The availability of vaccines for COVID-19, for example, has been very unequal, as we can see from this map of the world showing when vaccination coverage (defined as two vaccine doses per adult) was achieved around the world. This pattern of inequality is mirrored in almost all other health characteristics, including life expectancy, access to healthcare, number of doctors per member of the population, and so on.

Considerations of equality and equity are part of the solutions focus of planetary health: it is not enough to develop a vaccine, scientists and politicians should also think about how it will be equitably distributed and how equal access for all people can be assured. Often, the essential things people need are described as being dependent on Availability, Affordability, Accessibility, and Acceptability. For instance, food may be available in a city centre market, but the price may be so high that not everyone can afford it. Some people may live too far away to visit the market if no public transport is provided, and it may only sell food that does not match local tastes or conform to religious dietary laws. Even though the food is available, not everyone can or wants to eat it. These issues would need to be considered under considerations of equity and for social justice to be met.

This is especially important in planetary health as achievin equity may require some people to give up advantages they currently have – for example, for younger, low-risk groups to forego regular boosters for COVID19 until all people around the world have received at least two doses, which is considered the minimum for confering longer lasting immunity.

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[3] Equity and social justice

Some key papers:

The Canmore Declaration: Statement of Principles for Planetary Health

https://www.mdpi.com/2078-1547/9/2/31

Planetary Health Ethics: Beyond First Principles

https://www.mdpi.com/2078-1547/10/1/14 (and PHA handbook, Ch. 17)

The Right to a Healthy Life or the Right to Die Polluted?

https://heinonline.org/HOL/Page?handle=hein.journals/tulev16&div=8&g_sent=1&casa_token=&collection=journals

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[4] Movement building …

Activism
Research
Policy formation
Leadership

…and systems change

Picture from Pixabay

The fourth pillar of planetary health education is Movement Building and Systems Change.

Planetary Health strives to find solutions as well as just to document the problems. This can often involve policy advocacy and social activism. Groups such as Greenpeace and Friends of the Earth have been hugely influential in changing attitudes to the environment. Today, groups such as Extinction Rebellion are taking this forward. Many countries are now electing politicians who stand for environmental protection and green values. The politician shown here is Caroline Lucas, who represented the Green Party in the UK – students could be encouraged to research her career as a short project, or there may be local MPs who have stood on a ’green agenda’ who may be more relevant to study.

What environmental protests have recently taken place in your country, for example, and what are the main issues that catch the interest of your local politicians?

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[4] Movement building …

https://www.ippr.org/publications/faster-further-fairer

Pictures from Pixabay

Many groups that, in the past, were considered to be protest groups and troublemakers are now becoming more mainstream and are more able to influence policy. Many planetary health students today are likely to go on to influence policy and to write reports that help to bring about real change. Some will aim to change the system from the inside – often called ‘regime insiders’ by standing for political office, or becoming scientists who provide evidence – while others will take more direct action as ‘regime outsiders’, going on protest marches and lobbying for change even though they themselves are not able to change the law or make new policies. Many people start out as regime outsiders but gradually move ‘inside’ where they may be able to have more influence. Over time, societal views can change to make what were considered ‘outsider’ views more mainstream and likely to be accepted by most of society.

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[4] Movement building …

…needs good communication

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[4] Movement building …

Some key papers:

From public to planetary health: a manifesto

https://www.thelancet.com/manifesto/planetary-health?elsca1=&elsca2=email&elsca3=

What’s planetary about health? An analysis of topics covered in The Lancet Planetary Health’s first year

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30143-8/fulltext

This is a crisis: facing up to the age of environmental breakdown

https://www.ippr.org/research/publications/age-of-environmental-breakdown

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[4] Movement building …

Inter-related
Connected
Interdependent
Holistic

…and complexity

https://www.scielo.br/j/bn/a/pqsybB8vkxmzK4HqDLpsp5Q/?lang=en&format=html

Finally, the fifth pillar of planetary health education is Systems thinking – which goes full circle back to the idea of Socioeconomic Systems and Complex Adaptive Systems Theory we considered when thinking about humans’ interconnection with nature under Pillar 1.

Human and environmental health are interconnected, and understanding these systems – and how to research the whole system – is a key part of planetary health. No-one can be an expert in the entire system but you can learn how to map it and to find other experts with whom you can work to find more holistic solutions. For example, a well-planned sanitation system can provide natural fertilizer for farmers’ fields, biogas for cooking and can power electricity systems as well as just managing waste. Or a wood can provide shade for dairy cattle and help to protect a village from flooding. By thinking of the entire system, greater benefits can be generated and shared more widely, while understanding the system ensure that a change in one place does not have unexpected consequences elsewhere.

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[5] Systems thinking…

Picture from Pixabay

A key part of understanding systems is how they change, and whether this change comes through adaptation or transformation. Adaptation is a gradual change that happens slowly over time, so that people may not even notice it’s happening, such as a village gradually growing to come a town and then a city, or a lake gradually drying out over many generations, whereas a Transformation is more abrupt – a sudden flood that washes away a city, or a forest fire that burns the entire forest down. Over time, an area or nature feature may seem to transform if looked at only at set points, e.g, 100 years apart, but this transformation may have seemed like small adaptations to the people living through them. If we can anticipate transformations, they can be managed more easily, but if we don’t take care, they may reach a tipping point that triggers an unexpected change. There is a worry with planetary boundaries that, as we often don’t know exactly where the boundary is, a transformation could happen suddenly without sufficient warning.

We need to transform many current systems to ensure planetary health into the future, including energy systems, food systems, political and economic systems, too. As with so many other parts of planetary health, this will involve many different people from different countries, cultures, academic disciplines and sectors working together – but if they all have a shared basic education in planetary health and its core ideas, they will be able to work together more easily and cohesively and are more likely to be able to act collectively towards common goals.

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[5] Systems thinking…

Some key papers:

Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

https://www.thelancet.com/article/S0140-6736(10)61854-5/fulltext

Sustaining public health through systems thinking: planetary health’s critical role

https://www.sciencedirect.com/science/article/pii/S2352827321001191

Panarchy: theory and application

https://link.springer.com/article/10.1007/s10021-013-9744-2

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Educational ressources

https://www.planetaryhealthalliance.org/ph-education-materials

The promise of planetary health�https://www.youtube.com/channel/UCt-RNjESXMByBrMQQ63U0oA

Planetary health case studies: an anthology of global solutions�https://www.planetaryhealthalliance.org/case-studies

Research bibliography�https://www.planetaryhealthalliance.org/bibliography

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PH Education – action points

Could your research be the next planetary health case study?

At what age does planetary health education need to start?
Is planetary health a subject in its own right?
Or is it better taught as part of other course?
How much do you need to be taught?
And how much can you learn by yourself?

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