Planetary health and person‐centred healthcare practice

The interdependence between healthy people and a healthy planet is increasingly recognized. 'The Lancet Countdown on Health and Climate Change' has called for a 'people-centred', health-driven transformation to combat the effects of climate change (Romanello et al., 2023). In 2023, the United Nations Climate Change Conference (COP28) was the first of its kind to include health as a core theme reflecting a formal recognition of the impacts of climate change on health, and the health community's role in addressing this challenge. Simultaneously, there is an increasing desire for healthcare practice to be person-centred—where individual beliefs and values are respected, where patients and their families contribute to decision-making systems, and where all persons can flourish. This commentary explores ways in which healthcare practitioners can leverage the principles of person-centred practice to enrich their role as advocates for a flourishing human and planetary health. It identifies the intersections that exist between planetary health and person-centred practice from the perspective of the nursing profession. Importantly, it aims to provide a platform for person-centred healthcare to evolve and planetary health to be explicitly recognized in future healthcare research and practice. Person-centred healthcare practice is an ever-evolving concept and has been traditionally understood as having patients and their families at the centre of all decisions. While shared decision-making is an important aspect of person-centredness, McCormack et al. (2021) have argued that there are other concepts which are also fundamental to person-centred practice. These constructs have been included in their person-centred practice framework (PCPF, Figure 1). In this commentary, we posit that these constructs also encompass crucial aspects of planetary health. At its core, person-centred practice aims to achieve a healthful culture, a state in which 'good health and well-being flourish across geographic, demographic and social sectors', highlighting the inherent inclusion of planetary health within the PCPF (Evidence for action, University of California, 2024). It is evident that flourishing planetary health requires a collaborative and sharing approach, one that mirrors the person-centred practice's holistic approach to care. Societal trust and regard for the nursing profession positions nurses as genuine leaders in the emerging interdisciplinary field of planetary health. Interestingly, this trust extends beyond geopolitical and cultural boundaries—most cultures identify healthcare practitioners, such as nurses, as trusted collaborators in their healthcare approaches. This uniquely places them at the forefront of global health policy change through education, engagement and practice which has been historically acknowledged (Butterfield et al., 2021). It also allows them to significantly contribute to rapid uptake of policies, especially those pertaining to planetary and human health. Healthcare practitioners live and work closely in communities which are most impacted by climate change and are close to the people who are most vulnerable to its impacts. It is imperative that the role of healthcare practitioners such as nurses in planetary health should not go understated or indeed, underappreciated. In the following sections, we highlight the intersectionality between planetary health and the principles of person-centred practice. The domain of 'macro context' in the PCPF dictates that strategic and political factors influence the development of healthful cultures. Accordingly, significant health system change is needed to secure planetary health, combat the effects of climate change and ultimately achieve healthful cultures as imagined in the PCPF. Health professionals and decision makers, including nurses, must be partners in these activities and can advocate for a 'health in all policies' approach which recognizes that health outcomes are not shaped by health policy alone but are also deeply affected by strategic and political factors born of other sectors such as agriculture, commerce and the fossil fuel industry. Aligning with the need for macro health system change, a key principle is to minimize the need for healthcare activity, and this requires a strategic reorientation of health systems to focus on disease prevention and health promotion (Mortimer et al., 2018). Strategic health sector frameworks for climate action have elucidated the health co-benefits of mitigation, as well as highlighted the need for health systems' strengthening and adaptation. Health policy and strategic frameworks must go beyond the health sector to engage in multisectoral partnerships to address climate change within health systems, public and private sectors and civil society. Embedding sustainability into already established health quality frameworks is a promising strategy to support the transition to low-carbon health systems and climate adaptation. This includes optimizing the location of care through strengthening primary, emergency and out-of-hospital care pathways. This ensures that healthcare is provided at the most appropriate time and place, while reducing travel-related emissions. Sustainable clinical practice emphasizes the importance of patient empowerment and self-care (Mortimer et al., 2018) reflecting the 'person-centred processes' outlined in the PCPF. Working with a person's beliefs and values and sharing decision-making can empower patients, enhance self-efficacy and lead to improved health outcomes, thus reducing the need for healthcare (McCormack et al., 2021). Alongside this, enhancing digital health infrastructure and capability is essential and can improve health communication and access to care regardless of location or individual ability. A core domain of the PCPF is the 'practice environment' which is concerned with the context in which healthcare is experienced. Healthcare is provided by nurses to all communities and in all settings and the physical practice environment extends beyond hospital walls to include a complex array of natural and built environments. A healing physical environment is necessary to achieve healthful cultures. It implies the availability and access to clean air and water, temperate climates and access to natural environments such as green and blue spaces. Additionally, a healing physical environment is resilient against climate-related warming, extreme weather events, natural disasters and emerging disease epidemics. Climate change is a matter of social justice: It amplifies existing health inequities that disproportionately affect marginalized population groups, that is, those with the least capacity to mitigate risks to self and community (Kalogirou et al., 2020; Matthews et al., 2023). Healthcare practitioners such as nurses act in patient/clients' best interests and are traditionally strong advocates on issues of social justice, making planetary health inherently a healthcare issue. By creating a practice environment that is founded in shared decision-making systems (as laid out in the PCPF), nurses can be strategic leaders that ensure that all voices are included. Although the International Council of Nurses position statement on 'Nurses, climate change and health' clearly identifies nurses as leaders in this area, others have suggested that the nursing profession has been slow to respond and that beyond the rhetoric, lacks tangible and pragmatic direction in planetary health. This may align with a historic and traditional conceptualization of nurses as concerned with individual patients in local environments, and a failure to recognize the importance of the profession in securing global health across geographic, demographic and social sectors. The nursing profession must evolve to embrace an 'upstream' approach that considers the macro context, that is, the broader environment and the social, political, economic and health implications that intersect to impact individual health. Embedding planetary health in nursing and health curriculum has the potential to remove the current ambiguity of the professional role in relation to planetary health and broaden the nurse–environment relationship beyond the microsocial and localized environments that nurses traditionally engage in (Best et al., 2023). Central to nurses' engagement with the macro context is the concept of healthful cultures that values both those giving and receiving care; this enabling environment reminds us, and in fact, compels us to be a voice for change on issues of equity, such as climate change. Equipping emerging nurses with a foundational knowledge on planetary health is critical to support the profession to promote policy change, advocate effectively for climate change action and collaborate as equal partners in the design of health adaptation policies and resilient healthcare systems (ICN position statement). The person-centred practice framework offers a strategic opportunity to embed sustainability into nursing education and practice by providing a clearer and more explicit alignment of person-centred processes and the practice environment, within the macro context of health. The ICN position statement highlights the centrality of nurses to deliver integrated models of care that include actions to tackle climate change. These include reducing unnecessary travel, developing climate-informed health programmes, engaging in sustainable practices in healthcare practice and participating in policy and governance responses. It is expected that there will be an increased demand for these skills and attributes of the healthcare practitioners as the prevalence of non-communicable diseases coupled with climate change is likely to increase. The PCPF identifies these attributes as prerequisites for a person-centred practice and emphasizes that these are crucial to delivering person-centred healthcare. These personal attributes work in tandem with the person-centred processes to provide a holistic and authentic approach to achieving healthful cultures and environment. Knowing self, clarity of own beliefs and values and working with beliefs and values of others are vital attributes for person-centred practice. Therefore, it is evident that personal biases, religious values, ethical beliefs, cultural backgrounds and political ideologies play a significant role in healthcare policy and practice. Importantly, these beliefs and values also determine the understanding and acceptance of deteriorating planetary health and the consequent need and urgency to act. Interestingly, research has successfully demonstrated that, despite a diversity of political beliefs within nurses, the majority view planetary health as under threat and identify their role in addressing the effects on human health. To what extent this translates to changes in practice remains to be seen. One possible source of motivation and direction could come from 'integral ecology'—a concept that anchors on the bonds humans share with the natural world. Many cultures around the world are explicitly founded in this concept. For example, Andean people identify their world as originating from Pachamama—'Mother Earth' which is the universal source of life. In this worldview, nature is unique, sacred and interconnected with human health and being. First, peoples of Australia also hold similar beliefs where environment (land, sea and sky) and people's place within it are interconnected. Similarly, Hinduism and Buddhism describe nature as divine and identify a reliance of humans on nature for their flourishing and vice versa. Cultures where there is an explicit commitment to planetary health can be models for education and learning (Best et al., 2023). Intellectual exchange and knowledge sharing across cultures can provide healthcare practitioners with interpersonal skills that extend beyond their traditional practice. In turn, healthcare practitioners can support communities in revitalizing and strengthening cultural practices 'that protect Country and simultaneously build respectful collaborations for two-way sharing of different knowledge systems necessary for the benefit of all'. In this commentary, the intersectionality between planetary health and person-centred healthcare practice is explored from a nursing perspective. The PCPF provides an appropriate professional and strategic lever for climate action and healthcare sustainability. There are opportunities in future practice and research to use the principles of person-centredness to achieve healthful cultures while meeting the requirements for planetary health. It is also noteworthy that, although the PCPF implicitly recognizes planetary health as essential to human flourishing, there are opportunities for it to evolve by explicitly including planetary health as a necessary feature of healthful cultures. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians. No funding source is identified for this article. All the research for this article was conducted within the School of Nursing at The University of Sydney in Australia. The authors declare no conflict of interest. No primary data were generated for this commentary.