"I teach it because it is the biggest threat to health": Integrating sustainable healthcare into health professions education

Integrating environmental physiotherapy into New Zealand undergraduate education: exploring current practice

This paper describes the integration of environmental physiotherapy education into the physiotherapy curriculum in a New Zealand university in response to the environmental physiotherapy agenda and the University of Otago Sustainability Framework. We describe and discuss three learning activities, the associated challenges and lessons learnt, and the current position. Given the encompassing nature of environmental and health interactions, we aimed for multilayer immersive experiences using a range of pedagogical approaches. The first learning activity example exemplifies embracing and threading Aotearoa New Zealand's indigenous knowledge and practices throughout our BPhty curriculum. The second example demonstrates how environmental physiotherapy can be made explicit within a delineated learning activity. In the third example, we describe a clinical placement learning activity that occurred in our student-led private practice. Recent full accreditation of the curriculum by the New Zealand Registration Board and positive student evaluations and feedback demonstrate that this integrated holistic curriculum is both acceptable and enjoyable. Frequent and rapid curriculum modifications in response to the COVID19 Global pandemic's impact on teaching and learning have however prevented full formal curriculum evaluation at this stage. We envisage that this educational approach be an ongoing process of review and restructure. Aligned with global trends toward sustainability in healthcare, our goal is to prepare students to address the growing environmental influences on public health. By integrating environmental physiotherapy philosophy into the undergraduate physiotherapy curriculum, we aim to develop holistic healthcare perspectives in students that will strengthen future physiotherapy practice in New Zealand and internationally.

High consciousness-low application: sustainable development and sustainable healthcare in undergraduate physiotherapy education in Sweden

Background

Swedish undergraduate physiotherapy education lacks comprehensive integration of sustainable development in curricula. Factors related to educators' perspectives in preparing future physiotherapists for sustainable development and sustainable healthcare may shed light on this shortcoming.

Aim

This study aims to describe Swedish physiotherapy educators' (i) consciousness of sustainable development and its inclusion in teaching and learning activities, (ii) ecological worldviews, (iii) attitudes toward sustainability and climate change in physiotherapy, (iv) perceptions of education for sustainable development and sustainable healthcare and (v) examine the relationship between ecological worldview and attitudes toward sustainability and climate change in physiotherapy.

Method

A cross-sectional, descriptive study was performed using a digital survey to collect data from educators within undergraduate physiotherapy education at five higher education institutions in Sweden. Data was collected using the Sustainability Consciousness Questionnaire, the New Ecological Paradigm Scale, the Sustainability Attitudes in Nursing Survey 2, and questions related to knowledge, attitudes, and self-efficacy for education for sustainable development and sustainable healthcare.

Result

Most, but not all, of the 72 educators, (76%) were aware of Agenda 2030 and the sustainable development goals, and 17% included perspectives related to sustainable development in teaching and learning activities. The educators endorsed an eco-centered ecological worldview and had largely positive overall attitudes toward sustainability and climate change within physiotherapy. However, almost one-third (28%) disagreed that issues about climate change should be included in the physiotherapy curriculum. Most agreed about having content knowledge on climate and health (81%), while a smaller part agreed on having pedagogical content knowledge regarding how to inspire or educate for sustainable development (17-28%). There was also a wide variation in perceived self-efficacy in education for sustainable development and sustainable healthcare.

Conclusion

Despite the endorsement of eco-centered ecological worldviews and a rather high consciousness of sustainable development as an overall concept, there remains a disconnect to educational attitudes and actions among Swedish physiotherapy educators. This points to the need to explore the narrative of sustainable development within physiotherapy in Sweden rooted in broader concept understanding, ethics, and reflective practice for sustainable development. A key priority should be to offer new perspectives on professional identity and continuing professional development within sustainable development.

International Planetary Health Education in Undergraduate and Graduate Medical Curricula: A Scoping Review

Background Climate change is a public health emergency, yet planetary health education is absent for many medical and health professions trainees. Objective To perform a scoping review exploring the inclusion of planetary health in undergraduate and graduate medical education. Methods A search strategy was developed with a health sciences librarian and run on 6 databases from their inception to February 2022: MEDLINE, Embase, APA PsycInfo, CINAHL, Global Health, and Scopus. The Arksey and O'Malley framework was employed to broadly select publications that described the implementation of planetary health in undergraduate and postgraduate medical education. Commentaries were included if they outlined a potential curriculum. Extracted data was grouped thematically using an iterative approach based on competencies described, key considerations, and anticipated barriers. Results After screening 2407 articles, 42 were included. Thirty articles involved medical education at undergraduate or postgraduate levels, while 10 discussed multidisciplinary education including veterinary medicine, public health, and nursing. Two articles discussed planetary heath education for staff physicians. Reported competencies included eco-medical literacy, environmental inequity, and planetary health advocacy. Key considerations for curricular development included longitudinal implementation, interprofessional collaboration, and experiential learning through quality improvement projects. Barriers to implementation included time constraints and the lack of knowledgeable educators and administrative support for curricular change. Conclusions This scoping review outlines key recommendations and barriers to help facilitate the implementation of planetary health education in medical training.

Integrating planetary health education into tertiary curricula: a practical toolbox for implementation

Objective

To present a series of case studies from our respective countries and disciplines on approaches to implementing the Planetary Health Education Framework in university health professional education programs, and to propose a curriculum implementation and evaluation toolbox for educators to facilitate the adoption of similar initiatives in their programs. We emphasize the importance of applying an Indigenous lens to curriculum needs assessment, development, implementation, and evaluation.

Methods

Case studies from Australia and United States were collated using a six-stage design-based educational research framework (Focus, Formulation, Contextualization, Definition, Implementation, Evaluation) for teaching planetary health and methods of curriculum evaluation. These components were then mapped to derive the curriculum implementation toolbox reflecting the six-stage design-based educational research framework.

Results

The case studies demonstrated different approaches to successful integration of the Planetary Health Education Framework in medicine, nursing, public health, and allied health disciplines. This integration often involved Indigenous perspectives on environmental stewardship, holistic health, and community well-being into the curriculum. The case studies also highlighted the importance of community engagement, cultural competency, and interdisciplinary collaboration in curriculum development. Findings from case studies were used to propose a curriculum implementation toolbox to assist educators in adapting and integrating planetary health education into their own programs.

Discussion

While valuable frameworks for teaching planetary health in health science programs exist, challenges remain in implementing these frameworks in real-world educational environments. The proposed curriculum implementation toolbox offers practical strategies and resources for educators to incorporate these principles into their teaching. Additionally, the case studies reported here contribute to the growing body of literature on planetary health education pertinent to addressing the triple planetary crisis.

Rapid review: Guides and frameworks to inform planetary health education for health professions

ISSUE ADDRESSED

Human actions have led to a range of global environmental changes. Health professionals must be prepared to deliver systemic changes to mitigate and adapt to the ecological crisis. This rapid review aimed to describe exemplar frameworks that inform planetary health education across health professions.

METHODS

The rapid review methodology was informed by a scoping review process. A targeted search strategy was conducted using one representative database and additional strategies such as expert consultation and citation searching were used. Results are described narratively.

RESULTS

Of the 11 637 articles, 17 were eligible for inclusion. The frameworks differed, with many recently developed for health professions broadly using a range of methodologies, including qualitative research, opinion/consensus data, literature reviews, and adaptation of previous models. Models such as metric-based scoring indicators and Sustainable Quality Improvement were featured in the frameworks, as were the application of First Nations Natural Laws.

CONCLUSION

This rapid review identifies and showcases accessible, interdisciplinary frameworks to inform the integration of planetary health in curricula, highlighting a rapidly evolving field through which interdisciplinary collaborations in healthcare are important to inform its pedagogy and application. Health education is an important component of health promotion; and thus this rapid review offers a range of approaches that health professionals, health promotion practitioners, and educators can use to inform the integration of planetary health, including sustainable healthcare, into curricula. SO WHAT?: Educational frameworks are informed by research and practice and provide key guidance to practitioners and educators; summarising key available planetary health education frameworks consolidates and guides effective education and builds on the existing body of knowledge to support urgent pro-environmental change.

Triple planetary crisis: why healthcare professionals should care

Humanity currently faces an ecological crisis with devastating consequences to all living species. While climate change is estimated to lead to 250,000 extra deaths per year between 2030 and 2050, pollution is known to cause 9 million premature deaths: a figure much greater than the deaths caused by AIDS, tuberculosis and malaria combined. The healthcare sector is both burdened by, and contributes to, the impact of climate change and environmental degradation. Amidst glaring evidence of the interdependence of human health and the eco system, there is an urgent call for healthcare professionals to concern themselves with the triple planetary threat humanity currently faces. Without immediate mitigative measures, the future seems uncertain. Some healthcare systems at local, national and global levels have taken numerous initiatives to address, mitigate and adapt to these changes, however, these are not sufficient. A lack of awareness among healthcare professionals of the ecological crisis, its interconnectedness, and the role of healthcare in it, plays a significant role in the lack responsibility of healthcare professionals in this space. Therefore, this paper presents a discussion of the current landscape of the triple threat of climate change, loss of biodiversity, and pollution, while emphasising the contribution of healthcare professionals to it. Furthermore, interrelated concepts such as planetary health and eco-anxiety are briefly discussed. This perspective paper also presents several key prospective research areas that may lay the foundation for motivating healthcare professionals to play an active role in preventing and mitigating the ecological crises humanity currently faces.

Integrating the sustainable development goals into health professions' curricula: using the nominal group technique to guide their contextualisation

BACKGROUND

To embed the Sustainable Development Goals in health profession education, educators must contextualise them to their profession and geographical region. This study used the nominal group technique to contextualise the SDGs for Australian nutrition and dietetics tertiary education programs by determining the specific knowledge, skills, and values required for graduating dietitians to practise sustainably.

METHODS

In 2022, 23 experts in food and sustainability attended a group session that employed the nominal group technique to discuss the Sustainable Development Goals knowledge, skills, and values Australian dietetic students should develop. After the group session, participants ranked the Sustainable Development Goals according to their perceived level of importance for student dietitians. These data were analysed using multi-methods, including a summation of the rankings, directed qualitative content analysis and reflexive thematic analysis.

RESULTS

The three highest-priority Sustainable Development Goals identified were (1) Zero Hunger, (2) Good Health and Well-Being, and (3) Responsible Consumption and Production, which were then considered with the qualitative findings. The main categories that were generated from the content analysis reflected the broad knowledge, skills, and values student dietitians should develop. The preliminary codes provided specific details for each of the main categories. The thematic analysis generated two additional themes: the importance of Indigenous ways of knowing, being and doing, and authentic experiential learning activities.

CONCLUSIONS

The method employed for this study provides a useful framework for health professions to contextualise the Sustainable Development Goals to their profession and geographical region. For this study, the ranking process and the qualitative data analysis enabled the Sustainable Development Goals to be reframed in a way that would be meaningful for dietetic educators and students and demonstrate the interrelatedness of the goals. The direct qualitative content analysis and reflexive thematic analysis identified the knowledge, skills, and values student dietitians should develop.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study

AIM

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

DESIGN

A cross-sectional survey design.

METHODS

An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

RESULTS

There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively.

CONCLUSION

Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health.

IMPLICATIONS FOR THE PROFESSION

All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence.

REPORTING METHOD

We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Health profession education hackathons: a scoping review of current trends and best practices

BACKGROUND

While the concept of hacking in education has gained traction in recent years, there is still much uncertainty surrounding this approach. As such, this scoping review seeks to provide a detailed overview of the existing literature on hacking in health profession education and to explore what we know (and do not know) about this emerging trend.

METHODS

This was a scoping review study using specific keywords conducted on 8 databases (PubMed, Embase, Scopus, Web of Science, ERIC, PsycINFO, Education Source, CINAHL) with no time limitation. To find additional relevant studies, we conducted a forward and backward searching strategy by checking the reference lists and citations of the included articles. Studies reporting the concept and application of hacking in education and those articles published in English were included. Titles, abstracts, and full texts were screened and the data were extracted by 2 authors.

RESULTS

Twenty-two articles were included. The findings are organized into two main categories, including (a) a Description of the interventions and expected outcomes and (b) Aspects of hacking in health profession education.

CONCLUSION

Hacking in health profession education refers to a positive application that has not been explored before as discovering creative and innovative solutions to enhance teaching and learning. This includes implementing new instructional methods, fostering collaboration, and critical thinking to utilize unconventional approaches.

The potential of virtual healthcare technologies to reduce healthcare services' carbon footprint

The COVID-19 pandemic demonstrated the potential to reduce our carbon footprint especially by reducing travel. We aim to describe healthcare and health education services' contribution to the global climate emergency and identify the need for increased use of virtual health service delivery and undergraduate/postgraduate education to help reduce the impact of health service and health education delivery on the environment. Health care services, as one of the largest contributors to carbon emissions, must take steps to rapidly reduce their carbon footprint. Health services have unfortunately paid little attention to this issue until recently. Virtual healthcare and education have a valuable role in transition to a net carbon-zero outcome. Given the increasing use of and satisfaction with virtual health services such as telehealth, and the increase in virtual education opportunities, it is important that a concerted effort is undertaken to increase their use across health services and education in the future.

Virtual education strategies in the context of sustainable health care and medical education: A topic modelling analysis of four decades of research

BACKGROUND

The growing importance of sustainability has led to the current literature being saturated with studies on the necessity of, and suggested topics for, education for sustainable health care (ESH). Even so, ESH implementation has been hindered by educator unpreparedness and resource scarcity. A potential resolution lies in virtual education. However, research on the strategies needed for successfully implementing virtual education in the context of sustainable health care and medical education is sparse; this study aims to fill the gap.

METHODS

Topic modelling, a computational text-mining method for analysing recurring patterns of co-occurring word clusters to reveal key topics prevalent across the texts, was used to examine how sustainability was addressed in research in medicine, medical education, and virtual education. A total of 17 631 studies, retrieved from Web of Science, Scopus and PubMed, were analysed.

RESULTS

Sustainability-related topics within health care, medical education and virtual education provided systematic implications for Sustainable Virtual Medical Education (SVME)-ESH via virtual platforms in a sustainable way. Analyses of keywords, phrases, topics and their associated networks indicate that SVME should address the three pillars of environmental, social and economic sustainability and medical practices to uphold them; employ different technologies and methods including simulations, virtual reality (VR), artificial intelligence (AI), cloud computing, distance learning; and implement strategies for collaborative development, persuasive diffusion and quality assurance.

CONCLUSIONS

This research suggests that sustainable strategies in virtual education for ESH require a systems approach, encompassing components such as learning content and objectives, evaluation, targeted learners, media, methods and strategies. The advancement of SVME necessitates that medical educators and researchers play a central and bridging role, guiding both the fields of sustainable health care and medical education in the development and implementation of SVME. In this way, they can prepare future physicians to address sustainability issues that impact patient care.

Sustainability efforts in healthcare simulation and clinical learning: An international survey

BACKGROUND

Little is known about international environmental sustainability practices in healthcare simulation education. Understanding these practices can elucidate current differences in practice, promote sharing of current practices, and establish baseline efforts for improving sustainability practices globally. Therefore, an electronic survey was undertaken targeting international healthcare simulation centers to acquire a more comprehensive understanding of healthcare simulation education sustainability practices in differing international settings.

RESULTS

Only 40 % of respondents had a written sustainability plan, but 68.75 % indicated their center purchased environmentally preferable supplies, 100 % endorsed supply reuse, 60.4 % endorsed supply recycling, and 37.5 % endorsed sustainable supply disposal. Most participants cited "environmental consciousness" motivated these efforts. Comparison analyses found significant differences between the U.S. and Canada for recycling (p = 0.0065) and disposal (p = 0.0074), and between Canada and international countries for recycling (p = 0.01395).

CONCLUSION

Canadian simulation centers implement more waste reduction practices than any other country surveyed. Further research should investigate factors contributing to variability and perceptions of sustainability efforts, as well as differences in international waste reduction capabilities. Countries with the most successful waste reduction efforts should advertise and expand them. In addition, healthcare simulation centers must be aware of current options for plastic reuse and embed those practices into healthcare simulation centers. Embedded practices should be taught to all simulation educators and students, with the ultimate goal of students translating these ideas into practice. The summation of improving these sustainability efforts in healthcare simulation education can have a positive global impact.

Climate-sensitive health counselling: a scoping review and conceptual framework

Health professional societies and researchers call for the integration of climate change into health counselling. However, the scientific evidence and conceptual grounding of such climate-sensitive health counselling (CSHC) remains unclear. We conducted a scoping review identifying scientific articles on the integration of climate change into communication between health professionals and patients in health-care settings. Scientific databases (Web of Science, PubMed, and Google Scholar) were searched from inception until Nov 30, 2022. 97 articles were included, of which 33 represented empirical research, and only two evaluated the effects of CSHC. More than half of the articles originated from the USA and addressed physicians. We introduce a conceptual framework for CSHC, which elaborates on aims, content areas, and communication strategies, and establishes the guiding principle of integrating CSHC into routine activities of health care. This framework supports health professionals in implementing CSHC and enables researchers to conceptualise intervention studies investigating how CSHC can contribute to the health of patients and the planet.

Sustainable healthcare education: A systematic review of the evidence and barriers to inclusion

PURPOSE OF THE ARTICLE

Health professions education is failing to prepare students to practice sustainable healthcare despite the climate crisis an urgent provision of educational opportunities is required. This systematic review aimed to synthesise educational approaches applied to sustainable healthcare education within health professions curricula and critically evaluate their impact.

MATERIALS AND METHODS

Databases searched: APA PsycInfo, BEI, CINAHL, Embase, ERIC, Medline, Scopus, Cochrane Library, Web of Science, BASE, DART-Europe, EThOS and ProQuest. Secondary searching techniques were also utilised, with searching conducted October 2021. Eligible studies included healthcare professional students/trainees, exposed to sustainable healthcare education, and evaluated through impact on knowledge, attitudes or skills. Empirical studies of any publication status were included. Non-English language studies were excluded. Eligible studies were quality assessed using JBI (2022) critical appraisal checklists and synthesised narratively.

RESULTS

Twenty-three studies were included, comprising 3343 participants and seven health professions. Studies primarily adopted a quasi-experimental design and demonstrated variable quality. Most common educational approaches were workshops and clinical skills sessions, though eight different approaches were observed. Positive impacts were achieved for knowledge, attitudes and skills.

CONCLUSIONS

Diverse approaches have been applied to sustainable healthcare education, though no superior approach is evident. Instead, many effective approaches are outlined, to be adopted in alignment with the learning outcomes.

A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action

Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals' interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.

Embedding Indigenous knowledges and voices in planetary health education

Internationally, the health-care sector has been slower than many other sectors in reducing its carbon emissions and broader environmental footprint. Incrementally, tertiary education institutions are changing their focus to integrate environmental and social objectives, including planetary health, into teaching, research, and how the campus is operated. Planetary health and sustainable health-care are emerging topics in the education of health professionals. However, they have largely been limited to specific knowledge rooted in western epistemology with ad hoc curricula that do not consider the complex interdependence of ecosystems and human health. Because of the need to prepare the current and future health-care workforce for planetary consciousness and related practices, in this Personal View we provide an innovative case study that uses Indigenist health humanities (eg, narrative portraiture) and arts-based education strategies to offer a different way of seeing, knowing, and understanding planetary health. Embedding Indigenous knowledges and voices into planetary health education is an important first step in decolonising learning in health professional education.

An evidence-based roadmap to integrate planetary health education into the medical curriculum

The urgency for action on climate change is regarded as the defining issue of our time. Planetary health education prepares future healthcare professionals to promote the health of the planet, including sustainable healthcare. This has potential benefits for the healthcare system, patients, community, and the environment. However, many educators are not confident in explaining and inspiring students and many deans and educational staff report challenges when integrating planetary health into education. The roadmap presented in this paper uses evidence from medical education literature to support medical schools with implementing this type of education. The roadmap can be used as a guide for educators, university leadership, and policy-makers in the design of planetary health education.

Sustainable healthcare in medical education: survey of the student perspectives at a UK medical school

BACKGROUND

It is now a General Medical Council requirement to incorporate education for sustainable healthcare (ESH) into medical curricula. To date, research has focussed on the perspectives of educators and which sustainable healthcare topics to include in teaching. Therefore, due to this gap in the literature, we have investigated the perspectives of medical students in the UK regarding current and future incorporation of ESH in medical education.

METHODS

A survey was circulated to 851 clinical year medical students and students intercalating after completing at least one clinical year in a London University. The anonymous survey consisted of sections on the environmental impact, current teaching and future teaching of ESH.

RESULTS

One hundred sixty-three students completed the survey. 93% of participants believed that climate change is a concern in current society, and only 1.8% thought they have been formally taught what sustainable healthcare is. No participants strongly agreed, and only 5 participants (3.1%) agreed, that they would feel confident in answering exam questions on this topic, with 89% agreeing that more ESH is needed. 60% believe that future teaching should be incorporated in both preclinical and clinical years, with 31% of participants preferring online modules as the method of teaching.

CONCLUSION

Our study has stressed the lack of current sustainable healthcare teaching in the medical curriculum. There is student demand for ESH, however, uncertainty remains regarding who is best placed to facilitate ESH, how it should be delivered, and whether there is a gender discrepancy regarding sustainable healthcare importance, emphasising the need to close the gap between educational rhetoric and action.

Harnessing the pillars of institutions to drive environmentally sustainable hospital foodservices

Background

The cultural-cognitive, normative and regulative pillars of institutions influence the ability of hospitals to change how they function at an organizational and operational level. As more hospitals and their foodservices instigate changes to address their environmental footprint and impact on food systems, they move through the “sustainability phase model” from no response through to high level action and leadership. The aim of this study was to describe and compare the pillars of institutions between hospitals in different stages of achieving environmentally sustainable foodservices (business-as-usual vs. exemplar hospitals).

Methods

For this qualitative inquiry study, interviews were conducted with 33 hospital staff from 3 business-as-usual hospitals in Melbourne, Australia and 21 hospital staff from 14 exemplar hospitals across 9 countries. Participants were asked questions about their perspectives on environmental sustainability in foodservices and the barriers, enablers and drivers they experienced. Each data set was analyzed thematically and then compared.

Findings

There was a clear and distinct difference in responses and behaviors within each pillar between the exemplar and business-as-usual hospitals. The cultural-cognitive pillar identified a similarity in personal belief in the importance of addressing environmental impacts of foodservices, but difference in how staff saw and acted on their responsibility to drive change. The normative pillar uncovered a supportive culture that encouraged change in exemplar hospitals whilst business-as-usual hospital staff felt disheartened by the difficult processes and lack of support. The regulative pillar reflected business-as-usual hospital staff feeling restricted by government policy vs. exemplar hospital participants who were motivated to internalize government policy in different ways and work with other hospitals to advocate for better policy.

Interpretation

These findings highlight strategies related to each of the three pillars of institutions that can be used to drive effective, sustainable long term change within hospitals. This includes staff education and training, revisiting hospital culture and values around environmental sustainability, embedding sustainable foodservices in internal policies, and a comprehensive government policy approach to sustainable healthcare.

'Green podiatry' - reducing our carbon footprints. Lessons from a sustainability panel

Background

The eyes of the world will be on COP26 as it meets in Glasgow in November, 2021. Our planet is displaying weather extremes due to climate change which cannot be ignored, and which are deleterious for people’s health. Ironically, healthcare contributes to climate change, contributing approximately 5% of carbon emissions globally. Climate change due to global warming is ‘the biggest global health threat of the 21st century’.

Main body

The Australian Podiatry Association conference held a sustainability panel, hearing perspectives of industry and science, medicine and sport, fashion, and retail. Content unified a broad planet and human health message, which is highly relevant for podiatrists. Key themes included waste as a resource, exercise as evidence-based intervention, responsibility and circular economy recycling principles for end-of-life product (footwear) purchases, and wider ethical considerations of footwear and clothing.

The Anthropocene origin of climate change requires humanity to collaborate and to live more sustainably. Innovation is essential for better energy modes, cleaner air, human health and earth care.

Green Podiatry joins the concerted activity of medical and health groups within Australia. The UK’s NHS is an exemplar in this area, having already reduced healthcare emissions by 35%, and aiming for net zero by 2045, and perhaps sooner.

Conclusion

People are increasingly concerned about climate change, and COP26 is an important and imminent meeting for human and planet health.

This commentary on Green Podiatry directs us all to lighten our carbon footprint. A final, and forthcoming commentary will outline practical ways of positively incorporating climate change communication into the clinical setting.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00497-1.

The Drivers of Environmentally Sustainable Hospital Foodservices

Background: Hospital foodservices have the potential to positively contribute to the local food system and planetary healthcare. Understanding the factors contributing to the success of “exemplar hospitals” with environmentally sustainable foodservices gives an opportunity to reimagine foodservices and guide strategic planning. The aim of this study was to identify the drivers of sustainable hospital foodservices.

Methods: For this qualitative multiple case study, purposive sampling was used to identify exemplar hospitals internationally. Semi-structured interviews were conducted with staff with extensive knowledge of their foodservices to explore the drivers of sustainable practices. Relevant documents provided background on the case. These documents and interview data were analyzed using the framework and thematic analysis.

Findings: There were 21 participants from 14 hospitals recruited across nine countries. Sustainable foodservice practices included local and organic food procurement, gardens onsite, vegetarian menus, re-serving unopened portion-controlled items, traditional foods, and food waste composting. Four themes were identified: initiating drivers, supporting enablers, challenges, and influence. Initiating drivers that “sparked” sustainable practices included the values of individuals or the hospital (e.g., community, environmental, or religious values), logical solutions to a problem, or government requirements. Enablers that facilitated success included motivated individuals, dedicated personnel, supportive leadership, internal protocols, and perceived benefits. External enablers included being part of member organizations, government requirements, and learning from other hospitals. Exemplar hospitals had broader influence, including educating the hospital community, supporting other hospitals, and influencing government policies/targets. Common challenges were staff resistance and inadequate policy directive.

Interpretation: These findings examine the successful international cases of sustainable hospital foodservices to provide a global overview to assist with strategic planning both within hospitals and within governing bodies.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.