Recently, I had the privilege of catching up with an old colleague, Professor Razita Sham, who has been appointed as a Professor in the Kulliyyah of Medicine, International Islamic University Malaysia (IIUM). Prof Razita, who is retiring from UNIMAS, and I share a professional history. Although she is more senior than I am, we completed our public health training together at UKM from 1999 to 2003.
Currently, she serves as a short-term consultant for WHO, focusing particularly on One Health. At IIUM, she has been appointed to help with the implementation of the Master of Public Health (MPH) and Doctor of Public Health (DrPH) programmes. Meanwhile, I have been appointed as part of an expert group working on integrating planetary health into higher education, a role I am deeply passionate about.
During our discussion, we delved into the concepts of planetary health and One Health, which seem to be increasingly interconnected in global health discourse. Prof Razita shared an insightful perspective that resonates with me—she sees One Health as a process or approach, and planetary health as the ultimate outcome.
This conceptualisation makes sense. One Health provides a structured, actionable framework. Originating with a focus on food security, it has since expanded to address complex challenges such as zoonosis, where Prof Razita is currently contributing by developing an action plan. One Health’s strength lies in its ability to bring together human, animal, and environmental health experts to address interconnected health issues.
Planetary health, on the other hand, broadens the focus, encompassing the health of the Earth as a system, where human well-being is inextricably tied to the sustainability of natural systems. It represents the ultimate goal—a thriving planet that supports all forms of life, addressing not just zoonotic diseases but also climate change, environmental degradation, and inequities in global health.
While One Health provides clear, actionable steps, planetary health offers a vision of where those actions should lead us. Both are vital in today’s world, where challenges transcend traditional disciplinary boundaries. By integrating these approaches into education and action, we can ensure that the next generation of health professionals and policymakers is prepared to address these global challenges.
My conversation with Prof Razita left me inspired. It reinforced the importance of collaboration, not just across disciplines but also among those working on interconnected frameworks. As we move forward, aligning processes like One Health with outcomes like planetary health is essential for building a healthier, more sustainable future.
It was a pleasant and unexpected meeting, one that reminded me of how far we have come since our training days at UKM, and how much there is still to learn from one another as we navigate the evolving landscape of public and planetary health.
The integration of artificial intelligence (AI) in medicine is transforming healthcare, enabling advanced diagnostics, improved decision-making, and operational efficiencies. However, its application requires careful consideration to ensure that the essence of patient care—ethical responsibility and compassion—is maintained. Clear guidelines are essential to navigate this evolving landscape while simultaneously preparing medical professionals to harness AI effectively through education. As highlighted in a recent article by Hswen and Abbasi (2024), AI lacks emotional intelligence and fiduciary responsibility, which are critical in clinical decision-making. For example, while AI tools can enhance diagnostic accuracy, they cannot “worry” about a patient’s wellbeing or intuitively weigh the moral implications of medical choices.
AI in medicine should always be viewed as a tool to supplement human expertise, not replace it. Tasks requiring moral agency, such as delivering bad news or making ethically complex decisions, must remain the responsibility of clinicians. Transparency is paramount in AI deployment, particularly in patient-facing applications. When patients interact with AI systems, it is ethically imperative that they are informed. Hswen and Abbasi caution against deceptive practices, noting that even unintentional opacity can erode trust. Additionally, the protection of sensitive data must remain a priority. Robust safeguards are needed to prevent unauthorised access or misuse of patient information.
The increasing reliance on AI also sparks the need for a structured framework within medical education. Future clinicians must be equipped to understand, evaluate, and ethically apply AI tools in practice. This involves integrating core competencies such as algorithmic literacy, ethical awareness, and interdisciplinary collaboration into medical curricula. Scenario-based training, where students learn to interpret AI outputs alongside patient care, can provide practical insights. Furthermore, education must emphasise that while AI offers precision and efficiency, compassionate care and human connection remain irreplaceable aspects of medicine.
The future of AI in healthcare extends beyond its current applications. Emerging technologies such as autonomous surgical systems, digital biomarkers, and brain-computer interfaces promise transformative potential. Future research should focus on areas such as personalising care through multi-omics data, integrating AI into lifestyle medicine, and using AI for preventive healthcare. Ethical considerations must guide these advancements. For instance, ensuring that AI systems address, rather than exacerbate, healthcare inequities is crucial. Transparency in algorithm design, patient consent, and cultural sensitivity are essential elements in this process.
AI also holds promise for alleviating administrative burdens, enabling clinicians to dedicate more time to patient interaction. However, as Hswen and Abbasi observe, the unintended consequences of technology—such as increased clinician burnout due to overreliance on electronic systems—must not be overlooked. Efficiency should not come at the cost of quality care or meaningful clinician-patient relationships.
In addition to enhancing clinical practice, AI can revolutionise medical education by enabling adaptive learning and immersive simulations. Generative AI and virtual reality platforms can provide personalised training environments, allowing students to practice high-stakes scenarios. However, these tools must be rigorously tested to ensure alignment with medical evidence and ethical standards. Collaborative research between educators and technologists will be vital to optimise the educational use of AI.
The ethical integration of AI into healthcare requires a multidisciplinary approach, involving clinicians, data scientists, ethicists, and policymakers. As medicine evolves, guidelines and educational frameworks must ensure that technology serves humanity without undermining the moral fabric of care. By balancing innovation with compassion, we can prepare a future where AI enhances healthcare without compromising its core values.
Disclaimer
This article integrates insights from generative AI to enhance its development.
In the modern landscape of education and community engagement, success has long been measured by outputs—metrics like the number of publications, course completions, or participants reached. While these indicators of process are essential, they often offer only a superficial view of the real-world change that such efforts can achieve. True impact extends beyond these processes, reaching deeper levels of personal and societal transformation. Impact affects various spheres: individuals who experience personal growth, families whose values and dynamics are enriched, communities that gain cohesion, institutions that drive meaningful progress, nations that grow in stability and well-being, and even the planet, which benefits from sustainable practices and global cooperation. By shifting our focus from process to impact, we can foster change that is both meaningful and lasting.
Understanding Impact
Impact in education and community work can be conceptualised as the tangible, enduring benefits that result from these initiatives, spanning multiple levels. At the personal level, education or community engagement fosters individual growth, strengthening personal values and building resilience (Bryson et al., 2020). This transformation often extends to family dynamics, where these newly acquired values shape interactions, fostering environments that support learning, empathy, and well-being (World Health Organization [WHO], 2017). At the community level, the process of engagement is critical; however, true impact occurs when communities transform in ways that reflect growth and shared values, addressing issues from literacy to healthcare access (Fraser et al., 2019). Institutional impact further amplifies this by driving policies, shaping curricula, and creating initiatives that reinforce societal values and equity. Nationally, impactful education produces skilled professionals and engaged citizens, contributing to financial stability, political resilience, and sustainable progress (UNESCO, 2015). Ultimately, the ripple effect of these transformations has the potential to address global challenges, fostering planetary health and sustainability (Crawford et al., 2021).
Why Impact Matters
Aligning Actions with Purpose
While output-based metrics track the processes of learning, such as course completion rates or publication counts, focusing on impact reorients efforts toward purpose. This approach ensures that educational and research activities are truly meaningful, working to create compassionate professionals, sustainable communities, or informed citizens. In medical education, for example, impact could be measured by improved patient outcomes rather than just the number of doctors trained (Bryson et al., 2020).
Creating Sustainable Change
A focus on impact cultivates changes that endure beyond the lifespan of a project. In community health, for example, a programme aimed at reducing disease prevalence may have sustainable impact if it results in long-term behavioural change, such as improved hygiene practices or healthier lifestyle choices among community members (Green et al., 2018). Sustainable transformation, as opposed to temporary gains, requires that the underlying values and practices endure over time, leading to lasting benefits for individuals and societies.
Encouraging Accountability
Evaluating impact holds educators, researchers, and community leaders accountable not only for the processes they initiate but also for the long-term effects of their work. Questions of impact shift the focus from quantitative outputs to qualitative change, asking whether a project has improved social values, supported financial sustainability, or contributed to political stability (UNESCO, 2015). This accountability framework enhances the integrity of educational and research programmes by ensuring they deliver genuine societal benefits.
Enhancing Financial and Social Value
Focusing on impact also supports the wise allocation of resources, with funding directed towards projects that yield significant, long-term benefits. Financial impact can be seen in economic resilience, as educational programmes improve employability and health initiatives reduce public healthcare costs (Crawford et al., 2021). Social value is equally crucial; by promoting equity, inclusion, and community welfare, impactful initiatives strengthen the social fabric and build resilience.
Addressing Global Challenges and Planetary Health
Educational and research institutions, by aligning with the United Nations Sustainable Development Goals (SDGs), can actively contribute to planetary health and sustainability (UNESCO, 2015). For instance, research that advances environmental literacy or fosters sustainable practices directly supports global sustainability goals, emphasising that every local initiative has the potential to contribute to a healthier planet.
Measuring Impact Beyond Traditional Metrics
Impact measurement requires a nuanced approach, utilising tools and methods that capture both immediate and long-term effects across multiple domains. Personal growth can be assessed through reflective evaluations and surveys that track changes in values and behaviours (WHO, 2017). Community impact might involve participatory research methods that gather qualitative insights from community members, while financial sustainability can be gauged through Social Return on Investment (SROI) analyses, which quantify economic benefits against costs (Green et al., 2018). Policy analysis can measure political impact, tracing how research influences governance or legislative change (Bodilly et al., 2017). At the planetary level, environmental impact assessments aligned with SDG metrics allow institutions to measure contributions toward global sustainability (Crawford et al., 2021).
The Role of University Rankings in Measuring Impact
Increasingly, university ranking systems are recognising the importance of impact-focused metrics, moving beyond traditional outputs to capture the broader contributions of institutions to society and the environment. The Times Higher Education (THE) Impact Rankings evaluates universities based on their alignment with the United Nations Sustainable Development Goals (SDGs), offering insights into how institutions address global challenges such as poverty and health (Times Higher Education, n.d.). The QS Stars University Rating System includes an “Impact” category that assesses community engagement and social responsibility (QS Quacquarelli Symonds, n.d.), while the UI GreenMetric World University Rankings specifically measures environmental sustainability practices on campuses (Universitas Indonesia, 2023). U-Multirank, funded by the European Commission, takes a multidimensional approach that includes regional engagement and knowledge transfer, allowing for a more nuanced assessment of local impact (U-Multirank, n.d.). These rankings encourage universities to prioritise sustainable practices, community engagement, and social responsibility, fostering a global movement towards impact-driven education.
A Future Built on Impact
As we navigate the future of education, research, and community engagement, a focus on impact is essential for creating meaningful, lasting change. This approach reframes educational initiatives as investments in personal development, family and social values, financial resilience, political stability, and planetary health. By integrating these dimensions into the core of educational and research efforts, institutions can drive progress on multiple fronts, fostering a more resilient, equitable, and sustainable society. In essence, a shift from process to impact enables us to fulfil not only the immediate goals of education and research but also the broader, transformative changes that these fields can inspire.
Disclaimer: This article was created using OpenAI’s ChatGPT for research and educational purposes.
References
Bodilly, S. J., Chun, J., Ikemoto, G. S., & Stockly, S. (2017). Improving school leadership: The promise of cohesive leadership systems. Rand Corporation.
Bryson, J. M., Patton, M. Q., & Bowman, R. A. (2020). Working across boundaries: Making collaboration work in government and nonprofit organizations. John Wiley & Sons.
Crawford, M., Hoque, Z., & Moll, J. (2021). Public sector reform and performance management: Managing on the edge. Routledge.
Fraser, N., Bunting, M., & O’Brien, M. (2019). Community engagement: Key to better health and education outcomes. World Health Organization.
Green, C., Hinton, P., & Ridley, M. (2018). Sustainable health and community development: Building resilience and equity. Oxford University Press.
Times Higher Education. (n.d.). Impact Rankings 2023. Times Higher Education. https://www.timeshighereducation.com/impactrankings
U-Multirank. (n.d.). What is U-Multirank? https://www.umultirank.org
UNESCO. (2015). Education 2030: Incheon declaration and framework for action towards inclusive and equitable quality education and lifelong learning for all. UNESCO.
Universitas Indonesia. (2023). UI GreenMetric World University Rankings 2023. Universitas Indonesia. https://greenmetric.ui.ac.id/
World Health Organization. (2017). Community engagement framework for quality, people-centered, and resilient health services. WHO.
The evolving demands on healthcare systems worldwide have highlighted the need for direct-care physicians to adopt educational roles. A recent JAMA article by Sweigart, Watson, and Burger (2024) emphasises this trend, explaining that more physicians are being called upon to act as educators as training expands to new healthcare settings. This development is particularly relevant in Malaysia, where the demand for medical specialists continues to rise and where expanding training locations can address both capacity challenges and geographic disparities in specialist availability.
Malaysia’s medical specialist training is currently provided primarily by local universities, including both public and private institutions. These university-based programmes, while well-established, face limitations in the number of trainees they can accommodate. With the need for specialists projected to grow significantly, Malaysia must look beyond universities to scale up training opportunities. Increasing the number of Ministry of Health (MOH) hospitals involved in training offers a promising solution. By incorporating more MOH hospitals, especially in Sabah and Sarawak, Malaysia can provide specialist training opportunities close to home for doctors in these regions, reducing the need for them to relocate to Peninsular Malaysia. This decentralised approach aligns with the Ministry of Health’s objectives to improve healthcare accessibility across the country and to support equitable healthcare distribution.
Expanding training locations, however, brings forth the critical need to maintain quality and consistency across all settings. To ensure that trainees receive a high-quality, uniform education, a standardised curriculum is essential. The National Postgraduate Medical Curriculum (NPMC), developed by the Malaysian Public University Medical Deans Council under the Ministry of Higher Education, plays a pivotal role in addressing this need. The NPMC provides structured learning objectives, competency benchmarks, and assessment methods, ensuring that all trainees, regardless of training location, are prepared to meet the same rigorous standards. This curriculum, authored by experts nationwide, is designed to ensure that the training of specialists in Malaysia aligns with the country’s healthcare needs and meets the standards expected in modern medical practice (Amjad, 2024).
For this initiative to succeed, collaboration between universities and the Ministry of Health is essential. Universities bring established expertise in medical education, while MOH hospitals provide diverse clinical settings and cases essential for comprehensive training. A coordinated effort between these institutions can bridge the gap between academia and practical, patient-focused training. This collaboration can involve sharing resources, co-developing faculty development programmes to prepare MOH clinicians for teaching roles, and creating mentorship opportunities to support trainee learning in non-university settings. This integrated approach, as outlined in the JAMA article, requires that both universities and hospitals embrace the dual responsibilities of patient care and education to develop a future-ready healthcare workforce (Sweigart et al., 2024).
Through the combined efforts of universities, the MOH, and other stakeholders, Malaysia has an opportunity to create a sustainable and resilient specialist training framework. By expanding training locations to MOH hospitals, particularly in underrepresented regions, and implementing the NPMC, Malaysia can ensure that future specialists receive consistent, high-quality education across diverse settings. This strategy not only addresses the immediate need for increased specialist training capacity but also supports the broader goal of equitable healthcare distribution throughout the country.
Disclaimer: This article was generated with assistance from ChatGPT, an AI language model.
References
Amjad, N. M. (2024). Postgraduate clinical specialist training in Malaysia: At a crossroads. International Medical Journal Malaysia, 23(2), 1–3. Retrieved from https://journals.iium.edu.my/kom/index.php/imjm/article/download/2583/1483/16082
Sweigart, J. R., Watson, R., & Burger, A. (2024). The accidental teacher—Direct-care physicians increasingly placed in teaching roles. JAMA. https://doi.org/10.1001/jama.2024.17626
Reluctant I stood, thrust into this place, Not chosen by will, yet I embrace the grace, A weight I carry, solemn and true, Guided by purpose, though unsure of the view.
Time fades to whispers, deadlines blur, I heed no pressure from titles that stir, If power deems me fit to leave, Indifference shields what I believe.
Climbing the curve, each step uphill, Learning the dreams this place fulfills, A vision uncovered, first small, then wide, A call to the country, seen from inside.
Through my eyes, it grew, a daunting sight, To share with others, to bridge the light, Struggling to bring all minds as one, The task never finished, yet hardly begun.
Alone in thought, as shadows fall, Wrestling with doubts that stand so tall, A quiet fear this role has changed What once felt certain, now feels strange.
So I ask for guidance, Allah above, To keep my soul, to lead with love, May wisdom hold what pride may sway, And mercy light my lonely way.
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:
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
International Union for Conservation of Nature. (2023). Nature-based solutions. Retrieved from https://iucn.org/our-work/nature-based-solutions
Jin, H., Ma, T., Sha, X., Liu, Z., & Zhou, Y. (2022). Nanoplastics and cardiovascular diseases: A link from the environment to human health. Environmental Research, 204, 112281. https://doi.org/10.1016/j.envres.2021.112281
Landrigan, P. J., Fuller, R., Acosta, N. J. R., Adeyi, O., Arnold, R., Basu, N., & Zhong, M. (2018). The Lancet Commission on pollution and health. The Lancet Planetary Health, 2(1), e26-e36. https://doi.org/10.1016/S2542-5196(17)30173-8
Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., & Ezzati, M. (2021). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2224-2260. https://doi.org/10.1016/S0140-6736(12)61766-8
Myers, S. S., & Frumkin, H. (2020). Planetary health: Protecting nature to protect ourselves. Island Press.
Prescott, S. L., & Logan, A. C. (2019). Planetary health: From the wellspring of holistic medicine to personal and public health imperative. Explore, 15(2), 98-106. https://doi.org/10.1016/j.explore.2018.11.008
Prüst, M., Meijer, J., Westerink, R. H., & Brouwer, A. (2020). The plastic brain: Neurotoxicity of micro- and nanoplastics. Environmental Science & Technology, 54(18), 11431-11441. https://doi.org/10.1021/acs.est.0c02350
Rabinowitz, P. M., Natterson-Horowitz, B., Kahn, L. H., & Kock, R. (2018). One Health and Planetary Health: Perspectives from the U.S. National Institutes of Health. National Institutes of Health.
Raworth, K. (2017). Doughnut economics: Seven ways to think like a 21st-century economist. Chelsea Green Publishing.
Singer, A. C., Shaw, H., Rhodes, V., & Hart, A. (2019). Review of antimicrobial resistance in the environment and its relevance to environmental management in the context of planetary health. The Lancet Planetary Health, 3(7), e253-e261. https://doi.org/10.1016/S2542-5196(19)30078-1
United Nations. (2015). Transforming our world: The 2030 Agenda for Sustainable Development. Sustainable Development Goals (SDGs). Retrieved from https://sdgs.un.org/2030agenda
Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., Dias, B. F., & Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028. https://doi.org/10.1016/S0140-6736(15)60901-1
World Economic Forum. (2024). How pharma companies are investing in nature to improve human and planetary health. Retrieved from https://www.weforum.org/stories/2024/09/how-pharma-companies-are-investing-in-nature-to-improve-human-and-planetary-health/
Amid growing concerns about long-term health impacts and youth uptake, over 33 countries, including Brazil, India, and Singapore, have instituted complete bans on e-cigarettes and vaping products. These bans underscore health concerns, especially regarding potential harms and unknown long-term effects (Ecigator, 2024; Statista, 2024; Global Issues, 2024). In contrast, around 87 nations regulate vaping through age restrictions, advertising bans, and usage limitations to control accessibility, especially among minors (Global Issues, 2024).
Some countries, such as the United Kingdom, allow e-cigarettes as part of a harm reduction strategy, permitting regulated access to encourage adult smokers to transition away from traditional cigarettes. Australia has adopted a more conservative approach, requiring a prescription for e-cigarette access to balance harm reduction with health safety (Hawai‘i Public Health Institute, 2024). This global disparity highlights the ongoing debate surrounding vaping’s public health role, weighing its potential as a harm reduction tool against addiction risks and youth appeal. This article evaluates e-cigarettes using four established harm reduction criteria—reduction in harm, proven safety, efficacy, and accessibility—to determine whether they align with harm reduction standards.
Harm Reduction Criteria
For a product to qualify as a harm reduction tool, it must meet several key principles: demonstrate a reduction in health risks, provide conclusive evidence of short- and long-term safety, show effectiveness in reducing or eliminating harmful behaviours, and ensure accessibility without unintended consequences. This framework forms the basis for evaluating e-cigarettes as a harm reduction strategy.
Reduction in Harm
Harm reduction tools are intended to lower health risks significantly compared to current harmful behaviours. For e-cigarettes, this means offering a lower risk profile than traditional smoking. Public Health England estimates that e-cigarettes are “95% less harmful than smoking” due to the absence of combustion, which is the source of many toxic chemicals in cigarette smoke (McNeill et al., 2015). Studies indicate that e-cigarette vapour contains fewer carcinogens and toxic compounds than cigarette smoke, potentially reducing respiratory and cardiovascular risks (Glantz & Bareham, 2018).
However, e-cigarette vapour includes harmful substances such as formaldehyde and volatile organic compounds, and regular use has been associated with a 30% increased risk of respiratory issues like asthma and COPD (Bhatta & Glantz, 2020). The reduction in harm is further complicated by limited long-term data, leaving the full health impact uncertain. While e-cigarettes may reduce exposure to certain toxins, their overall health implications remain unclear, meeting this criterion only partially.
Proven Safety
Safety is fundamental for any harm reduction strategy, requiring thorough evaluation for short- and long-term impacts to avoid introducing new health risks. Current evidence on e-cigarette safety is limited due to their recent introduction, with most studies focusing on short-term effects. Research has raised concerns about increased cardiovascular and respiratory risks; for example, e-cigarette users have been found to have a 56% higher risk of myocardial infarction than non-users, underscoring cardiovascular safety concerns (Bhatta & Glantz, 2020).
The history of tobacco emphasises the risks of adopting products without robust safety data. Although tobacco use dates back to 6000 BCE, its addictive and harmful properties were not widely recognised until the 16th century. Cigarettes were marketed as safe until serious health risks were confirmed in the 1950s, nearly a century after their mass production began. E-cigarettes, similarly promoted as safer alternatives without long-term data, risk repeating this historical error. Without comprehensive long-term data, e-cigarettes do not meet the safety criterion.
Efficacy
Harm reduction strategies should be effective in reducing or eliminating harmful behaviour. Some studies suggest that e-cigarettes may assist smokers who struggle with traditional cessation methods. A trial by Hajek et al. (2019) found e-cigarettes to be nearly twice as effective as nicotine replacement therapy (NRT) when combined with behavioural support. Furthermore, widespread e-cigarette use could potentially prevent over 6.6 million premature deaths among American smokers (Levy et al., 2017).
However, “dual use” — when individuals continue to smoke while using e-cigarettes — raises concerns, as it can increase overall nicotine exposure, potentially offsetting some of the harm reduction benefits. Evidence on long-term cessation is mixed, with some users returning to smoking or maintaining an e-cigarette dependency (Hartmann-Boyce et al., 2016). While e-cigarettes may offer a transitional tool for some smokers, dual use and sustained dependency challenge their efficacy as a full harm reduction strategy, meeting this criterion only partially.
Accessibility and Acceptability
A harm reduction tool should be widely accessible and acceptable to those who may benefit from it. E-cigarettes are widely available in numerous countries, accessible through online platforms and retail outlets. Their popularity, particularly among younger users, is often attributed to diverse flavours and appealing designs. In the UK, approximately 3.6 million adults reported using e-cigarettes in 2021, demonstrating significant accessibility and acceptance (ONS, 2021).
However, the popularity of e-cigarettes among youth raises ethical concerns. In the United States, vaping among high school students surged from 1.5% in 2011 to 27.5% in 2019, driven by flavoured products and youth-oriented marketing (Cullen et al., 2018). This trend complicates the harm reduction goal, as increased nicotine addiction among youth poses a new public health risk. While e-cigarettes meet the accessibility criterion, ethical concerns about youth uptake remain significant.
Conclusion
Evaluating e-cigarettes against harm reduction criteria reveals only partial compliance. While e-cigarettes may reduce exposure to certain toxins compared to smoking, they lack conclusive long-term safety data and show mixed efficacy, especially given the potential for dual use. Although they are accessible and popular, especially among youth, this appeal introduces ethical challenges and potential health risks.
The history of tobacco illustrates the risks of endorsing products without sufficient safety evidence. Healthcare professionals should avoid repeating these mistakes by endorsing e-cigarettes as a harm reduction tool prematurely. High standards of evidence are essential to protect public health and ensure that harm reduction strategies genuinely benefit those in need.
Disclaimer: This article was drafted with the assistance of ChatGPT for research synthesis and writing. All information included is derived from reputable sources and cited in APA format.
References
Bhatta, D. N., & Glantz, S. A. (2020). Electronic cigarette use and myocardial infarction among adults in the US population assessment of tobacco and health. Journal of the American Heart Association, 8(12), e012317. https://doi.org/10.1161/JAHA.119.012317
Cullen, K. A., Ambrose, B. K., Gentzke, A. S., Apelberg, B. J., Jamal, A., & King, B. A. (2018). Notes from the field: Use of electronic cigarettes and any tobacco product among middle and high school students—United States, 2011–2018. MMWR Morbidity and Mortality Weekly Report, 67(45), 1276–1277. https://doi.org/10.15585/mmwr.mm6745a5
Ecigator. (2024). Overview of vaping regulations by country. Ecigator. Retrieved from https://www.ecigator.com/vaping-regulations-country/
Glantz, S. A., & Bareham, D. W. (2018). E-cigarettes: Use, effects on smoking, risks, and policy implications. Annual Review of Public Health, 39, 215–235. https://doi.org/10.1146/annurev-publhealth-040617-013757
Global Issues. (2024). Ban or restrict? Quandary facing governments as vaping entices teens worldwide. Global Issues. Retrieved from https://www.globalissues.org/
Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K., Bisal, N., … & McRobbie, H. J. (2019). A randomised trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine, 380(7), 629–637. https://doi.org/10.1056/NEJMoa1808779
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Hartmann-Boyce, J., McRobbie, H., Bullen, C., Begh, R., Stead, L. F., & Hajek, P. (2016). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.CD010216.pub3
Levy, D. T., Borland, R., Lindblom, E. N., Goniewicz, M. L., Meza, R., Holford, T. R., … & Warner, K. E. (2017). Potential deaths averted in the USA by replacing cigarettes with e-cigarettes. Tobacco Control, 27(1), 18–25. https://doi.org/10.1136/tobaccocontrol-2017-053759
McNeill, A., Brose, L. S., Calder, R., Hitchman, S. C., Hajek, P., & McRobbie, H. (2015). E-cigarettes
The role of a medical educator or clinical lecturer goes beyond disseminating knowledge; it embodies the spirit of mentorship, guidance, and the holistic development of future healthcare professionals. However, the current landscape in medical education appraisal and promotion systems appears to shift this focus, often prioritising individual achievements over collective institutional goals. This article argues that such systems, heavily influenced by university ranking metrics, could undermine the very essence of education and teamwork within academic institutions.
The Shift Toward Personal Achievements
Medical educators once prided themselves on their role as mentors and nurturers of student growth. In the Islamic tradition, this role aligns with the concept of murabbi—a teacher who fosters not just academic knowledge but also spiritual and ethical development. Unfortunately, modern appraisal systems place less emphasis on these nurturing aspects of education. Instead, faculty members are often encouraged to pursue individual accolades, primarily through research publications and citations.
The increasing focus on research outputs as the primary criterion for academic advancement has led to what many term a “publish or perish” culture, where quantity often supersedes quality in scholarly work. According to research, universities are driven by global ranking systems that primarily focus on research outputs, leading to a shift in faculty priorities from education and mentoring towards securing personal research achievements (Macfarlane, 2011). This change has contributed to the diminishing role of faculty as murabbi—those who mentor with a view to nurturing holistic, well-rounded graduates.
The Dangers of Ranking Games
University rankings have gained disproportionate influence in shaping the behaviours and strategies of academic institutions. Metrics such as the number of publications, citation counts, and journal impact factors have become the dominant benchmarks for academic success. A study by Hazelkorn (2015) highlighted the problematic reliance on such rankings, which often fail to account for the teaching mission of universities. The tendency to align institutional goals with these metrics, regardless of context or educational mission, is creating an environment where educators are pressured to focus on individual performance at the expense of broader educational goals.
This pressure can lead to unintended consequences. For instance, Macfarlane (2011) noted that academic staff are incentivised to prioritise activities that boost their individual research profile, potentially leading to a neglect of their teaching responsibilities. This imbalance risks reducing the overall quality of education and mentorship that students receive.
The Neglect of Teaching and Real Collaboration
A career in medicine and medical education is about more than research output. Yet, the current systems undervalue teaching excellence, mentorship, and institutional service. Lecturers may feel demotivated to invest in these areas if they do not contribute directly to promotion prospects. This not only stifles the quality of education but also discourages real collaboration between faculty members. In medical education, where interdisciplinary cooperation and teamwork are essential, such an environment can be detrimental to both faculty cohesion and student outcomes.
Collaboration is crucial in fostering innovation and holistic educational approaches, particularly in clinical settings where teamwork is a fundamental part of patient care. If academic reward systems are misaligned, these efforts may go unrecognised. In their study, Berthelsen and Hølge-Hazelton (2016) discuss how institutional cultures that prioritise research output over collaborative teaching can lead to a siloed approach within faculties, impeding teamwork and collegiality.
The Need for Systemic Change
To address these issues, there must be a recalibration of the appraisal and promotion systems in medical education. Institutions need to re-emphasise the importance of teaching and mentorship, not just as supplementary activities, but as critical components of academic careers. Moreover, universities should develop frameworks that recognise and reward collaborative efforts and interdisciplinary initiatives.
By valuing the role of a murabbi—the educator who shapes not only the intellect but also the ethical and moral compass of future healthcare professionals—institutions can foster a more holistic and balanced academic environment. According to van Schalkwyk et al. (2015), including student feedback and peer evaluations in promotion criteria can help re-establish the importance of teaching and mentorship in the academic appraisal process.
Conclusion
If medical education is to stay true to its purpose, the current focus on individual achievement in appraisal systems must shift towards a more balanced approach that values education, collaboration, and mentorship. Faculty members should be empowered and motivated to contribute to the overall vision of their institutions, embracing their roles as educators and murabbi. Without such systemic changes, teamwork, collaboration, and the essence of medical education risk being eroded, ultimately compromising the quality of healthcare professionals we produce.
References
Berthelsen, H., & Hølge-Hazelton, B. (2016). Interdisciplinary collaboration: Barriers and facilitators across disciplines. Nursing Education Today, 40, 32-37. https://doi.org/10.1016/j.nedt.2016.02.007
Hazelkorn, E. (2015). Rankings and the reshaping of higher education: The battle for world-class excellence. Palgrave Macmillan. https://doi.org/10.1057/9781137446671
Macfarlane, B. (2011). The morphing of academic practice: Unbundling and the rise of the para-academic. Higher Education Quarterly, 65(1), 59-73. https://doi.org/10.1111/j.1468-2273.2010.00467.x
van Schalkwyk, S., Hafler, J., Brewer, T., et al. (2015). Fostering communities of practice: A qualitative study of the role of academic institutions in advancing education scholarship. Academic Medicine, 90(6), 802-808. https://doi.org/10.1097/ACM.0000000000000698
Medical education is transforming significantly due to generational shifts in learners’ expectations, learning styles, and demands. With the rise of Millennials, Generation Z, and the emerging Generation Alpha, traditional approaches in medical training are being challenged. The educational system and teaching methods must evolve to ensure that medical education continues to produce competent physicians who can thrive in a modern healthcare environment. This article explores the impact of generational differences on pre-clinical and clinical medical training, examines the implications for patient-doctor relationships, and discusses whether these changes improve training outcomes.
Overview of Generations
Different generations have distinct learning preferences and expectations due to the unique social, cultural, and technological environments in which they were raised. The following table provides a brief overview of the generations relevant to today’s medical students:
Generation
Birth Years
Key Characteristics in Learning
Multi-taskers prefer hands-on and tech-enhanced learning
Baby Boomers
1946-1964
Prefer structured, instructor-led learning, value authority and tradition
Limited use of digital tools, prefer face-to-face learning
Generation X
1965-1980
Independent, self-paced learners, value practical application
Comfortable with gradual tech integration
Millennials
1981-1996
Collaborative, favor active learning, expect flexibility and instant feedback
Heavy reliance on technology, prefer blended learning
Generation Z
1997-2012
Multi-taskers, prefer hands-on and tech-enhanced learning
Proficient with digital tools, demand real-time feedback
With Millennials and Generation Z now making up the bulk of medical students, their learning preferences are driving changes in how medical education is delivered, particularly in the pre-clinical and clinical years of training.
Pre-Clinical Years: The Changing Face of Classroom-Based Teaching
The pre-clinical years (Years 1-2) of medical education are typically dominated by classroom-based learning. Historically, this has been characterised by instructor-led lectures, textbooks, and passive learning. However, as Millennials and Generation Z students enter medical school, their learning preferences increasingly diverge from this traditional model.
A study by Cook et al. (2010) highlighted that modern learners prefer more interactive, student-centred learning environments. Millennials and Generation Z tend to favour active learning techniques such as problem-based learning (PBL) and team-based learning (TBL), where collaboration and real-world application are prioritised over rote memorisation and passive listening. They also expect to learn through technology-enhanced methods, such as digital modules, videos, and interactive simulations (Chen et al., 2017).
Many students still appreciate structured, face-to-face teaching, particularly in the early stages of medical education. However, they often find long, traditional lectures disengaging and difficult to follow. Studies have shown that incorporating more flexible, blended learning methods can enhance student engagement without sacrificing the benefits of in-person instruction (Ruiz et al., 2006). The use of flipped classrooms, where students access lecture material online and engage in active problem-solving during class, is one such method that has been well-received by Generation Z learners (Chen et al., 2017).
Clinical Years: Adapting the Apprenticeship Model
The clinical years (Years 3-5) of medical education rely heavily on the traditional apprenticeship model, where students learn by observing and participating in patient care under the supervision of experienced clinicians. This model, which emphasises hands-on experience, has been the backbone of medical education for centuries. However, generational shifts are impacting the effectiveness and appeal of this approach.
Millennials and Generation Z students expect more structure, real-time feedback, and integration of technology in their clinical training. A study by Jolly et al. (2019) found that younger generations prefer continuous, structured feedback, often facilitated through digital platforms. This is in contrast to the traditional approach of delayed feedback, which may come at the end of a clinical rotation or after assessments.
Moreover, workplace-based assessments (WBA), a key element of competency-based training, must evolve to meet these expectations. The use of e-portfolios and mobile assessment platforms allows for real-time feedback and progress tracking, which aligns with the learning preferences of digital-native students (He et al., 2012). Additionally, simulations and virtual reality (VR) tools are becoming increasingly valuable in clinical training, allowing students to practise skills in a controlled environment before working with real patients (Lyon & McLean, 2017).
Impact on Patient-Doctor Relationships and Training Outcomes
One of the key concerns about these generational shifts in medical education is whether they affect the quality of patient-doctor relationships and the overall effectiveness of training. Studies evaluating the impact of adopting more flexible, technology-driven approaches have shown promising results. For instance, a systematic review by O’Brien et al. (2020) found that the use of simulation-based learning and real-time feedback tools in clinical training improved students’ communication skills and patient interactions.
Furthermore, studies have demonstrated that incorporating digital tools into workplace-based learning does not detract from the development of essential clinical skills. On the contrary, it may enhance them by providing students with more opportunities to practise and refine their skills in a safe environment before engaging with patients (Ruiz et al., 2006). This is particularly important for Millennials and Generation Z, who thrive on structured learning and immediate feedback.
The Jolly et al. (2019) study also found that students who receive frequent, real-time feedback tend to perform better in patient interactions and clinical assessments. The introduction of digital tools like e-portfolios has streamlined the feedback process, allowing for more detailed, competency-based evaluations of students’ performance. These findings suggest that adopting technology-enhanced learning methods in medical education may not only meet the preferences of modern learners but also improve their readiness for clinical practice.
Challenges in the Transition to Digital Learning
Despite the potential benefits of integrating technology into medical education, some challenges must be addressed. One significant challenge is the risk of over-reliance on digital tools at the expense of face-to-face patient interactions. Prensky (2001), who coined the term “digital natives,” warned that while digital-native generations are adept at using technology, they may struggle with interpersonal communication if not properly trained in real-world settings.
Therefore, while technology can enhance learning, it should complement, not replace, hands-on patient care experiences. Medical schools must strike a balance between providing opportunities for digital learning and ensuring that students develop the humanistic qualities necessary for effective patient care, such as empathy, communication, and ethical decision-making (O’Brien et al., 2020).
Conclusion: The Need for Systemic Change
The generational shifts in medical education are undeniable, and both the system and educators must evolve to meet the changing needs of learners. The preference for interactive, technology-enhanced learning methods among Millennials and Generation Z requires medical schools to rethink traditional teaching models in both pre-clinical and clinical training. Blended learning, flipped classrooms, and digital tools for real-time feedback are all valuable strategies to enhance student engagement and improve clinical competencies.
However, the adoption of these methods must be carefully managed to ensure that the development of key patient-doctor relationships and communication skills is not compromised. Studies suggest that, when implemented thoughtfully, these changes can improve training outcomes and better prepare students for the demands of modern clinical practice.
In conclusion, the future of medical education lies in balancing traditional methods with innovative, technology-driven approaches that cater to the learning preferences of modern students. By embracing this change, educators can ensure that medical education continues to produce skilled, competent, and compassionate physicians.
References
Chen, F., Lui, A. M., & Martinelli, S. M. (2017). A systematic review of the effectiveness of flipped classrooms in medical education. Medical Education, 51(6), 585-597.
Cook, D. A., Levinson, A. J., & Garside, S. (2010). Time and learning efficiency in Internet-based learning: A systematic review. Advances in Health Sciences Education, 15(5), 755-770.
He, J., Baxter, S. L., Xu, J., Zhou, X., & Zhang, K. (2012). The practical implementation of artificial intelligence technologies in medicine. Nature Medicine, 25(1), 30-36.
Jolly, B., & Boud, D. (2019). Assessment for learning in the workplace: Workplace-based assessment and feedback in clinical practice. Medical Education, 43(4), 311-317.
Lyon, P. M., & McLean, M. (2017). How do we handle generational differences in medical education? BMC Medical Education, 17(1), 150.
O’Brien, B. C., Irby, D. M., & Curry, R. H. (2020). Improving patient-centered care through medical education reform. Journal of Graduate Medical Education, 12(2), 134-141.
Prensky, M. (2001). Digital natives, digital immigrants. On the Horizon, 9(5), 1-6.
Ruiz, J. G., Mintzer, M. J., & Leipzig, R. M. (2006). The impact of e-learning in medical education. Academic Medicine, 81(3), 207-212.
The rise of planetary health as an essential framework for addressing the intersecting challenges of human and environmental health has created a need for clarity. However, it is often confused with other important global frameworks, including global health, sustainable development goals (SDGs), Education for Sustainable Development (ESD), environmental health, and One Health. Each of these frameworks carries distinct objectives and approaches. The concept of Sejahtera, deeply embedded in Malaysia’s National Education Philosophy, offers a holistic lens that integrates not only physical and environmental health but also mental, social, and spiritual well-being. By streamlining these overlapping frameworks through Sejahtera, higher education can adopt a more balanced and culturally relevant approach to global well-being. This article explores the need for curriculum reform in higher education to incorporate both planetary health and Sejahtera.
Origins and Frameworks of Health and Sustainability
Each framework—whether it is planetary health, global health, or the SDGs—arose at different times in response to specific global challenges. Their individual inception dates and objectives highlight the need to integrate them into a coherent framework for education. This can be achieved by leveraging Sejahtera’s holistic approach.
Table 1 provides a comparative overview of these frameworks, outlining their origins, year of inception, time frames, and objectives.
Table 1: Comparison of Planetary Health, Global Health, ESD, One Health, Environmental Health, and SDGs
Framework
Origin of Idea
Year Announced
Time Frame
Objective
Environmental Health
Rooted in public health practices of the 19th century, focusing on the relationship between environment and health.
19th century, formalised mid-20th century
Ongoing
To manage and mitigate environmental risks to reduce the burden of disease and promote healthy living environments (WHO, 2021).
Global Health
Emerged from public health and international health efforts, particularly during the 20th century, and became well-established post-2000.
Mid-20th century but evolved into the modern concept in the 2000s.
Ongoing
To address health disparities and improve health equity by focusing on global health challenges, with an emphasis on disease prevention and access to healthcare.
One Health
Developed from the veterinary and medical sciences with a focus on human-animal-environment interactions, particularly zoonotic diseases.
Early 2000s
Ongoing
To achieve optimal health for humans, animals, and the environment through a multidisciplinary approach, particularly in the control of zoonotic diseases.
ESD (Education for Sustainable Development)
Introduced by UNESCO to incorporate sustainable development into education systems worldwide.
2002
Target 2030
To foster knowledge, skills, values, and behaviours that promote sustainability across various aspects of society.
SDGs (Sustainable Development Goals)
Evolved from the Millennium Development Goals (MDGs), adopted by the United Nations to address a wide range of global challenges.
2015 (UN General Assembly)
Target 2030
To create a comprehensive framework for sustainable development, addressing poverty, inequality, climate change, and health through 17 interconnected goals.
Planetary Health
Initiated by the Rockefeller Foundation-Lancet Commission, focusing on the connection between human health and the state of natural ecosystems.
2015
Ongoing
To safeguard human health by preserving the integrity of the Earth’s natural systems, recognising the importance of maintaining ecological balance to support human well-being.
Sejahtera: Clarifying Overlapping Frameworks
Sejahtera offers a valuable framework that can help clarify the confusion between these overlapping global health and sustainability frameworks. Malaysia’s National Education Philosophy highlights the importance of fostering holistic well-being, which encompasses not only intellectual development but also emotional, spiritual, and physical balance. The National Education Philosophy emphasizes the creation of balanced individuals who contribute to societal harmony and well-being based on faith, knowledge, and a sense of responsibility (Kementerian Pendidikan Malaysia, 2021).
This philosophy resonates with planetary health’s emphasis on sustainability and human health, but Sejahtera extends it by adding a spiritual and ethical dimension that is often absent in other global frameworks. By integrating Sejahtera into higher education curricula, universities can foster a more holistic approach that addresses not only the scientific and medical aspects of planetary health but also its cultural and spiritual dimensions.
Curriculum Reform: Integrating Sejahtera and Planetary Health
To achieve this integration, universities must shift toward interdisciplinary learning that incorporates the social, spiritual, and cultural dimensions of well-being alongside environmental and health sciences.
Incorporating Sejahtera and planetary health requires fostering a curriculum that moves beyond a purely scientific understanding of environmental health. For example, medical students could be taught about the impacts of environmental degradation on mental health, while also exploring the spiritual practices that help individuals and communities cope with these challenges. Case-based learning can be employed to engage students in real-world scenarios where they must balance scientific knowledge with ethical and spiritual considerations.
Sustainability projects on university campuses can also provide hands-on learning opportunities, allowing students to apply planetary health and Sejahtera principles to create green spaces, conserve energy, and promote community resilience. These projects help students understand the practical applications of sustainability while also fostering a sense of responsibility toward the environment and society.
Streamlining Frameworks for a Coherent Educational Approach
Given the frequent confusion between planetary health and other frameworks like global health, the SDGs, and One Health, integrating Sejahtera provides a unifying philosophy that clarifies these overlapping areas. Sejahtera’s focus on holistic balance offers a cohesive framework that brings together the strengths of each of these approaches, providing students with a clear and integrated understanding of how they can promote sustainable well-being. By incorporating Sejahtera into higher education curricula, universities can ensure that students are equipped with the knowledge, skills, and values necessary to tackle the world’s most pressing environmental and health challenges.
Conclusion
Incorporating Sejahtera and planetary health into higher education curricula offers a transformative opportunity to promote a holistic and integrated approach to global health and sustainability. While planetary health provides the scientific foundation for understanding the relationship between human health and the environment, Sejahtera adds a culturally grounded framework that promotes harmony between humans, nature, and society. This alignment with Malaysia’s National Education Philosophy ensures that future generations are equipped not only to address the environmental and health challenges of our time but also to foster spiritual and ethical well-being in their personal and professional lives.
Disclaimer: The ideas expressed in this article were generated with assistance from ChatGPT, an AI language model.
References
Capon, A. G., & Horton, R. (2019). Planetary health: Safeguarding health in the Anthropocene epoch. The Lancet, 390(10114), 865-870.
Kementerian Pendidikan Malaysia. (2021). Falsafah Pendidikan Kebangsaan. Available at https://www.moe.gov.my.
Rockström, J., Steffen, W., Noone, K., Persson, Å., Chapin III, F. S., Lambin, E., … & Foley, J. A. (2009). A safe operating space for humanity. Nature, 461(7263), 472-475.
Rockefeller Foundation-Lancet Commission. (2015). Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028.
Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., Ferreira de Souza Dias, B., … & Rockström, J. (2015). Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973-2028.
UNESCO. (2014). Education for Sustainable Development: A Roadmap for Implementing the Global Action Programme on ESD. Available at https://unesdoc.unesco.org/ark:/48223/pf0000230514.