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 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/
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.