A planetary health curriculum for medicineBMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2385 (Published 06 October 2021) Cite this as: BMJ 2021;375:n2385
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Anna Moore´s call to include Planetary Health (PH) in med schools is supported by Wonca (World Organization of Family Doctors), which stated in 2016 that it is "imperative that Planetary Health (PH) be included in the core curriculum of medical schools, family medicine residencies and further professional development." (1)
Despite a global academic push to integrate PH into the healthcare curriculum, a well established framework remains a challenge (2; 3); thus, teachers must embrace new approaches. One such experience is the use of actor-network theory (ANT) to create a diagram describing interconnections between a patient's clinical problem and planetary health proximal and distal determinants of health of him/her (4). ANT has been widely used in anthropological studies to depict complex interrelations. In my experience, this can be an effective teaching tool to help siloed mindsets understand the bigger picture.
Another pathway to be explored is to include Planetary Health Care in the principles guiding primary care (5), and elucidate how evidence based medicine can bring co-benefits for both patient and planet. An example is the case of protecting from overtreatment, or simply avoiding albuterol spray for asthma relief, when powder inhalers with budesonide plus formoterol may be more reasonable (6) - which avoids healthcare carbon footprint. In my teaching experience, highlighting straightforward actions can unleash enthusiasm by med students, as they realize how much can be done.
Finally, med students may be interested in Wonca´s Online Course on Planetary Health for Primary Care, which has been well accepted by the international community (7).
(1) WONCA Statement on Planetary Health and Sustainable Development Goal. May, 2017.
(2) Guzmán CAF, Aguirre AA, Astle B, Barros E, Bayles B, Chimbari M, El-Abbadi N, Evert J, Hackett F, Howard C, Jennings J, Krzyzek A, LeClair J, Maric F, Martin O, Osano O, Patz J, Potter T, Redvers N, Trienekens N, Walpole S, Wilson L, Xu C, Zylstra M. A framework to guide planetary health education. Lancet Planet Health. 2021 May;5(5):e253-e255. doi: 10.1016/S2542-5196(21)00110-8. Epub 2021 Apr 21. PMID: 33894134.
(3) Shaw E,Walpole S,McLean M, et al. AMEE consensus statement: planetary health and education for sustainable healthcare. Med Teach2021;43:272-86. doi:10.1080/0142159X.2020.1860207. pmid:33602043
(4) Barros, E; et Al. Actor network theory to map planetary health interconnections: a clinical case study. The Lancet Planetary Health. Meeting Abstracts| Volume 3, SPECIAL ISSUE, S2, September 01, 2019. https://doi.org/10.1016/S2542-5196(19)30145-7
(5) Barros, E; et Al. Planetary health care and Barbara Starfield´s legacy. June 10, 2021. BMJ GH Blogs. https://blogs.bmj.com/bmjgh/2021/06/10/planetary-health-care/
(6) Ish P, Malhotra N, Gupta N. GINA 2020: what's new and why? J Asthma. 2021 Oct;58(10):1273-1277. doi: 10.1080/02770903.2020.1788076. Epub 2020 Jul 2. PMID: 32586146.
(7) WONCA. Planetary Health for Primary Care. May 2021. https://www.globalfamilydoctor.com/News/WONCAEnvironmentlaunchesplanetar...
Competing interests: No competing interests
I read with interest Anna Moore’s article calling for a planetary health curriculum (1).
Tackling climate change and biodiversity loss is vital regarding their catastrophic health consequences. Natural-system tipping points may be close and cutting greenhouse gas (GHG) emissions is more urgent than ever. To limit global temperature rise below 1.5°C, we must now advocate for wide and equitable changes in societies (2).
The WONCA is currently providing GPs with knowledge and improving their skills to act within the planetary health framework (3). On an individual level, we are already used to facing daily choices considering our environmental impact. For example, concerns such as food, clothing, as well as traveling should focus on low carbon footprint and fair trade. With patients, we are invited to communicate more about environmental issues (3,4). On a collective level, general practitioners could mobilize society stakeholders to drive significant behaviour changes. Higher leadership could push healthcare organisations towards net-zero achievement and policy makers towards more efficient actions (3-5).
According to the previously mentioned issues, we understand our commitment is essential and must be equal to the trust placed in us.
To aim for more systemic action, a planetary health curriculum should obviously be implemented in medical schools. Concurrently, health authority guidelines should address such an important topic to support this implementation and future practice. One of our main concerns is our practice still remains in accordance with the law, ethics, and good medical practice. So we need guidelines. Of course, planetary health is a new framework and few guidelines are yet available. For instance, we browsed the website of the French National Authority for Health (HAS), the French counterpart of the National Institute for Health and Care Excellence. No specific guidelines were found matching keywords « planetary health », « climate change », or « biodiversity » (6).
According to the current environmental crisis and the need for urgent actions, the purpose of this letter is to push relevant health authorities to embed planetary health framework into new guidelines. Thus, curriculums and systemic actions on a larger scale would be further fostered. Individual actions would be better protected.
Finally, it should be highlighted that healthcare sector contributes significantly to global GHG emissions, accounting for nearly 5% (5). That’s why health authorities have also a responsability to get involved in environmental issues, assisting physician leaders to pave the way for a healthier and more sustainable world.
1 Moore A. A planetary health curriculum for medicine. BMJ 2021;375:n2385.
2 Atwoli L, Baqui AH, Benfield T, Bosurgi R, Godlee F, Hancocks S and al. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. BMJ 2021;374:n1734.
3 WONCA Working Party on the Environment, Rio Grande do Sul Telehealth Center (TelessaúdeRS-UFRGS), Alan Abelsohn A, Aoife Kirk A, Floss M, organizers. Planetary Health for Primary Care. Porto Alegre: TelessaúdeRS-UFRGS; 2021.
4 Dobson J, Cook S, Frumkin H, Haines A, Abbasi K. Accelerating climate action: the role of health professionals. BMJ 2021;375:n2425.
5 Sherman JD, McGain F, Lem M, Mortimer F, Jonas WB, MacNeill AJ. Net zero healthcare: a call for clinician action. BMJ 2021;374:n1323.
6 Haute Autorité de Santé. https://www.has-sante.fr (accessed October 12, 2021).
Competing interests: No competing interests
Anna Moore makes a strong argument for a planetary health curriculum for medicine (1).
The necessity for this and for a complexity thinking are evident from many directions, naming just three recent ones:
• BMJ editorial Oct 2021 calling for urgent action on climate disaster https://www.bmj.com/content/375/bmj.n2441,
• BMJ Opinion Aug 2021 “The climate crisis is not slow and gradual but unpredictable and catastrophic” https://blogs.bmj.com/bmj/2021/08/10/the-climate-crisis-is-not-slow-and-...,
• The Oct 2021 Nobel Prize in Physics award for contributions to climate science, using chaos, complexity and complex systems science (2).
These indicate that health and planetary health reflect complex dynamic interactions, with chaos, complexity and complex systems its basic science.
A planetary health curriculum would be one example of the application of complexity science as the science of complex interactions towards planetary health, which could also be applied to medicine, health, nursing, society and anything complex (3-5).
It would also help to develop a complexity thinking, useful in addressing complex global issues, including planetary health (6).
This could inspire a complexity thinking curriculum, including chaos, complexity and complex science as the art, science and philosophy of medicine, health, planetary health, nursing, and everything complex (2-6).
1 Moore A. A planetary health curriculum for medicine. BMJ 2021; 375:n2385 doi: https://doi.org/10.1136/bmj.n2385 (Published 06 October 2021)
2 The Royal Swedish Academy of Sciences Oct 5, 2021. Press Release: Popular Information. The Nobel Prize in Physics 2021.
https://www.nobelprize.org/prizes/physics/2021/popular-information/ (accessed Oct 16, 2021).
3 Rambihar VS, Rambihar SP, Rambihar VS Jr. Tsunami Chaos and Global Heart: using complexity science to rethink and make a better world. 2005. Vashna Publications. Toronto, Canada.
http://www.femmefractal.com/FinalwebTsunamiBK12207.pdf (accessed Oct 16, 2021).
4 Rambihar VS. CHAOS: From Cos to Cosmos: a new art science and philosophy of medicine, health … and everything else. Vashna Publications. Toronto 1996.
5 Rambihar V, Wilson J, Vali Y, LeBlanc L, Jagdeo D, Caryer C, Howes E. Chaos 2000: a new science of nursing for the new millennium. Complexity and Chaos in Nursing Journal. Summer 1999. https://cas.uwo.ca/resources/Chaos%20Complexity%20Nursing%20Mill%201999.pdf
(Accessed Oct 16, 2021).
6 Rambihar VS, Rambihar SP, Rambihar VS Jr. Chaos Complexity Complex Systems Covid-19: 30 years teaching health professionals chaos and complexity. 10th International Conference on Complex Systems, NECSI 2020. https://static1.squarespace.com/static/5b68a4e4a2772c2a206180a1/t/5f1f12... (accessed Oct 16, 2021).
Competing interests: No competing interests