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Redvers N, Lockhart F, Zoe JB, Nashalik R, McDonald D, Norwegian G, Hartmann-Boyce J, Tonkin-Crine S. Indigenous Elders' voices on health-systems change informed by planetary health: a qualitative and relational systems mapping inquiry. Lancet Planet Health 2024; 8:e1106-e1117. [PMID: 39674198 DOI: 10.1016/s2542-5196(24)00277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 10/11/2024] [Accepted: 10/22/2024] [Indexed: 12/16/2024]
Abstract
Indigenous Peoples and their knowledge systems are increasingly being looked to for solutions regarding climate change, including within clinical health-care settings. Indigenous Elders specifically are noted knowledge keepers within their communities and are often looked to with great respect for their Land-based knowledges as they pertain to planetary health approaches. We sought to explore the views of health-systems change informed by planetary health within the circumpolar north from the perspective of Indigenous Elders. We held a sharing circle, in which Elders identified four interconnected themes following a cyclical pattern that were also depicted with relational systems mapping, including the past and how we got here, where we are now, where we need to go in the future, and our reflections. Our findings showed that any concepts related to planetary health that are discussed within health systems cannot be disconnected from the context around them. Overall, health systems were stated to be currently devoid of any environmental context or consideration.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department for Continuing Education, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Rassi Nashalik
- Arctic Indigenous Wellness Foundation, Yellowknife, NT, Canada
| | | | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, MA, USA
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Prescott SL. Planetary health: A new approach to healing the Anthropocene. Ann Allergy Asthma Immunol 2024; 133:649-657. [PMID: 39173905 DOI: 10.1016/j.anai.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 07/16/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
The Anthropocene is a proposed geological epoch reflecting the large-scale impact of human activity on the Earth's natural systems. This era is also characterized by other significant threats to ecologic well-being that are less evident in the sedimentary records. Extensive environmental changes with industrialization and urbanization have also contributed to declining biodiversity and microbial dysbiosis in essential ecosystems-the original and foundational lifeforms that continue to sustain virtually all ecosystems today, including our own. These changes, along with numerous other social and ecologic disruptions at all scales are implicated in the rising rates of physical and mental ill-health, particularly the immune dysregulation and noncommunicable diseases that characterize the Anthropocene. This narrative review considers how urgent structural changes in how we live are essential to the future of human health and the flourishing of all life on Earth. It explores planetary health as a solutions-oriented, transdisciplinary field and social movement aimed at addressing these interconnected global challenges through integrated ecologic approaches. Planetary health considers not only the vital biophysical "planetary boundaries" required to support human flourishing, but also the upstream social, political, and economic ecosystems that support (or undermine) well-being at all scales. The value systems and the worldviews that have contributed to our global challenges are a central consideration in the planetary health agenda-emphasizing the imperative to address structural inequalities, injustices, and the social, emotional, and spiritual dimensions of unrealized human potential. Promoting these inner assets is essential to human flourishing and fostering the cultural capacities necessary to ensure sustainable planetary health.
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Affiliation(s)
- Susan L Prescott
- Medical School, University of Western Australia; Family and Community Medicine, University of Maryland, Baltimore, Maryland; Planetary Health Network, Nova Institute for Health, Baltimore, Maryland.
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3
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MacKenzie-Shalders K, Zadow G, Hensley-Hackett K, Marko S, McLean M. Rapid review: Guides and frameworks to inform planetary health education for health professions. Health Promot J Austr 2024; 35:864-874. [PMID: 37866347 DOI: 10.1002/hpja.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
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.
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Affiliation(s)
- K MacKenzie-Shalders
- Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - G Zadow
- Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - K Hensley-Hackett
- Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - S Marko
- Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - M McLean
- Medical Education, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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Römer J, Herrmann A, Molkentin K, Müller BS. Application of Motivational Interviewing in climate-sensitive health counselling - A workshop report. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 189:50-54. [PMID: 39168771 DOI: 10.1016/j.zefq.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION This workshop report explores the application of Motivational Interviewing (MI) in Climate-sensitive Health Counselling (CSHC) within the context of primary health care. As there is a growing interest in the connection of individual health and climate change mitigation, we provide practical guidance on integrating MI techniques in CSHC. METHODS In June 2023, a 2-day workshop on MI was conducted at the Institute of General Medicine, University of Cologne. The workshop, facilitated by a certified MI trainer, combined theoretical content with practical group exercises. In a second workshop the staff of the Institute of General Medicine discussed the application of MI in CSHC. RESULTS We identified and specified five tools to apply MI in CSHC: A) risk assessment scores, B) relevance assessment scales, C) decision matrices, D) confidence assessment scales, and E) SMART goals. These tools provide practical insights for integrating MI into primary care consultations, offering a time-efficient approach to CSHC. DISCUSSION Our results present a promising approach for healthcare professionals to incorporate climate-related aspects into health counselling of patients. Feasibility and effects of MI in CSHC are still unclear and require further research. CONCLUSION The tools identified provide practical guidance for the application of MI in climate-sensitive health counselling (CSHC) as well as guidance on conducting appropriate studies.
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Affiliation(s)
- Johanna Römer
- Institute of General Medicine, University Hospital Cologne, Medical Faculty of University of Cologne, Cologne, Germany
| | - Alina Herrmann
- Institute of General Medicine, University Hospital Cologne, Medical Faculty of University of Cologne, Cologne, Germany; Heidelberg Institute of Global Health, University Hospital Heidelberg, Medical Faculty of Heidelberg University, Heidelberg, Germany.
| | - Kira Molkentin
- Institute of General Medicine, University Hospital Cologne, Medical Faculty of University of Cologne, Cologne, Germany
| | - Beate S Müller
- Institute of General Medicine, University Hospital Cologne, Medical Faculty of University of Cologne, Cologne, Germany
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Redvers N, Hartmann-Boyce J, Tonkin-Crine S. Nature Prescriptions and Indigenous Peoples: A Qualitative Inquiry in the Northwest Territories, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:806. [PMID: 38929052 PMCID: PMC11203734 DOI: 10.3390/ijerph21060806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians' and Indigenous Elders' views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6G 2M1, Canada
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (J.H.-B.); (S.T.-C.)
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (J.H.-B.); (S.T.-C.)
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (J.H.-B.); (S.T.-C.)
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Krippl N, Mezger NCS, Danquah I, Nieder J, Griesel S, Schildmann J, Mikolajczyk R, Kantelhardt EJ, Herrmann A. Climate-sensitive health counselling in Germany: a cross-sectional study about previous participation and preferences in the general public. BMC Public Health 2024; 24:1519. [PMID: 38844875 PMCID: PMC11155184 DOI: 10.1186/s12889-024-18998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND In response to climate change (CC), medicine needs to consider new aspects in health counselling of patients. Such climate-sensitive health counselling (CSHC) may include counselling patients on preventing and coping with climate-sensitive diseases or on leading healthy and climate-friendly lifestyles. This study aimed to identify previous participation in and preferences for CSHC as well as associated sociodemographic and attitudinal factors among the general public in Germany. METHODS We conducted a cross-sectional study in a population-based online panel in five German federal states (04-06/2022). We performed descriptive statistics and multivariable regression analysis to assess prior participation in CSHC and content preferences regarding CSHC, as well as associations between sociodemographic variables and general preference for CSHC. RESULTS Among 1491 participants (response rate 47.1%), 8.7% explicitly reported having participated in CSHC, while 39.9% had discussed at least one CSHC-related topic with physicians. In the studied sample, 46.7% of participants would like CSHC to be part of the consultation with their physician, while 33.9% rejected this idea. Participants aged 21 to 40 years (versus 51 to 60), individuals alarmed about CC (versus concerned/cautious/disengaged/doubtful/dismissive), and those politically oriented to the left (vs. centre or right) showed greater preference for CSHC in the multivariable regression model. Most participants wanted to talk about links to their personal health (65.1%) as opposed to links to the health of all people (33.2%). CONCLUSIONS Almost half of the participants in this sample would like to receive CSHC, especially those who are younger, more alarmed about CC and more politically oriented to the left. More research and training on patient-centred implementation of CSHC is needed.
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Affiliation(s)
- Nicola Krippl
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Nikolaus C S Mezger
- Global and Planetary Health Working Group, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06097, Halle (Saale), Germany
| | - Ina Danquah
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Hertz-Chair Innovation for Planetary Health, Center for Development Research (ZEF), Rhenish Friedrich Wilhelm University of Bonn, Genscherallee 3, 53113, Bonn, Germany
| | - Jessica Nieder
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Silvan Griesel
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jan Schildmann
- Institute for History and Ethics in Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 20, 06112, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin, Luther University Halle-Wittenberg, Magdeburger Straße 8, 06097, Halle (Saale), Germany
| | - Eva J Kantelhardt
- Global and Planetary Health Working Group, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06097, Halle (Saale), Germany
| | - Alina Herrmann
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Institute of General Medicine, University Hospital Cologne, Medical Faculty Cologne University, Kerpener Straße 62, 50937, Cologne, Germany
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7
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Redvers N, Hartmann-Boyce J, Tonkin-Crine S. Patient-planetary health co-benefit prescribing in a circumpolar health region: a qualitative study of physician voices from the Northwest Territories, Canada. BMJ Open 2024; 14:e081156. [PMID: 38431297 PMCID: PMC10910660 DOI: 10.1136/bmjopen-2023-081156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Despite climate change being described as a code red for humanity, health systems have been particularly slow in both climate mitigation and adaptation responses. The effects of climate change on health and health systems will not be felt equally, with underserved and marginalised communities disproportionately impacted. The circumpolar region is warming at 3-4 times the global rate, amplifying already existing socioeconomic barriers and health inequities, with particular amplified effects for the substantial Indigenous population in the area. OBJECTIVES AND SETTING We therefore sought to explore perspectives of physicians around patient-planetary health (P-PH) co-benefit prescribing in a circumpolar region in the Northwest Territories (NWT), Canada, known to be one of the ground zero levels for climate change. METHODS Thirteen semi-structured physician interviews were carried out in the NWT region between May 2022 and March 2023 using purposive sampling. Interviews were transcribed verbatim and reflexive thematic analysis was carried out to identify key themes. RESULTS There were three main themes identified including (1) current healthcare system does not support planetary health, (2) supporting patient-planetary health is currently difficult for clinicians and (3) considering change in the NWT to support patient-planetary health. Participants noted key opportunities to move planetary health forward, with the NWT having the potential to be an innovative model for planetary health-informed change for other health systems. CONCLUSION The NWT health system has unique features due to its rural and remote nature and smaller population base. Despite this, our study identified some key opportunities for advancing P-PH co-benefit efforts. The identified opportunities may be considered in future intervention, organisational change and policy-making efforts with potential relevance in other settings.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lippman D, Stump M, Veazey E, Guimarães ST, Rosenfeld R, Kelly JH, Ornish D, Katz DL. Foundations of Lifestyle Medicine and its Evolution. Mayo Clin Proc Innov Qual Outcomes 2024; 8:97-111. [PMID: 38304165 PMCID: PMC10831813 DOI: 10.1016/j.mayocpiqo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field's evolution, there is strong evidence that the 6 pillars of LM-a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.
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Affiliation(s)
| | - Mariah Stump
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Erica Veazey
- St. Mark’s Family Medicine Residency, Salt Lake City, UT
| | | | - Richard Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - John H. Kelly
- American College of Lifestyle Medicine, Chesterfield, MO
| | - Dean Ornish
- Preventive Medicine Research Institute, University of California, San Francisco, CA
| | - David L. Katz
- American College of Lifestyle Medicine, Chesterfield, MO
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9
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Quitmann C, Griesel S, Nayna Schwerdtle P, Danquah I, Herrmann A. Climate-sensitive health counselling: a scoping review and conceptual framework. Lancet Planet Health 2023; 7:e600-e610. [PMID: 37438001 DOI: 10.1016/s2542-5196(23)00107-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023]
Abstract
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.
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Affiliation(s)
- Claudia Quitmann
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Silvan Griesel
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Patricia Nayna Schwerdtle
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany; Interdisciplinary Centre for Scientific Computing (IWR)-Climate Change and Health AI Lab, University of Heidelberg, Heidelberg, Germany; School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ina Danquah
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany
| | - Alina Herrmann
- Institute of Global Health, University Hospital Heidelberg, Medical Faculty University Heidelberg, Heidelberg, Germany; Institute of General Medicine, University Hospital Cologne, Medical Faculty University of Cologne, Cologne, Germany.
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10
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Redvers N, Wright K, Hartmann-Boyce J, Tonkin-Crine S. Physicians' views of patient-planetary health co-benefit prescribing: a mixed methods systematic review. Lancet Planet Health 2023; 7:e407-e417. [PMID: 37164517 DOI: 10.1016/s2542-5196(23)00050-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 05/12/2023]
Abstract
Health professionals are increasingly called to become partners in planetary health. Using patient-planetary health (P-PH) co-benefit prescribing framing, we did a mixed methods systematic review to identify barriers and facilitators to adopting P-PH co-benefit prescribing by physicians and mapped these onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). We searched electronic databases from inception until October, 2022, and did a content analysis of the included articles (n=12). Relevant categories were matched to items in the COM-B model and TDF. Nine barriers and eight facilitators were identified. Barriers included an absence of, or little, knowledge of how to change practice and time to implement change; facilitators included having policy statements and guidelines from respected associations. More diverse study designs that include health professionals, patients, and health-care system stakeholders are needed to ensure a more holistic understanding of the individual, system, and policy levers involved in implementing clinical work informed by planetary health.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department for Continuing Education, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Kyla Wright
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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11
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Hoogeveen D, Atleo CG, Patrick L, Kennedy AM, Leduc M, Parkes MW, Takaro TK, Gislason MK. On the possibility of decolonising planetary health: exploring new geographies for collaboration. Lancet Planet Health 2023; 7:e179-e183. [PMID: 36754474 DOI: 10.1016/s2542-5196(22)00334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
Decolonial planetary health aspires to centre the diversity and importance of Indigenous thought and stewardship. In this Viewpoint, we explore research in planetary health across holistic worldviews and western scientific approaches. We base our examination of decolonising interventions in planetary health by exploring how global trajectories play out in British Columbia, Canada. A central part of this analysis is highlighting intercultural thinking to promote an anti-colonial, anti-racist, and reciprocal approach to climate change and global health inequities across geographical space and within planetary health discourse. Our perspective encompasses an asset-based examination, which focuses on the Indigenous scholarship in planetary health that is already underway and considers how rigorous engagement with epistemic and geographical diversity can strengthen and advance planetary health. This is a place-based response to planetary health, as British Columbia experiences climate catastrophes that are impacting whole communities, cutting through major transportation systems, disrupting supply chains, and creating a further burden on public health agencies and authorities that are spread thin by COVID-19 response. We argue for a progressive acknowledgment of decolonising work that is pushing research and practice in planetary health forward.
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Affiliation(s)
- Dawn Hoogeveen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Clifford G Atleo
- School of Resources and Environmental Management, Simon Fraser University, Burnaby, BC, Canada
| | - Lyana Patrick
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Angel M Kennedy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Maëve Leduc
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Margot W Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Maya K Gislason
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Prescott SL, Logan AC, Bristow J, Rozzi R, Moodie R, Redvers N, Haahtela T, Warber S, Poland B, Hancock T, Berman B. Exiting the Anthropocene: Achieving personal and planetary health in the 21st century. Allergy 2022; 77:3498-3512. [PMID: 35748742 PMCID: PMC10083953 DOI: 10.1111/all.15419] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 01/28/2023]
Abstract
Planetary health provides a perspective of ecological interdependence that connects the health and vitality of individuals, communities, and Earth's natural systems. It includes the social, political, and economic ecosystems that influence both individuals and whole societies. In an era of interconnected grand challenges threatening health of all systems at all scales, planetary health provides a framework for cross-sectoral collaboration and unified systems approaches to solutions. The field of allergy is at the forefront of these efforts. Allergic conditions are a sentinel measure of environmental impact on human health in early life-illuminating how ecological changes affect immune development and predispose to a wider range of inflammatory noncommunicable diseases (NCDs). This shows how adverse macroscale ecology in the Anthropocene penetrates to the molecular level of personal and microscale ecology, including the microbial systems at the foundations of all ecosystems. It provides the basis for more integrated efforts to address widespread environmental degradation and adverse effects of maladaptive urbanization, food systems, lifestyle behaviors, and socioeconomic disadvantage. Nature-based solutions and efforts to improve nature-relatedness are crucial for restoring symbiosis, balance, and mutualism in every sense, recognizing that both personal lifestyle choices and collective structural actions are needed in tandem. Ultimately, meaningful ecological approaches will depend on placing greater emphasis on psychological and cultural dimensions such as mindfulness, values, and moral wisdom to ensure a sustainable and resilient future.
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Affiliation(s)
- Susan L Prescott
- Medical School, University of Western Australia, Nedlands, WA, Australia.,Nova Institute for Health, Baltimore, Maryland, USA.,ORIGINS Project, Telethon Kids Institute at Perth Children's Hospital, Nedlands, WA, Australia
| | - Alan C Logan
- Nova Institute for Health, Baltimore, Maryland, USA
| | | | - Ricardo Rozzi
- Cape Horn International Center (CHIC), University of Magallanes, Puerto Williams, Chile.,Philosophy and Religion, University of North Texas, Denton, Texas, USA
| | - Rob Moodie
- School of Population and Global Health (MSPGH), University of Melbourne, Parkville, Vic., Australia
| | - Nicole Redvers
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sara Warber
- Nova Institute for Health, Baltimore, Maryland, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Blake Poland
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Brian Berman
- Nova Institute for Health, Baltimore, Maryland, USA.,Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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McLean M, Phelps C, Smith J, Maheshwari N, Veer V, Bushell D, Matthews R, Craig B, Moro C. An authentic learner-centered planetary health assignment: A five-year evaluation of student choices to address Sustainable Development Goal 13 ( Climate Action). Front Public Health 2022; 10:1049932. [PMID: 36408043 PMCID: PMC9671629 DOI: 10.3389/fpubh.2022.1049932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
A Code Red has been declared for the planet and human health. Climate change (e.g., increasing temperatures, adverse weather events, rising sea levels) threatens the planet's already declining ecosystems. Without urgent action, all of Earth's inhabitants face an existential threat. Health professions education should therefore prepare learners to not only practice in a changing world, but authentic educational activities should also develop competencies for global and planetary citizenship. Planetary health has been integrated across the five-year Bond University (Australia) medical curriculum. It begins in the second week of Year 1 and ends with a session on Environmentally Sustainable Healthcare in the General Practice rotation in the final year. The purpose of this article is to describe the outcomes of the first 5 years (2018-2022) of a learner-centered planetary health assignment, underpinned by the 2030 United Nations (UN) Sustainable Development Goals (SDGs), in the second year of a five-year medical program. Using systems and/or design thinking with a focus on SDG13 (Climate Action) plus a second SDG of choice, self-selected teams of 4-6 students submit a protocol (with feedback) to develop a deliverable "product" for an intended audience. Data analysis of the first 5 years of implementation found that the most frequently selected SDGs in addition to SDG13 were: SDG12 Sustainable Production and Consumption (41% of teams), mostly relating to healthcare emissions and waste; SDG3 Health and Well-being (22%), generally involving the impact of air pollution; and SDG6 Clean Water and Sanitation (15%). A survey at the concluding conference garnered student feedback across various criteria. The planetary health assignment is authentic in that teams provide solutions to address climate change. Where appropriate, final "products" are sent to local or federal ministers for consideration (e.g., policy proposals) or integrated into the curriculum (e.g., learning modules). We believe that the competencies, attitudes, and values fostered through engagement with planetary health. Throughout the medical program, as evidenced by their evaluations, stands students in good stead to be change agents, not only in clinical practice but in society. An awareness has been created about the need for planetary citizenship in addition to global citizenship.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Christian Moro
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
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14
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Keswani A, Akselrod H, Anenberg SC. Health and Clinical Impacts of Air Pollution and Linkages with Climate Change. NEJM EVIDENCE 2022; 1:EVIDra2200068. [PMID: 38319260 DOI: 10.1056/evidra2200068] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Air Pollution Impacts and Climate Change LinksAs part of the NEJM Group series on climate change, Keswani and colleagues review the linkages between climate change and air pollution and suggest strategies that clinicians may use to mitigate the adverse health impacts of air pollution.
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Affiliation(s)
- Anjeni Keswani
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Susan C Anenberg
- George Washington University Milken Institute School of Public Health, Washington, DC
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15
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Talking about Climate Change and Environmental Degradation with Patients in Primary Care: A Cross-Sectional Survey on Knowledge, Potential Domains of Action and Points of View of General Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084901. [PMID: 35457768 PMCID: PMC9029888 DOI: 10.3390/ijerph19084901] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023]
Abstract
Purpose: General practitioners (GPs) could play a role in mitigating climate change by raising awareness of its impact on human health and implementing changes to improve population health and decreasing environmental footprints. The aim of this study was to assess GPs’ knowledge and perspectives about the health impacts of climate change. Method: A questionnaire was sent to 1972 GPs in the French-speaking part of Switzerland. Knowledge of the impact of environmental degradations and climate change on health and willingness to address climate change with patients, to be exemplary and to act as role models were surveyed as well as demographic characteristics of GPs. Results: Respondents (N = 497) expressed a high level of self-reported knowledge regarding climate change, although it was lower for more specific topics, such as planetary health or health–environment co-benefits. Participants mostly agreed that it is necessary to adapt clinical practice to the health impacts of climate change and that they have a role in providing information on climate change and its links to human health. Conclusion: Most of the GPs were concerned about environmental and climate degradation. However, this study revealed a gap between the willingness of GPs to integrate the impact of climate change on health into their clinical activities and their lack of overall knowledge and scientific evidence on effective interventions. A promising way forward may be to develop co-benefit interventions adapted to the clinical setting on diet, active mobility and connecting with nature.
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