sustainability in nurse education and other health professions

Frances Mortimer's picture

Almost all the articles and resources in the SHE Network so far have been about medical student teaching.  Does anyone know what's going on in nursing courses and for the other health professions?


Hmm, a very interesting

Linda East's picture

Hmm, a very interesting question.  I have been a nurse educator for 20 years and have always been vaguely 'green'.  However, I've only recently connected the dots in terms of personal and professional/pedagogical practice.  So I'm still trying to work out this question for myself!  Luckily, I have an excellent guide in Benny Goodman of Plymouth University, who has published a very helpful paper on this topic.

I am off to Cornwall for the weekend, and will be meeting Benny on Monday.  I'm sure we'll be posting more then.  As a starter, I'm really impressed with the teaching resources for medical students available on this site, and would love to do something similar for nurses.


Midwifery Curriculum

Lorna Davies's picture

Hi there

I am a midwifery lecturer based in Christchurch New Zealand. We developed two blended delivery courses around  sustainability and midwifery prctice when we redeveloped our curriculum five years ago. The courses are part of Year 1 and Year 3 delivery. The first course gives a global perspective of midwifery and inrtoduces the students to sustainable healthcare. In Year 3 the students are introduced to the concept of sustainability in midwifery practice in terms of resource management; faciliatating social sustainability and working in a sustainable way. The courses have proved to be very popular. During the development, we discovered that thtere was a dearth of infomration around sustainability and midwifery practice and consequently myself and two colleagues here went on to publish a book with Routledge called Sustainability, Midwifery and Birth (Davies, Daellenbach and Kensington 2011) I am currently undertaking a doctoral study exploring midwifery as a sustainable healthcare practice. I would love to hear from any other midwives out there or anyone who may benefit from our experiences to date.



Nursing and midwifery education

Heather Baid's picture

I'm a lecturer at the University of Brighton - a few months back a number of us in the School of Nursing and Midwifery (lecturers and administrators) reformed a School level Sustainability group. 

We've just set up a webpage (still in early stages of development) and email contact:


It would be nice to hear from others interested in sustainability issues related to nursing, midwifery, or paramedic education / clinical practice (we also have a paramedic programme within our School).

I'm aware of sustainbility education within the School of Health Professions for OTs as well - if anyone is interested in sharing experiences for any one the above, you could use the and I will forward on to the appropriate people.

For this School of Nursing and Midwifery Sustainability group, we've written a strategy to help guide us in what 'sustainability' really means to us within the School - this is such a broad term covering so many different things with relevance for  both education and health care.  Some of the key areas we've discussed are where 'sustainability' fits into the curriculum itself, research, physical environment, day to day work as a School, student/staff experience.....

Personally, I am particularly interested in how to measure the carbon footprint of clinical nursing practice in order to have a better understanding of the current environmental impact and plan out ways to improve on this.

It would be nice to hear from others about their experiences as educators and/or health care practitioners.



Linda East's picture

Thanks for the input, Lorna and Heather.  Lorna, I will send your message on to colleagues our Division of Midwifery here at Nottingham - I'm not sure whether any of them are engaged with sustainability or not.  Heather, it was great to see your web site, the bulletein and that you have got as far as a strategy.  We are just starting out on the journey in the School of Nursing, Midwifery and Physiotherapy here at Nottingham, so this is an inspiration as to how we could take things forward.

Benny and I met up in Truro on Monday, and are preparing our presentation for this conference:

We'll add a link to the slides once they're ready.

Best wishes,



N and M education

benny_goodman's picture

Great to hear from you Heather and Lorna! We in Plymouth have been trying to implement sustianability in the curriculum for nurses and we are also working on how to ensure our undergraduate programmes address the issues. As part of our revalidation of our degree programme I wrote a paper on 'principles' for sustainability. I also run a blog and a facebook group on theses topics. The facebook group was orginally for student nurses but it is branching out to include anyone interested in sustainability: My blog is on and see for example Climate change and nursing, why nursing may duck the issue.


Sustainability in Healthcare Educatio

Lorna Davies's picture

Great to make contact with you all and to see all of the exciting things that are starting to happen. Great paper Benny and I have joined the FB group.  Would love to attend the conference but sadly won't make this one.  Is anyone specifically interested in social sustainability and healthcare?  This is my focus for my doctorate. I kind of think that if we can crate community then we stand a better chance of getting economic and environmental tenets onto the agenda.

Be interested to hear what you think?



Social sustainability

benny_goodman's picture

Hi Lorna, i have been thinking about this from the political economy perspective as I think 'community' as an idea/experience has its roots in the forms of political economy a society takes. Briefly, the culture of communities (a society's 'superstructure') is 'determined' in the last instance by its economic base (its infrastructure). Thus the 'victory' of neoliberal capitalism and its financial and consumerist forms are shaping our social values in a non sustainable fashion. Communities that are attempting 'low impact' are few and struggling to survive in this context. In parts of the world they are being extinguished by the relentless pursuit of profit, the Canadian tar sands is just another tragic example. In short any attempts to create a sustainable community has to address the political ramifications of capital relationships. This is why social justice and climate justice sit side by side. Just this morning on 'Start the Week' Andrew Marr discussed the relationship between markets and morals with the political philosopher Michael Sandel. In his latest book, What Money Can't Buy, Sandel questions the dominance of the financial markets in our daily lives, in which everything has a price. this accords with work such as that by Tim Jackson and Clive Hamilton (Requiem for a Species). David Harvey in 'The enigma of Capital' and 'Rebel Cities' explains the dynamic very well indeed and there is a great RSA events animation on the underlying economic dynamic that has got us in this mess.  This all seems a long long way from nursing but it is the economic base from which all our arguments about the delivery, type and access to health care stem. We have to question why the richest 0.01% have vastly increased their wealth so much that the NHS costs pale into relative insignificance (JK Galbraiths' private affluence v public squalor). I'll stop there. 


Markets and Morality

Rachel Stancliffe's picture

Hi Benny, Lorna and all 

just to let anyone who is in/near Oxford know that there is a chance to hear Michael Sandel this evening and ask questions - details here

Monday May 21 – 6 pm in the Chapel, St Peter's College, Oxford

 Andrew Marr will chair a debate about Markets and Morality following a talk by Professor Michael Sandel – Harvard’s celebrated political philosopher whose book  ‘ What Money Can’t Buy – The Moral Limits of Markets’ has just been published.  His ‘Justice’ course is the most over-subscribed Harvard course.

Michael will discuss his ideas with Professor Ngaire Woods – of the new Blavatnik School of Government- and Professor Jeremy Waldron – Oxford’s Professor of Social and Political Theory.

contact Mark Damazer [], Master at St Peter's College
01865 278911


Micheal Sandel

benny_goodman's picture

I heard him this am on 'start the week'  - his argument is in accord with many critiques of political economy. I find the RSA a fabulous resource:



Nurse Education Today article

benny_goodman's picture I hope this link works. It outlines an argument for sustainability in the nursing curriculum.


Education that is fit for purpose

Sarah Walpole's picture

Great to hear about what is going on in Plymouth (I really enjoyed your article Benny), and your PhD research on social sustainability Lorna.


I'm involved in developing teaching on sustainability for medical undergraduates in Leeds. For better or perhaps for worse, we often try to fit sustainability to the learning objectives of the course. Often it is difficult find space in the course to teach/facilitate learning about sustainability as a core function of the NHS even when you can demonstrate that it is an essential learning outcome or helps to meet the learning objectives, however it is good to be reminded of the functions of education beyond meeting set learning objectives. I think we are trying to achieve third order learning (changing perspectives), but we sometimes resort to approaches that promote second and first order learning, because it's easier to enter the curriculum that way/ we are more used to it..


Likely due to our "biomedical model" mode, I see and talk much more about cardiovascular, respiratory and mental health, than about community when learning and teaching about environmental change and health. I tend to mention community and concepts/pathways through which community might be developped (e.g. access to green spaces may promote community cohesion), but I don't tend to focus on this - perhaps feeling that I know less about it or that it will be less well received as I don't have quantitive research findings to back up my points. It would be interesting to hear more about your research Lorna.


I wonder to what extent you are in touch with /working with the medical school in Plymouth Benny, and if they have been developing teaching along similar lines to you, or even if you are able to provide any "interprofessional education" on sustainability?


Education fit for purpose

benny_goodman's picture

Thanks sarah for the kind comment. I have recently contacted my medical colleagues here with a view to developing a special study unit for the med students on sustainability and health. I was prompted by Sally El-Sayeh. I am always interested in the interprofessional angle, this topic is not 'owned' by any one profession and of course affects all. There is a real challenge to square the demand for a technically skilled clinical workforce focused in illness/disease management and a transformative education that sets new agendas for the coming health paradigms and contexts. I am always reminding myself of David Orr's point regarding the 'what is education for? question and his comment that many of the current issues were created by the elite universities and very bright graduates in all disciplines who nonetheless have not stopped to consider what the utlimate aims were. Education is not the solution in this context, it is the problem producing more 'business as usual' nonsense. Economics has had a slap in the face since 2008 but you would not think so given the dominance of the debate by outmoded positions. At root are at least two approaches to the issue: the technico-rational approach that seeks to adjust the systems and technical processes we currently have (includes carbon reduction targets but not economic structural reforms) and the other what has been called 'deep green' approaches which advocate a complete reappraisal of how our society operates. I am not sure which will be the right approach. If Mark Lynas is correct, and if get to 4 degrees then the race is on for super technical advances for survival...but i digress......



benny_goodman's picture

If health is based on social determinants (WHO 2008), if health is based on the physical environment (Barton and Grant 2006), then, just as slavery and apartheid were crimes aganst humanity, ecocide is a crime against the planet that supports human life. Nurses have a role in promoting health of individuals, communities and populations (NMC 2010), so that means arguing for ecocide to be made a crime? Wright Mills (1959) clearly pointed out a social and political role for the 'emancipated liberal educator', nurses who realise the direct links between industrial practices and human health may have this moral obilgation to address such seemingly 'un-nursing' issues?

The petrochemical industry (which gets a $600 trillion subsidy globally) could become a criminal. So, banks and governments should withdraw support for criminals. The arguments against this (introducing ecocide as a crime) are the same arguments made by slave traders. However, the moral imperative won out over the economic imperative. Perhaps we should view our own use of oil as a crime? Individuals will find it hard to wean off it, but the petrochemical industry should be forced to stop, give them some time to prepare, say 5 years before ecocide becomes law.


Polly's books on the subject of course give a much deeper reasoning and a path forward. However it is a form of futures thinking that right now may seem 'wierd' but future generations may think was a long time coming?

Polly presented her ideas at a recent RSA event: 'Earth is our business':



Principles and Pointers for the Curriculum - updated

benny_goodman's picture

We argue there is a ‘sustainability-climate change-health’ triad (Goodman and Richardson 2010) which makes it an imperative that we examine notions of sustainability and climate change in the curriculum. This paper will begin by briefly outlining the need for addressing sustainability (and climate change) in the nursing curriculum by reference to global issues. This will be followed by a discussion on the implications for education, focusing on the ‘what is education for’ question. Available here:


Short Overview of the Global and UK mandate for Sustainability

benny_goodman's picture

Climate Change, Sustainability and Health – making the links. Human-induced, i.e. ‘anthropogenic’ global warming and unsustainable patterns of living, such as the overuse of fossil fuels for personal transport, are implicated in a health threat to individuals and populations. Costello et al (2009) in a paper in the Lancet argued that ‘climate change is the biggest threat to public health this century’, although this particular claim is disputed by some authors (Goklany 2009).

Nonetheless, on December 4th 2011, the first Global Climate and Health Summit brought together over 200 participants from more than 30 countries and concluded with the adoption of the Durban Declaration on Climate and Health and the Health Sector Call to Action. The delegates called for a ‘fair, ambitious and binding global treaty, and urged all countries to commit to immediate strong climate action to protect and promote health’. This follows previous suggestions by organisations such as the Climate and Health Council and the BMJ that health professionals should take a leadership role in putting health at the core of sustainability and in addressing the health and security aspects of climate change. The Sustainable Healthcare Education (SHE) network is currently engaging in a national consultation on ‘priority learning outcomes’ (PLOs) for medical education. This work has been carried out in collaboration with and prompted by the General Medical Council. This is an exciting development and carries forward sustainability into medical education as an explicit theme for ‘Tomorrow’s Doctors’.

Various international health and nursing organisations have also published position statements on climate change: The American Nurses Association 2008 House of Delegates (2008), International Council of Nurses (2008), the Royal College of Nursing Australia (RCNA) and Australian College of Nursing (2012). Thus, many in the health professions globally and especially those working in Public Health have accepted sustainability and climate change as hugely important areas for education and practice.

However this is not just about climate change. The issues around sustainability (e.g. biodiversity loss, desertification and soil erosion) do not require that climate change is an established fact or even that the health impacts will be as they are predicted. There are many other sustainability and environmental issues resulting from current human practices that negatively impact on the health of populations and, if not addressed, through for example Agenda 21, could seriously threaten the health of the global population in the future.

This has been recognised for over three decades and has a much longer history even than that. During the 1980’s the United Nations General Assembly established the Brundtland Commission which published in 1987 a report: ‘Our Common Future’. This was a global initiative to unite countries around sustainability principles. During the World Summit on Sustainable Development (WSSD) in Johannesburg in 2002, the International Association of Universities (IAU), the Association of University Leaders for a Sustainable Future (ULSF), Copernicus Campus, and UNESCO launched the Global Higher Education for Sustainability Partnership (GHESP) to promote education for sustainable development in particular among higher education institutions. Again, in 2002, the United Nations General Assembly proclaimed the years from 2005 to 2014 as the Decade of Education for Sustainable Development (DESD). Responses by governments around the world include ‘Caring for Our Future’ (2006) which is the Australian Government’s Strategy. The United States’ response to DESD includes a partnership of several hundred individuals, organizations, and institutions dedicated to the overall aim of seeing sustainable development fully integrated into education and learning.

In the UK the Higher Education Academy (HEA) has a ‘thematic area’ of education for sustainable development with a purpose to help institutions develop curricula and pedagogy. We now have curricula guidance such as the HEA’s ‘Future Fit Framework’ (Sterling 2012) which is designed for educators interested in sustainability education applied to their discipline, to assist them with developing their ‘sustainability lens’. Finally the National Health Service recognises its sustainability responsibilities, especially as a high net contributor to carbon emissions, and has provided resources and a carbon reduction strategy to address sustainability in everyday healthcare practice.

The sustainability ambitions of Plymouth University are well established and underlined in the new corporate strategy. Sustainability cuts across academic disciplines and can apply in all. Many students cite sustainability as an important aspect of both choosing their University and for their future careers. Nursing has a very important role to play in both addressing health impacts and in supporting the NHS in its sustainability ambitions. Nurse Education can play a key part in promoting the sustainability literacy of the nurse of the future.


Critique of Climate change as a health threat

benny_goodman's picture

I missed this the first time but it needs reading: "Climate change is not the biggest global health threat" by Indur Goklany (2009) The Lancet 374:9694 pp 973-974.


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