Global climate change is widely recognised as a growing global health threat and amplifier of environmental risks to health. However, it is also a significant opportunity to urgently realise huge co-benefits from mitigating and adapting to climate change, while simultaneously addressing the environmental determinants of health.(1–3) Africa is highly vulnerable to climate-health impacts, and therefore urgently needs to build capacity in climate mitigation, adaptation, and advocacy. This is certainly no less true of South Africa, which is a significant emitter of global-warming greenhouse gases and is already vulnerable to heat, drought, flooding, homelessness, unemployment, and deep-rooted poverty. South Africa's climate policies and plans therefore recognise the need for more capacity in climate change awareness and adaptation.(4,5)
Health professionals have an ethical duty to lead in protecting public health from global environmental change, especially given the public trust that they generally enjoy.(6) This includes minimising the massive environmental impact of health systems, from energy and water use to toxic and plastic waste, which has been so evident during the COVID-19 pandemic.(7)
The healthcare sector has a key role to play in meeting the global Sustainable Development Goals (SDGs), in reducing its carbon emissions by 2050, and in adapting and building resilience to growing climate change impacts. Commitments to build low-carbon and resilient healthcare systems are central to the COP26 Health Programme, signed by close to 100 countries, and training health workers for climate action is a key component. The WHO-Civil Society Working Group to Advance Action on Health and Climate Change called on health education stakeholders in June 2022 to incorporate climate change into curricula, to prepare health professionals ‘to recognize and address the health risks and impacts of climate change and to ensure functioning healthcare systems in a climate-changed future’.(8)
Education for Sustainable Healthcare (ESH) has been defined as the organization of health professions education to develop knowledge, skills, and attitudes about the interdependence of human health and planetary ecosystems, or planetary health. This includes the effects of climate and environmental changes on health, and conversely, the environmental impacts of healthcare systems. There is growing international practice and research about integrating sustainability into various educational contexts and health professions curricula that needs to be adapted appropriately for local settings.(9–13)
Experiences and key lessons from international ESH practice have been consolidated by the Association for Medical Education in Europe (AMEE) in their Consensus Statement on Planetary Health and Education for Sustainable Healthcare.(14) The Statement urges health professionals to deliver system-wide changes to address the planetary ecological crisis, and asserts that faculty development, eco-ethical leadership and planetary health action across disciplines are urgently needed to help meet environment-related SDG targets by the year 2030. (Figure 1)
Relationship between planetary health, indigenous ecological perspectives, and the knowledge, values, and practices of education for sustainable healthcare
The need for education about Planetary Health (PH) and Sustainable Healthcare (SH) in South Africa is consistent with calls for health professionals to be more socially and environmentally accountable. The 2018 Consensus Report of the Academy of Science of South Africa (Reconceptualising of Health Professionals in South Africa), for example, acknowledged threats to national health security from emerging infectious, environmental, and behavioural risks in a context of rapid demographic and epidemiological changes.(15) Although education about planetary health and sustainable healthcare is starting to develop in South African faculties, the related learning objectives, learning activities and assessment of such content is currently limited.(16)
The Education for Sustainable Healthcare (ESH) Special Interest Group (SIG) of the Southern African Association of Health Educationalists (SAAHE) was established in July 2021 to promote education about PH and SH in southern Africa. Since its inception it has developed a growing community of practice, shared ESH resources, and hosted webinars on ESH topics. In March 2022 the ESH SIG co-hosted a workshop on Planetary Health Education in African Primary Health Care Curricula and drafted a Position Statement on Integrating Planetary Health and Environmental Sustainability. The statement summarises some of the key challenges, in our view, to education about Planetary Health and Sustainable Healthcare in Africa viz. limited leadership, awareness and planetary health action in educational institutions, and insufficient integration of ESH into health professions curricula. It also has several recommendations for addressing these challenges, inspired by the AMEE Consensus statement, including the need to urge health science faculties to aim for net zero carbon emissions by 2050; to empower educators to advocate for policies and practices that promote planetary health; to encourage incentives for innovation in ESH and planetary health; to share resources and examples of best practice; and to continually monitor progress towards specific goals for integration of ESH into health professions education.
The AMEE Consensus Statement concludes that ‘Our health and well-being are dependent on a healthy planet. The window of opportunity to protect our ecosystems is fast disappearing, so urgent, collective, transdisciplinary action is required. The 2020s can be the decade in which we step up action on pressing issues such as a changing climate.’(14) As health professionals have been on the frontline of the COVID-19 response, so too will they be needed in confronting the crisis, and the public health opportunity, of climate change.
May this be the decade in which we truly step up climate action.