Introduction
The MBBS programme is designed to produce doctors who are competent, compassionate, and safe. This aim extends beyond technical proficiency to cultivate healthcare professionals who are ethically driven, empathetic, and dedicated to the wellbeing of both their patients and society at large. As the world faces increasingly complex health challenges due to environmental crises, these qualities of compassion and competency must also extend to planetary health. Recognising the profound connections between human and environmental health, doctors today must be prepared to understand and address health issues within a broader ecological context.
Moreover, the future of healthcare is uncertain, and doctors will confront unknown and unpredictable challenges. Emerging diseases, environmental degradation, and new public health threats will require healthcare professionals who are adaptable, forward-thinking, and equipped to approach health holistically. Integrating planetary health into the MBBS curriculum aligns with these objectives, preparing future doctors to respond to the interwoven challenges of environmental and human health. Through the framework of Education for Sustainable Development (ESD) and recent updates to the Malaysian Qualifications Framework (MQF), medical educators can seamlessly incorporate planetary health principles without increasing total learning time. This paper outlines how these concepts can be embedded within the existing curriculum, equipping the next generation of doctors to safeguard both human health and environmental sustainability in an unpredictable future.
Understanding Planetary Health, Sustainability, OneHealth, and Nature-Based Solutions
Planetary health, sustainability (specifically, the Sustainable Development Goals or SDGs), OneHealth, and nature-based solutions (NbS) are interconnected yet distinct approaches within environmental and health frameworks. Here’s a comparison:
| Aspect | Sustainability (SDGs) | Planetary Health | OneHealth | Nature-Based Solutions (NbS) |
| Scope | Broad, covering environmental, social, and economic pillars (United Nations, 2015; Raworth, 2017) | Focuses on how environmental health affects human wellbeing (Whitmee et al., 2015; Myers & Frumkin, 2020) | Specifically targets interactions between human, animal, and environmental health, particularly zoonotic diseases (Rabinowitz et al., 2018) | Practical actions that protect, sustainably manage, or restore ecosystems to address societal and health challenges (IUCN, 2023) |
| Primary Goal | To balance current needs with preserving resources and stability for future generations (United Nations, 2015) | To protect human health by safeguarding natural ecosystems and addressing environmental risks (Whitmee et al., 2015) | To address health risks at the intersection of human, animal, and environmental health, especially focusing on zoonoses | To leverage natural systems to enhance resilience and provide ecosystem services that benefit both human and planetary health (IUCN, 2023) |
| Focus Areas | Resource management, waste reduction, social equity, economic stability, and environmental protection (Raworth, 2017) | Human health impacts from climate change, pollution, and ecosystem degradation (Prescott & Logan, 2019; Myers & Frumkin, 2020) | Zoonotic disease control, ecosystem health, and the interconnectedness of human and animal health (Rabinowitz et al., 2018) | Climate change adaptation, ecosystem restoration, green infrastructure, urban green spaces, and sustainable agriculture (World Economic Forum, 2024) |
| Applications | Multisectoral approach: energy, agriculture, economics, social policy, etc. (United Nations, 2015) | Primarily within healthcare and public health, with a focus on preventing environmental impacts on human health (Myers & Frumkin, 2020) | Predominantly used in infectious disease control, veterinary science, and environmental health | Used in urban planning, public health, climate resilience, water management, and more (IUCN, 2023; World Economic Forum, 2024) |
| Relationship to Health | Indirect: Sustainable practices support health by maintaining stable resources and healthy environments (Raworth, 2017) | Direct: Addresses how environmental degradation leads to immediate and long-term health impacts on populations | Direct: Examines the specific health implications of human-animal-environment interactions, focusing on shared diseases | Direct: NbS provide ecosystem services that enhance air and water quality, reduce disease vectors, and promote mental and physical wellbeing (IUCN, 2023) |
| Scope Comparison | Broader scope, incorporating planetary health as a subset (United Nations, 2015) | More focused within sustainability, specifically relating to environmental impacts on health (Whitmee et al., 2015) | Narrowest scope, focusing specifically on health issues arising from human-animal-environment interactions (Rabinowitz et al., 2018) | Targeted approach within planetary health, using ecosystems to deliver sustainable health and environmental outcomes (World Economic Forum, 2024) |
This table clarifies that sustainability is the broadest framework, with planetary health focusing on environmental impacts on human wellbeing. OneHealth and NbS are more specific, with NbS providing actionable solutions that align with both planetary and human health.
The Role of Nature-Based Solutions in Planetary Health and Medical Education
Nature-based solutions, supported by frameworks like those from the International Union for Conservation of Nature (IUCN), are integral to planetary health, providing ecosystem services that benefit human wellbeing. Examples include the role of green urban spaces in reducing respiratory diseases, wetlands in water purification, and mangroves in coastal resilience. Pharmaceutical companies are also beginning to invest in NbS, recognising their importance in sourcing medicinal compounds sustainably and supporting biodiversity that mitigates disease spread (World Economic Forum, 2024).
By incorporating NbS concepts into medical education, future healthcare professionals can better understand how ecosystem health directly impacts human health. This approach allows doctors to recommend preventive strategies that support both individual and community health, aligning with planetary health goals.
Seamless Integration of Planetary Health and NbS in Medical Education
Nature-based solutions can be seamlessly integrated into MBBS modules. Here’s a structure for how these topics align with existing curriculum goals:
1. Physiology and Pathology
• Embed environmental factors, such as pollution and climate change, in discussions of respiratory and cardiovascular health.
• Include studies on nanoplastic exposure and its potential inflammatory effects in cardiovascular health modules (Jin et al., 2022).
• Integrate the effects of urban green spaces on lowering rates of respiratory diseases due to reduced pollution and increased physical activity.
2. Community Medicine and Public Health
• Teach how NbS can mitigate vector-borne diseases, such as dengue and malaria, by restoring wetlands and promoting urban green spaces.
• Discuss the importance of sustainable food systems within nutrition topics, linking agroforestry practices with improved nutrition and reduced pesticide use (World Economic Forum, 2024).
• Explore mental health benefits of nature exposure, using urban green space initiatives as a case study.
3. Pharmacology
• Examine sustainable medicinal sourcing and the role of biodiversity in providing plant-based medicines. Pharmaceutical companies’ investments in biodiversity protection reflect this approach (World Economic Forum, 2024).
• Discuss antibiotic stewardship to prevent environmental contamination and antimicrobial resistance (Singer et al., 2019).
4. Clinical Rotations
• Include case studies that address health impacts of environmental changes, such as heat-related illnesses and waterborne diseases from pollution and ecosystem degradation.
• Emphasize NbS as community-level solutions in clinical practice, such as recommending exposure to green spaces for stress management and discussing community advocacy for clean water and air.
Expected Outcomes of Integrating Planetary Health and NbS
Aligned with the updated MQF and ESD principles, the following are the expected outcomes for medical graduates 4-5 years after completing a curriculum that integrates planetary health and NbS:
1. Holistic Patient Care with Planetary Health Awareness
Graduates will deliver patient care that considers environmental factors affecting health, advising patients on lifestyle choices that support both personal and planetary wellbeing.
2. Advocacy for Sustainable Healthcare
Graduates will promote sustainable practices in healthcare settings, such as reducing waste, supporting biodiversity, and conserving energy, contributing to planetary health goals.
3. Community Engagement and Environmental Health Advocacy
Graduates will educate communities on the benefits of NbS, advocating for policies that promote health through clean air, water, and urban greenery.
4. Ethical Responsibility in Environmental Health
Graduates will understand their role in promoting ecosystem protection as a foundation for health, supporting efforts to reduce health disparities related to environmental degradation.
Recommendations
Integrating planetary health and NbS into the MBBS curriculum, without adding new topics, enriches medical education by promoting a global awareness of health interdependencies. This integration equips doctors to address health in ways that support human and environmental sustainability, making a positive impact on society and the planet.
Disclaimer
This article was created with assistance from ChatGPT, an AI language model, to provide an overview of integrating planetary health into medical education. While the content has been reviewed to ensure accuracy and relevance, readers are encouraged to consult additional sources and expert opinions when implementing educational frameworks.
References
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