Acquiring an operative sustainability expertise for health professionals
Authors: Matthieu J Guitton, Julien Poitras
Journal: The Lancet Planetary Health (2017)

The effects of human activities on planetary ecosystems are nearing a point of no return. It is getting increasingly clear that population-wide behavioural changes will have to be the basis of any solution.1Nyborg K Anderies JM Dannenberg A et al.Social norms as solution.Science. 2016; 354: 42-43Crossref PubMed Scopus (337) Google Scholar, 2Amel E Manning C Scott B Koger S Beyond the roots of human inaction: fostering collective effort toward ecosystem conservation.Science. 2017; 356: 275-279Crossref PubMed Scopus (142) Google Scholar, 3Crist E Mora C Engelman R The interaction of human population, food production, and biodiversity protection.Science. 2017; 356: 260-264Crossref PubMed Scopus (307) Google Scholar, 4Guitton MJ The water challenges: alternative paths to trigger large-scale behavioural shifts.Lancet Plan Health. 2017; 1: e46-e47Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar Yet, in order for such changes to occur, a substantial proportion of the population has to be willing to endorse them. Because health professionals are heavily connected with all layers of the population and can have a major impact on societal issues,5Faulkner LR McCurdy RL Teaching medical students social responsibility: the right thing to do.Acad Med. 2000; 75: 346-350Crossref PubMed Scopus (43) Google Scholar, 6Goodman B Developing the concept of sustainability in nursing.Nurs Philos. 2016; 17: 298-306Crossref PubMed Scopus (11) Google Scholar, 7Moser AM Stigier FL Haditsch B Physicians' responsibility for planetary health.Lancet Plan Health. 2017; 1: e56Summary Full Text Full Text PDF Scopus (6) Google Scholar they might be able to encourage positive changes. Getting professionals invested in the desired transformation could be done through training. In other words, health professionals' education could be a gate to global sustainability and a planetary health revolution. Although appealing, this general concept does not tell much about how to put the ideas into practice. How can health professionals be encouraged to get involved and be concerned about planetary health issues? How can they be given the knowledge and the will to invest in this mission? In other words, how can the desired behavioural changes be put into action? These questions are far from trivial, because the overwhelming majority of physicians are not equipped to face the changes that population health will go through in the climate change era.8Valois P Blouin P Ouellet C Renaud JS Bélanger D Gosselin P The health impacts of climate change: a continuing medical education needs assessment framework.J Contin Educ Health Prof. 2016; 36: 218-225Crossref PubMed Scopus (10) Google Scholar The acquisition of an operative sustainability health expertise by health professionals could be divided into two aspects: increasing awareness of the social accountability inherent to being a health professional in an endangered planetary context (mindset); and enhancing the basic and applied knowledge of how the changing conditions of Earth will affect human health (expertise). Sustainability skills should not be considered as ectopic in the context of health professional training. Indeed, human health is actualised in the biosphere in which we live. The changing conditions of Earth's biosphere will inevitably affect human health. Planetary health is inherently interdisciplinary, and should be taught in an interdisciplinary context. Optimal strategies should concomitantly adopt varied and complementary pedagogical tools. The first approach to knowledge acquisition is the classic method: conventional courses provided by expert teachers. The main problem with this approach is that experts who can provide lessons in this field are scarce. Universities could rely on specialists with neighbouring expertise, such as sustainability experts, geologists, social scientists, or ecology scholars. Even if conventional classroom-type lectures by external (non-health sciences) teachers could provide a way of imparting primary knowledge to students of health-care professions, a major interdisciplinary dialogue would nonetheless be required to optimise course content to target this very specific population of health-care students. Yet, medical education is not just a process of knowledge acquisition, but also, maybe more importantly, it is the acquisition of skills and new ways of thinking.9Rodriguez-Paz JM Kennedy M Salas E et al.Beyond “see one, do one, teach one”: toward a different training paradigm.Postgrad Med J. 2009; 85: 244-249Crossref PubMed Scopus (99) Google Scholar Although conventional courses are a perfectly legitimate way to acquire specific theoretical knowledge, a major component of the training of health-care professionals relies on practical training in clinical settings, which is traditionally provided under the guidance of mentors with backgrounds similar to those of the students. For clinical mentors to train students in global sustainability skills, the mentors have to be trained first. This training would happen only at the very earliest after one student generation. However, the challenges that the Earth is facing cannot wait; the training of mentors needs to be accelerated. Online-based pedagogical tools, such as online communities of learning or university-triggered massive online open courses could provide interesting solutions. Unfortunately, educational systems are often refractory to change, and the necessary evolution in health sciences teaching is likely to face possible inertia, including from teachers themselves. Medical schools would have to use some motivating factor to facilitate the transition from current models to more integrative models, and one possible path is the control over advancement of the professorial career. A constructive way to promote involvement of clinical mentors in sustainability would be to acknowledge their efforts to enhance their own skills in this field. Clearly, such approaches should be widespread. As a planet, Earth is a fully integrated system, and environmental problems are global. Trying to solve these planetary issues with only local approaches will fail. Integrating active sustainability leadership with health-care responsibility cannot be the fight of a few countries: a global endeavour is needed to achieve a global impact. However, this might not be feasible in reality. Indeed, the problem of unequal repartition of resources takes its full meaning in the context of this global crisis: developing countries are confronted with more environmental problems, but with less-educated populations and fewer academic resources. Knowledge transfers are clearly necessary, yet such noble goals might not be easy to achieve.10Babich LP Bicknell WJ Culpepper L Jack BW Social responsibility, international development, and institutional commitment: lessons from the Boston University experience.Acad Med. 2008; 83: 143-147Crossref PubMed Scopus (15) Google Scholar Indeed, developed countries have their own agenda. In the current economic situation of scarce resources, developed countries need the full power of their academic resources to train their health professionals to satisfy the needs of their own populations. Although international collaborations between developed and developing countries are commendable, they are clearly unbalanced. Once again, virtual space-conveyed education could provide some interesting complementary solutions to this problem by providing powerful cost-efficient media to help the circulation of ideas and knowledge. Such initiatives would thus be a testimony to the social accountability of the richest countries by providing ways for others to implement health sustainability in their health systems. That would be true expression of sustainability development: from local actions to helping the human population as a whole. We declare no competing interests. Cognition, heuristics, and biases behind environment-related behavioursWe read with great interest Matthieu Guitton and Julien Poitras' Comment1 published in The Lancet Planetary Health, and we would like to reinforce the importance of environmental education for health professionals. Particularly, some health disciplines—such as Psychology, which is often neglected in this field—might have a cardinal role in environmental protection because they can help to support the delicate and long process of changing people's attitudes and behaviours for the protection of the environment they live in. Full-Text PDF Open Access