Incorporating sustainability into community-based healthcare practice

Health-Promoting and Sustainable Behavior in University Students in Germany: A Cross-Sectional Study

Health-promoting and sustainable behaviors, such as active transportation and sustainable diets, are associated with positive effects on human health and the environment. In order to unlock the potential of university students as key actors and multipliers, it is of interest to investigate their level of knowledge about the health effects of climate change and their willingness toward and implementation of health-promoting and sustainable behaviors. In November 2021, an online survey was conducted among students at the University of Regensburg, Germany. A total of 3756 participants (response rate 18%; mean age 23 years; 69% women) provided valid data. A large proportion of medical students (48%) considered themselves well-informed about the health-related effects of climate change, while only a small proportion (22%) of students within economic/computer/data sciences and law felt informed. Most participants knew about the impact of climate change on malnutrition (78%), but considerably fewer were aware of its impact on cardiovascular diseases (52%). Participants who considered themselves informed were consistently more willing to engage in climate-friendly behavior, and this willingness was also reflected in their actions, as they simultaneously promoted a healthy lifestyle. Across all academic disciplines, there is a strong need for knowledge transfer regarding topics that combine health and sustainable development.

Health service planning and sustainable development: considering what, where and how care is delivered through a pro-environmental lens

The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed.

Drivers of Physicians' Engagement in Addressing Eco-health Problems

Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians' engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians' engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.

Beyond financial efficiency to support environmental sustainability in economic evaluations

The healthcare sector is one of the largest polluters in the UK, accounting for 25% of total emissions of carbon dioxide of the public sector. Ironically, it is the healthcare sector itself that is primarily affected by any deterioration in the environment affecting individuals' health and their demand for healthcare. Therefore, the healthcare sector is a direct beneficiary of its own steps towards sustainability and is more and more viewed as the one who should lead the change. In this article, we first review the concepts of financial and environmental sustainability. Second, we discuss the existing evidence of sustainable changes within this sector. Third, we propose a simple adaptation of the classic cost-effectiveness analysis to incorporate carbon footprinting to account for these external costs. We illustrate our method using the case of in-centre versus home haemodialysis. We conclude that home dialysis is always a preferable alternative to in-centre treatment based on a cost-effectiveness analysis. Finally, we discuss the limitations of our approach and the future research agenda.

Education, practical training and professional development for public health practitioners: a scoping review of the literature and insights for sustainable food system capacity-building

OBJECTIVE

Noting the upstream positioning of sustainable food systems (SFS) to multiple global crises, the present review described examples of emerging and promising practices to support SFS-oriented education, practical training (PT) and continuing professional development (CPD) among trainees and public health practitioners (PHP). A secondary objective was to compile the evidence into practical considerations for educators, supervising practitioners and professional associations.

DESIGN

A scoping review of the literature published between 2007 and 2017 was conducted in May 2017 using four databases: CINAHL, MEDLINE, Scopus and HSSA, along with bibliography hand-searching and expert consultation. Articles were screened for relevance and specificity by independent raters.

RESULTS

Nineteen articles were included for analysis. Two-thirds of the articles related to dietitians and public health nutritionists. Emerging practices included curriculum-based considerations, incorporation of 'sustainability' within professional competencies and self-reflection related to SFS. Descriptions of SFS-related education, PT and CPD practices appeared largely in the literature from developed countries. Articles converged on the need for ecosystems, food systems and sustainability considerations within and across practice to support current and future practitioners.

CONCLUSIONS

There is growing interest in SFS but guidance to support educators and preceptors is lacking. Updates to dietary guidelines to reflect issues of sustainability are a timely prompt to examine the education, training and development needs of trainees and PHP. Practical examples of emerging practices can empower PHP to promote SFS in all areas of practice. More research is needed to address identified gaps in the literature and to improve SFS-specific education, PT and CPD.

Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

Exploring Australian health promotion and environmental sustainability initiatives

Issue addressed Health promotion practitioners have important roles in applying ecosystem approaches to health and actively promoting environmental sustainability within community-level practice. The present study identified the nature and scope of health promotion activities across Australia that tackle environmental sustainability. Methods A mixed-method approach was used, with 82 participants undertaking a quantitative survey and 11 undertaking a qualitative interview. Purposeful sampling strategies were used to recruit practitioners who were delivering community-level health promotion and sustainability programs in Australia. The data were analysed thematically and interpretation was guided by the principles of triangulation. Results Study participants were at various stages of linking health promotion and environmental sustainability. Initiatives focused on healthy and sustainable food, active transport, energy efficiency, contact with nature and capacity building. Conclusion Capacity building approaches were perceived as essential to strengthening this field of practice. Healthy and sustainable food and active transport were suitable platforms for simultaneously promoting community health and sustainability. There was potential for expansion of programs that emphasise contact with nature and energy issues, as well as interventions that emphasise systems thinking and interdisciplinary approaches. So what? It was promising that Australian health promotion programs have started to address complexity rather than single issues, as evidenced by explicit engagement with environmental sustainability. However, more effort is required to enable a shift towards ecosystem approaches to health.

Healthy Cities and the Transition movement: converging towards ecological well-being?

This commentary identifies similarities, differences and opportunities for synergy and mutual learning between the Healthy Cities and the Transition movements. We outline what we consider to be the ‘pressing issues’ facing humanity and the planet in the early 21st century; consider the extent to which health promotion has engaged with and addressed these issues; compare Healthy Cities and the Transition movement; and conclude by suggesting possibilities for moving forward.

'Ecological embeddedness' and Its Public Health Implications: Findings From an Exploratory Study

Western culture over the last two centuries has become significantly ecologically 'dis-embedded', with nature increasingly reduced to resources for human use. The consequence is global environmental degradation, including accelerating climate change. Much recent research supports associations between nature contact and human health and well-being, and between feelings of nature-connectedness and pro-environmental attitudes and behaviours. The oft-cited Ottawa Charter for Health Promotion (WHO, Ottawa Charter for Health Promotion, 1986) emphasises human-environment inextricability; however public health discourse and response has not fully engaged with this recognition. This qualitative study explored the attitudes, motivations, and experiences-including formative influences-of six individuals whose behaviour was congruent with recognition of human-nature interconnectedness; such individuals may be understood as ecologically embedded. Key aspects of participants' experience, identified through grounded theory thematic analysis, were (i) connecting with nature (especially in childhood); (ii) seeing the threat and taking it personally; (iii) the nature of reality; (iv) dedicated beyond the ego-oriented self; and (v) sustaining the eco-centric self. The findings highlight the necessity for cross-sectoral advocacy at all levels of government policy development focused on recognition of human-environment connectedness, especially bridging health, planning and education policies affecting children. Only thus will both population health and ecological health on which population health depends be possible.