Tag: sustainable literacy

The medics get it – sustainable literacy in education

Sustainability, health and education – Priority Learning Outcomes for health professionals.



Although some scientists and commentators such as Indur Goklany, have disputed claims about the precise impacts of climate change and human health, it is nonetheless accepted that wider environmental factors can and do impact severely upon health. Climate change, as has been pointed out before, is only one aspect of the relationship between the environment and health and focusing on it may not always be helpful. Instead, many medical and other organisations in the UK have clearly accepted that our relationship with the environment is a foundation upon which health is based. This relationship is also part of our socio-political relationships and forms the matrix of connections and systems that life on earth depend on. Oil and its production, distribution and exchange is a fact of that socio-political and environmental relationship – what John Urry calls the carbon based economy-society.


At this point the connection between health and social analysis might begin to seem tenuous, especially to those steeped in a biomedical frame of reference. However, within health education there are two perspectives that bring issues around sustainability, whether they be political, social and/or environmental, back into focus. The Social Determinants of Health and the Inequalities in Health literature raise issues about our relationship both to the environment and to each other and the impact this has on individual, community and population health. Both of these perspectives on health may well be addressed in undergraduate medical and nursing education, but the extent to which they are, is not currently mapped. Although these two perspective do not always explicitly discuss the environment they do focus attention beyond the individual and biology. A great example is Barton and Grant’s (2006) ‘health map’ which clearly models determinants of health. Their paper, and model for health, would or should be a foundational read in undergraduate health education emphasising as it does biodiversity, climate change and the global ecosystem as key determinants of health.


This has now been explicitly accepted by some in the medical profession following the publication of three specific priority learning outcomes for the education of ‘Tomorrow’s Doctors’. This publication follows calls for medical graduates to be sustainability literate and is based on a General Medical Council’s request for learning outcomes for environmental sustainability in medical education. A call for nursing in general, and the Nursing and Midwifery Council (NMC) in particular, for nursing to be more explicit on sustainability and environmental health in its educational standards for undergraduate nursing education has not resulted in a similar request by the NMC for learning outcomes of this nature. The NMC prefer to see this subsumed under general public health.


The priority learning outcomes just published on the Sustainable Healthcare Education network are:


1. Describe how the environment and human health interact at different levels.

2. Demonstrate the knowledge and skills needed to improve the environmental sustainability of health systems.

3. Discuss how the duty of a doctor to protect and promote health is shaped by the dependence of human health on the local and global environment.


The site helpfully expands on these outcomes.


An important point is that although sustainability literacy may involve explicit new curricular content for doctors, for example critical reflection on the philosophy of dualism and anthropocentrism, it is also about developing a perspective on health, a lens through which we see anew the relationship between human health and the environment. Medical schools may already address models of healthcare delivery that go beyond the biomedical to embrace and examine biopsychosocial, salutogenic and complementary approaches. The European Centre for Environment and Human Health based in Truro, Cornwall,  is an example of a research centre specifically and explicitly addressing sustainability and environmental issues.


Thus we have the medical profession very clearly stating that sustainability and environmental health should be explicit in the education of our doctors of the future. This of course follows on from other clear statements such as the first University College London and the Lancet Commission on managing the health effects of climate change report.


These learning outcomes have been called ‘priority’ learning outcomes and this perhaps reflects the seriousness with which the issues are taken. A counter is that of course Public Health is a core component of both medical and nursing education, so why the need to make sustainability specific? Why indeed have ‘priority’ learning outcomes if this is being covered already within public health education. The answer may be that ‘Public Health’ itself is a multi perspectival subject in which it is possible that biomedical and epidemiological approaches could dominate while downplaying the environmental and social determinants of health. It is certainly possible to address public health without critically examining and understanding sustainability. The General Medical Council seem to have accepted this,  and hence their call for these learning outcomes. The Nursing and Midwifery Council have considered that their own standards that inform education practice are broad enough so that sustainability can be incorporated into undergraduate programmes within Public Health teaching. This might be a mistake, because if educators do not have a sustainability perspective, or lens, then they may well miss a vital aspect of health education.


The publication of the medical priority learning outcomes on the other hand gives a very clear message to those developing educational experiences for doctors. The message is that to fully understand human health one has to address environmental, social and political determinants of health. This understanding then feeds into strategies and actions  to address inequities in health and the environmental health crises that may severely impact on individuals, communities and populations. Other health professions might learn from this approach taken by the GMC.

Changing our mindset for health and sustainability

Changing our mindset for health and sustainability

“In this century it has become clear that the fundamental social problem is now the relationship between humankind as a whole and our global environment” (David Loy 1988 p 302).

This is also on the 2 degrees site

As I have previously suggested, health care professionals are becoming more alert to the issue of climate change and how this might affect the health of populations in the future. Climate change is only one aspect of sustainability, others of course relate to issues such as food production, distribution and security. The solutions put forward to address the myriad issues appear to be based in two different, but not necessarily mutually exclusive, approaches: 1) the technico-rational and 2) philosophical. If health care professionals are to put forward plans of action then they need to consider some of their philosophical and ideological assumptions that underpin those solutions.  I would suggest that a little more philosophical enquiry into the nature of society and our relationship to ‘nature’ just might prompt a rethink of our reliance on technical solutions.


The first, technico- rational, approach implicitly accepts dominant modes of thinking, which could be called ‘modernist’.  It is often based upon various philosophical traditions without explicitly critiquing them. These traditions, such as rationalism, empiricism and dualism, can be traced back to the Enlightenment and the dawn of western science. These ideas of course underpin much of modern capitalism which is another taken for granted economic model underpinned by philosophical assumptions about how the social world works.


A modern exponent of this is Daniel Ben Ami who, in ‘Ferraris for All’, argues that what is required is more economic development and growth, i.e. much, much more of the same, in order that humanity can better control nature and to come up with scientific and technical solutions to such issues as ocean acidification, climate change and soil erosion. Capitalism, rationalism, empiricism and dualism are implicit in this way of thinking. In short, this accepts the current economic growth based model and an understanding of how we relate to nature through extraction and development of natural resources for human use. The answer for sustainability and human health is improved technologies. I think there are flaws in this approach, one of which is that it relies too much on assuming what brought us success in the past, i.e. capitalism and technological development, will continue to do so in the future. That is to say it is based on inductive logic and its flaw; past patterns might predict the future but cannot guarantee it. As Nicolas Naseem Taleb reminded us, there might be a black swan to confound the ‘all swans are white’ logic.


David Loy’s comment leads us to the second approach, the philosophical, in that we might want to examine some of the assumptions that underpin the technico-rational, and especially ‘dualism’ – the separation between man and nature, mind and body. Loy contrasts Eastern non dualist philosophical traditions, with mainly Western dualism in that  “….there is no distinction between “internal” (mental) and “external” (physical), which means that trees and rocks and clouds, if they are not juxtaposed in memory with the “I” concept, will be experienced to be as much “my” mind as thought and feelings” (p140). This then is a non dualist viewpoint in which ‘us’ includes the biosphere; we are indivisible as human beings from all life forms and all matter.


In Cartesian dualism, the Platonic tradition and the Judeo-Christian religious tradition, the self is separate from nature and is understood to be the source of awareness, meaning and value. This results in a devaluing of the physical world in which the human self is separate and superior.  The human ‘subject’ is separate from the natural ‘object’, and so what we do to ‘it’ is not part of ‘us’. Dumping toxins into the oceans is acceptable because the ocean is not part of us – it is a waste sink, we are doing something to a separate ‘it’. The human subject then becomes capable of confronting an objective world, a world which is there for our use.  The idea of human exceptualism (Catton and Dunlap 1978) – that man is special and apart from nature – takes root in this discourse.


This sentiment harks back to Francis Bacon, who argued in 1620 “The world is made for man, not man for the world”. In ‘The New Atlantis’ , Bacon thought that by and through the application of scientific and technological dominion over nature, men would usher in a new age of abundance and comfort.  This has echoes in Sigmund Freud’s (1927) assertion: ‘The principal task of civilization, its actual raison d’etre, is to defend us against nature’.


The call to have dominion over, to conquer, to harness, control or subjugate nature is predicated upon this idea of separateness from it. This control is thus predicated upon the self in opposition to nature which Yagelski (2011) calls  ‘the problem of the self ‘:  “My argument here is that the prevailing Western sense of the self as an autonomous, thinking being that exists separately from the natural or physical world is really at the heart of the life-threatening environmental problems we face”. Shabecoff (2001) suggested that concerns expressed in critiques by environmentalists of this dualist interpretation resulted in the ‘Heidelberg Appeal’ , a document signed by many scientists,  which reasserted that progress by man always involved harnessing nature to man’s needs.

However, we know that human health is inextricably bound with the physical and natural environment and what Charles Eisenstein calls ‘separation’, i.e. dualist thinking, results in practices that are injurious to us. In this regard Chivian and Bernstein (2010) argue the biodiversity is crucial to human health and I suggest that we might do better to consider ourselves part of nature not separate from it. Is it a philosophical step too far to consider that the clearing of Amazon rainforest is therefore as injurious to my health as contracting a virus?  Changing low energy light bulbs is a technical solution, perhaps I also need to change the way I think.

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