Conceptual frameworks, competencies, contents and teaching methods in planetary health education for health students and professionals: a global systematic scoping review

Abstract

Background

Planetary Health studies the impact of the global environmental crisis on health. Urgent transdisciplinary, intersectoral, and holistic solutions adapted to local realities are needed. Designing training programs attuned to contextual needs of diverse groups and geographical areas is crucial. Planetary health programs are emerging worldwide, but little is known about their scope and learning outcomes. A systematic scoping review is needed to shed light on the state of planetary health education.

Objectives

This review aims to identify existing frameworks, competencies, content, and teaching methods in planetary health education.

Methods

Following PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines, we included studies targeting undergraduate and postgraduate students, focusing on skills, knowledge, and abilities related to planetary health, published in English or Spanish. No exclusions were made based on geographic area, study design, or publication period. Databases consulted were MEDLINE via PubMed, Scopus, Web of Science, and ProQuest. Selection and data extraction processes were conducted systematically.

Results

We included 73 articles, with 88% from high-income countries and 49% focused on health professionals. Conceptual frameworks identified include "One Health," "Sustainable Development Goals," and the "Planetary Health Education Framework." Transversal skills (complex problem-solving, systemic thinking, collaboration, interdisciplinary) and specific competencies (understanding health interactions with climate change, pollution) were outlined in 45% of studies. Half of the studies described 23 general topics and 93 specific content areas. Teaching methods included in-person (59%), virtual (12%), and hybrid models (29%).

Conclusions

This review highlights the heterogeneity in conceptual frameworks, competencies, content, and teaching methods in planetary health education for health professionals. Future research should focus on developing and evaluating evidence-based educational models to address the evolving challenges of planetary health. Recommendations include enhancing collaboration among stakeholders and integrating innovative teaching methods to improve planetary health education.

Trial registration

The protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).

Clinical trial number: not applicable.

Introduction

Background

The Anthropocene era has brought significant global health improvements [1, 2]including a doubling of life expectancy to 72.6 years by 2019. However, these gains have come at the cost of unsustainable resource consumption and environmental degradation [3]exceeding six of nine planetary boundaries [4, 5] Health benefits remain unequally distributed, with life expectancy in 2021 ranging from 52.5 years in Chad to 84.8 years in Japan [6] and disparities also evident within nations. Addressing these challenges requires Planetary Health education that promotes health equity and sustainability while recognizing the urgent need to balance human development with the planet's finite resources [7].

Rationale

In 2015, coinciding with the launch of the Sustainable Development Goals (SDG) by the United Nations, the Rockefeller Foundation and the Lancet Commission defined Planetary Health as"the maximum achievement of health, well-being and equity through a use of the Earth's natural resources that is within limits that allow humanity to prosper, without compromising the economic, political and social systems of future generations" [1]. This concept builds upon previous notions of environmental sustainability, global health, environmental epidemiology, and “One Health”, emphasizing inter- and transdisciplinary collaboration, solutions-oriented strategies, and health co-benefits.

Knowledge gap

Recent reports from the Intergovernmental Panel on Climate Change (IPCC) [8], the United Nations Environment Program (UNEP), and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) [9] have further underscored the urgent need for action at all levels to adapt, mitigate and reverse the impacts of the climate crisis on global health. The challenges are complex, transversal and unevenly distributed, vulnerable communities, particularly in low- and middle-income countries, facing disproportionate risks due to factors such as geographical location, political instability, population density, and resource dependency [10]. The pressure on natural systems, understood as the excessive use of resources, deforestation, changes in land use, or the consumption, resource and energy needs of an increasingly"westernized"population, also increases susceptibility to zoonotic diseases and future pandemics [11]. Adaptation therefore requires systematic transitions towards a more sustainable society, operating within the limits of the planet in a fair and equitable way. This implies fundamental changes, ranging from an energy transition, rethinking of food systems and habits, urban planning, and land use. For this reason, it is important to acquire new skills and abilities across various professional areas and incorporate transdisciplinary approaches. To achieve this, we need to train competent and committed people across the world, in order to drive research and transformation at a"glocal"level (both local and global). With this review we aim to map the most relevant conceptual frameworks, competencies, contents, and teaching methods in this field making it possible to improve quality of future capacity building strategies in planetary health.

Objectives

Universities play a pivotal role in training professionals equipped to address these complex challenges through high-quality research and transdisciplinary approaches. As highlighted in the 2019 United Nations report [12] and the São Paulo Declaration on Planetary Health, there is a growing demand for Planetary Health education across all curricular levels [13]. This training is crucial for fostering a generation of leaders capable of driving research, innovation, and transformative change at both global and local levels.

Search for existing reviews

While the number of Planetary Health courses is increasing, they often remain as elective or supplementary modules, primarily available in high-income countries such as Canada, Scotland, England, Switzerland, the Netherlands, the United States or Spain. There is a pressing need to expand access to these educational opportunities, particularly in vulnerable regions. By empowering individuals with the knowledge and skills to address the specific needs of their communities, we can foster resilience and promote equitable solutions to the multifaceted challenges of Planetary Health. An international organisation of medical educators has produced a consensus on planetary health and education for sustainable healthcare [14] The consensus consists of learning outcomes, objectives, and strategies to deliver sustainable healthcare education, aiming to raise awareness of healthcare professionals. However, a more comprehensive and systematic scoping review considering broader multidisciplinary scopes beyond health professions education remains necessary.

Relevance

This systematic scoping review aims to identify generic existing frameworks, competencies, content, and teaching methods in Planetary Health education which could be adapted based on individual school or program needs. This information will be used to co-design a conceptual framework for community-driven training in the field. Results of this systematic scoping review will be relevant to educational practice and the development of the planetary health field.

Review question

This global systematic scoping review aims to answer the following review question: What are the conceptual frameworks, competencies, contents, and teaching methods currently used in Planetary Health education for health professionals, and how are these elements applied in different educational contexts?”.

Methods

To explore the complexities and evolving nature of Planetary Health education, a systematic scoping review is employed. This methodology is particularly suited for synthesizing and mapping existing evidence in emerging, complex, or heterogeneous fields, where conducting a precise systematic review might be premature. Systematic scoping reviews are instrumental in clarifying concepts, identifying key elements within the existing literature, and uncovering knowledge gaps that need further research. Importantly, in systematic scoping reviews, the primary focus is on breadth and comprehensiveness rather than on the critical appraisal of individual study quality, allowing for a broad overview of the landscape. This approach aligns with the objectives of this study, which seeks to comprehensively map the current state of Planetary Health education to inform the development of a robust and contextually relevant training framework.

The protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).

Search strategy

In line with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) statement [15]a comprehensive search strategy was developed to ensure transparency and reproducibility. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Scopus, Web of Science, and ProQuest.

The search terms were structured around three thematic blocks:

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[A]: Core concepts of Planetary Health (Planetary Health, One Health, environmental health, ecohealth, global health, international health, climate change).

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[B]: Educational aspects (Capacity Building, training, skills, education, formation, learning, teaching).

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[C]: Conceptual and structural elements (Framework, system, model, outline, frame).

The final search strategy was adopted following an iterative refinement approach. After an initial screening of 50 articles the review team examined the results and iteratively refined the search strategy to maximize the capturing of the diversity of educational approaches in planetary health.

The full search strategy for each database is available in Appendix 1. Appendix 4 shows the previous iterations of the search strategy.

Keywords within each block were identified based on prior knowledge and refined through preliminary searches. The search was executed using Boolean operators ('OR'and'AND'), combining terms as follows: (Block A) AND (Block B) AND (Block C). Given the relatively recent emergence of Planetary Health as a field, the search terms were intentionally broad to capture relevant literature that may use related terminology (e.g., climate and health). However, only articles explicitly aligned with the core principles of Planetary Health mentioned in its definition [1] were included. The search was supplemented by a manual review of reference lists from selected articles.

Study selection

The selection of the studies according to the previously described search strategy was carried out and followed considering inclusion and exclusion criteria. Population: Studies focusing on undergraduate, postgraduate, or lifelong learning populations were included, while those targeting primary or secondary education were excluded. Concept: Thematic relevance was ensured by including studies addressing skills, knowledge, content, or basic abilities related to Planetary Health, while excluding those focused on unrelated competencies. Context: The review encompassed studies from any geographic region and various designs, including systematic and narrative reviews, observational studies, and descriptive studies. However, study protocols, letters to the editor, and articles lacking peer review were excluded. Articles published in English or Spanish were considered, while those in other languages were not. The publication period was limited to the last 10 years (2014–2024) due to the fact that Planetary Health concept was officially launched in 2015 [1].

Search results were downloaded and managed using Covidence, a specialized systematic review software. After removing duplicates, titles and abstracts were screened independently by two reviewers according to the pre-defined inclusion/exclusion criteria. Prior to full screening, the review team conducted a calibration exercise on a sample of 20 articles to ensure consistent application of the inclusion/exclusion criteria. One of the reviewers was always the same person (CC) while the second one was one of the rest of the team (COG, SOB, AM, IRM, RWR, SML, AF, MLl, DS, CDP, ED, DYF, IW). Full texts of potentially eligible articles were then retrieved and assessed independently by the same reviewers. Disagreements were resolved through discussion or, if necessary, by a third reviewer. Reasons for exclusion were documented at each stage and available in Appendix 2. Inter-rater reliability was assessed using Fleiss'kappa to measure the agreement between one consistent reviewer and a second reviewer selected from a group of 13 individuals. As this is a scoping review, formal quality assessment of included studies was not conducted.

Data extraction

A standardized data extraction form was developed and piloted on a subset of included articles to ensure consistency and comprehensiveness. The following data elements were extracted from each study:

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Bibliographic Information: Title, authors, publication year, journal, and language.

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Study Characteristics: Study design and main concept (Planetary Health, One Health, global health).

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Population Characteristics: Target audience (health professionals, students), professional roles, level of professional development, and sample size (if applicable).

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Educational Context: Educational level (undergraduate, postgraduate, lifelong learning), geographic context, and any reported conceptual frameworks.

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Educational Content and Methods: Specific competencies and skills addressed, content areas covered, and teaching methods employed (online, face-to-face, problem-based learning).

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Study Findings: Key results, conclusions, and recommendations for future research or practice.

Data extraction was performed by one reviewer using the standardized form.

Data analysis

The extracted data was analysed thematically in accordance with the instructions of Nowell et al. [15]This involves the following steps: 1) understanding the data; 2) creating provisional categories; 3) identifying categories and competencies; 4) revising the categories; 5) defining the categories; 6) final description of the data using the categories.

Results

Search strategy and study selection

The initial database search yielded 7,021 references. After removing 1,454 duplicates (21%), 5,567 unique references remained. These underwent title and abstract screening, resulting in 492 articles selected for full-text review. Of these, 373 were excluded for not meeting the inclusion criteria: lack of relevant intervention (28%, n = 103), intervention and/or outcome mismatch (25%, n = 92), ineligible population (19%, n = 72), lack of relevant outcome (15%, n = 57), inappropriate publication type (11%, n = 40), wrong language (1%, n = 3), or misalignment with the core concept of Planetary Health (1%, n = 3).

During the data extraction phase, an additional 46 articles were excluded for similar reasons: misalignment with the core concept of Planetary Health (26%, n = 12), lack of relevant outcome (22%, n = 10), inappropriate publication type (20%, n = 9), intervention and/or outcome mismatch (17%, n = 8), lack of relevant intervention (13%, n = 6) or ineligible population (2%, n = 1). A detailed list of excluded studies and reasons is provided in Appendix 2. The study selection process is visually summarized in the PRISMA flow diagram (Fig. 1). The inter-rater reliability analysis yielded a Fleiss'kappa value of 0.62 (p < 0,001), indicating a high level of agreement among the raters.

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Study characteristics

The detailed description of the 73 articles included in this systematic scoping review is included in Appendix 3. Only 14 of the included explicitly focused on Planetary Health. The remaining articles addressed related topics, with the most frequent being climate change (n = 14), sustainable development (n = 12), followed by environmental health (n = 8) and the intersection of climate change and health (n = 7). Other less frequent topics included One Health and global health (n = 6 each), systems thinking (n = 2), and public health, environmental education, and global citizenship (n = 1 each).

The most frequent study design (52%, n = 38) involved descriptive analyses of conceptual frameworks, educational objectives, methodologies, or intended competencies. Qualitative methodologies, such as focus groups or semi-structured interviews, were employed in approximately a quarter of studies (26%, n = 19). These explored student and teacher perspectives on various modules, courses, or programs, capturing opinions, motivations, feedback, and perceived impacts. A smaller proportion of studies (5%, n = 4) utilized mixed methods, combining focus groups with quantitative approaches like questionnaires. Additionally, 12% of the included articles (n = 9) were reviews, encompassing three scoping reviews, four narrative reviews, and two systematic reviews. The remaining articles included one cross-sectional study, one pre-post study, and one randomized controlled trial (RCT) that specifically examined the use of refutation texts to counter misinformation on controversial Planetary Health topics.

Target population

Regarding the educational level of the target audience and considering that only university and post-university studies were included in this review, 60% (n = 44) were aimed at undergraduate students, 10% (n = 7) at postgraduate students, and 11% (n = 8) at lifelong learners. In 15% of studies (n = 11), the educational level was not specified between university and post-university level, and in three studies, it was unclear whether the target audience was undergraduate or postgraduate. The primary target audience for the included trainings was health professionals, with 49% (n = 36) of studies focusing on various health disciplines: medicine (n = 11), nursing (n = 8), public health (n = 3), pharmacy (n = 1), dentistry (n = 1), occupational therapy (n = 2), psychology (n = 1), and general health professionals (n = 8). Another 44% (n = 32) of studies addressed a mixed audience of health professionals without specifying disciplines. The remaining studies targeted social science professionals (n = 2), veterinarians (n = 1), and engineers (n = 1).

Geographical scope of the studies

The vast majority of included studies (88%, n = 64) originated from high-income countries, with the United States (n = 32) being the most represented. Other high-income countries contributing to the studies included Canada (n = 3), Great Britain (n = 7), Australia (n = 6), Japan (n = 1), New Zealand (n = 1), and various European countries (n = 14). In contrast, only 9 studies (12%) were identified from low- and middle-income countries (LMICs), with two studies each from Uganda and Mexico, and one study each from West Africa, East Africa (multi-country), Indonesia, Grenada, and Southeast Asia (multi-country collaboration). Of the 73 studies included, one was published in Spanish, and the remaining 72 were published in English.

Objective of the studies

The objectives of the included studies varied widely. Some studies (n = 20) focused on developing theoretical frameworks to identify the skills required for Planetary Health professionals. Others built upon existing frameworks, aiming to define competencies and learning objectives in greater detail. Several studies also described the content and methodologies used in implementing educational programs, including the development of comprehensive curricula. A subset of studies employed research-based approaches to analyse student and teacher opinions, motivations, and the perceived impact of pilot or established Planetary Health courses.

Main theoretical frameworks

Of the 73 included studies, 28 (38%) described using a total of 20 distinct conceptual frameworks for education in Planetary Health and related fields. Notably, only one framework was explicitly designed for Planetary Health training [16] while the others were adapted from related fields like One Health, Global Health, and the Sustainable Development Goals. Table 1 provides a list of the identified frameworks, the articles that referenced them, and a brief description of each. Among these, the One Health [17], Sustainable Development Goals [18] and the Planetary Health Alliance's Planetary Health Education Framework [16] emerged as the most commonly utilized. Figure 2 offers graphical representations of some of the most relevant and frequently used conceptual frameworks.

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One included article [47] specifically reviewed conceptual frameworks, identifying 17 distinct options. However, only three of these (SDG, PHEF, and WE-ACT PLEASE) were also found in the other included studies. The remaining 14 frameworks identified in the review article were not incorporated into Table 1, as they represented a blend of frameworks, teaching methods, and content, rather than standalone conceptual frameworks. Furthermore, some of these 14 frameworks focused narrowly on specific aspects of Planetary Health, such as food or green energy, without addressing the broader, holistic concept.

Main skills

Thirty-three (45%) studies described the skills the different teaching programs aim to develop. Table 2 lists the transversal competencies that, while not specific to Planetary Health, are instead relevant to being able to engage with it. Table 3 highlights skills which are more specific to Planetary Health.

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As illustrated by Table 2, the transversal skills needed refer to having the ability to face complex problems, use systemic and reflective thinking, communicate effectively towards different groups, including the general public and decision makers, cooperate and collaborate in inter and transdisciplinary teams, and maintain an equity and ethics focus.

Table 3 highlights the need for specific competencies in Planetary Health, such as understanding the intricate relationship between human health and environmental factors, encompassing the impacts of climate change, pollution, extreme weather events, and land-use changes. Additionally, the identified competencies underscore the importance of conducting high-quality research to advance knowledge in Planetary Health and develop innovative, multi-level solutions that promote both human well-being and environmental sustainability.

Main contents

The specific teaching content of the various training programs was outlined in 33 (45%) of the selected studies. This content was directly linked to the intended learning outcomes of the respective programs. Table 4 provides a comprehensive overview, categorizing the content into 23 general themes and 93 specific subtopics, and indicating which articles addressed each specific learning objective.

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Climate change emerged as the most frequently addressed content area, with five articles specifically focusing on climate change education and its health implications. Notably, a substantial number of articles also covered topics related to ethics (n = 9) and complex systems (n = 6). In most training programs, the content tended to concentrate on a single general topic (out of the 23 identified), with limited coverage of specific content areas within that topic. However, one article stood out by addressing a comprehensive range of specific topics (72 out of 93), thereby integrating multiple general content areas. It's important to acknowledge that many articles only provided module or subject titles without detailing the specific content covered, potentially obscuring the full breadth of topics addressed in these programs.

Main teaching methods

The majority of studies (67%, n = 49) in this review addressed teaching methods. Among these, face-to-face methodologies were the most prevalent (n = 29), followed by hybrid (n = 14) and virtual (n = 6) approaches. Tables 5, 6, and 7 categorize and list these methodologies, differentiating between completely virtual, face-to-face, and hybrid training.

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Online learning employs strategies like videos, podcasts, photo analysis, and interactive text or case study analysis to boost student motivation and engagement, which are crucial due to high online dropout rates. Hybrid courses combine these with community experiences, service-learning, problem-based learning, and other methods that blend online and in-person activities. Face-to-face training, similar to hybrid models, fosters strong student interaction and localized relevance, resulting in courses tailored to the local context. Case studies, a common strategy across all formats (mentioned in 13 articles), and community-based learning (10 articles: 8 face-to-face, 2 hybrid), are particularly effective in hybrid and in-person settings. While online courses facilitate a global perspective by connecting geographically dispersed students, hybrid and in-person formats more easily cultivate community connections.

Discussion

This review highlights a growing interest in Planetary Health education mainly in high-income countries, despite its relatively recent emergence. More established fields like global health and climate change education offer a greater volume of educational resources, but Planetary Health distinguishes itself through a strong emphasis on inter- and transdisciplinary. This complexity is reflected in the identified competencies, which prioritize systems thinking, problem-solving, and collaboration across diverse disciplines and stakeholders.

Our findings show that there is a geographical gap in planetary health education to the detriment of low-income countries, since only 12% of identified articles are from these countries. This is a key outcome of our review because it sheds new light on the pathways that planetary health education should follow in the near future. Planetary health education should put the focus on these countries, not only as receivers of education or training content, but also as co-producers of such content so that courses and training will be meaningful for them.

Regarding the conceptual frameworks being used in planetary health education, it is noticeable that One Health and SDG are dominant in almost half of the reviewed papers (34 over 73) whereas the framework explicitly design for planetary health training is minor (16 over 73), which denotes that planetary health is still an incipient body of knowledge or discipline in terms of education. Indeed, planetary health was defined only 10 years ago [1]. These findings suggest that it is time to devote time and effort to strengthen and better define a conceptual framework for planetary health education that can guide the definition of skills and competences to be developed.

In this regard, our review has also allowed us to identify those transversal skills that are being addressed throughout planetary health education. Most of them resonate with the sustainability competencies defined by the European Union [90], including those related to embracing complexity in sustainability (systems thinking, critical thinking), acting for sustainability (collective action, political agency) and embodying sustainability values (supporting fairness). However, those sustainability competences referred to envision sustainable futures in the face of uncertainty, ambiguity and risk, such as exploratory thinking, seem to be not considered so explicitly in planetary health education yet. Further efforts in improving planetary health curriculum should be addressed to include these competences to teach how to deal with uncertainty.

Regarding teaching methods used, as expected, there are profound differences between digital and face-to-face training, since face-to-face courses benefit from more participatory methodologies and techniques that have been proved to foster students'engagement and motivation. To avoid digital training courses in planetary health education, face the same motivational challenge that has been previously identified in digital training in environmental education [91], there is a need to improve planetary health educators'ability to use innovative teaching methods also when teaching online.

Education is a fundamental axis for transforming society [89]. In order to move towards a “Healthy Planet” it is essential to make people aware of the impacts that the environmental crisis can have on their health and on all the Earth's systems. It is particularly important to train professionals from different fields (health, engineering, architecture, life sciences, social sciences, education itself) and society in general, emphasizing the most vulnerable populations, many of whom are already suffering the impacts of climate change, to define and implement resilience strategies. Educational programs can therefore be a key lever to generate real societal changes. In recent years, dedicated Planetary Health courses (postgraduate or master's level) have begun to appear, primarily in high-income countries. However, the diverse challenges of Planetary Health necessitate educational initiatives that target professionals from a broader range of fields and prioritize vulnerable populations disproportionately affected by the environmental crisis. These initiatives should also include non-professionals as well as community engagement to achieve a bottom-up transdisciplinary approach and to ensure that the right stakeholders define the context-specific mitigation and adaptation strategies. It is extremely necessary to support creation and implementation of planetary health courses in low- and middle-income countries where according to our findings there is a clear gap. These educational initiatives should not only elucidate the causes and impacts of the crisis but also foster the identification of context-specific mitigation and adaptation strategies. The implementation of capacity building strategies in LMICs can be challenging and needs to overcome specific barriers such as limited financial resources, inadequate infrastructure, lack of trained personnel, political instability, and insufficient access to technology and data. In this review we have identified some experiences that can be examples of how to develop contents and case studies adapted to the LMIC specific context such as the one in Southeast Asia [30] where the DPSIR framework was found to be suitable for bringing together a range of stakeholders from different disciplines, roles, and countries, to learn, understand and derive sustainable solutions for planetary health problems in a coastal setting. Another example is that of the network of One Health Central and Eastern Africa universities, which developed core competencies and modules in One Health that were key to delivering knowledge and skills to a multidisciplinary workforce and building a framework on which One Health curricula can be designed and implemented in central and Eastern Africa [26]. Several training modalities already exist that address partial or, in some cases, more global aspects of Planetary Health. However, these programs are mostly found in high-income countries. The reference frameworks that are most used and adapted to Planetary Health are the sustainable development objectives, the conceptual framework of One Health and those defined by the Planetary Health Alliance. These frameworks all seek to train people in various aspects, among which the management of complexity and systemic thinking stands out. These concepts underpin the role of interdisciplinary and teamwork for collaborating and cooperating towards finding effective and feasible adaptation and resilience solutions to the ongoing effects of the environmental crisis. The contents described within the different trainings revolve around obtaining the necessary skills to transform society in a way that is healthier and more sustainable. The contents range from knowledge-based aspects, such as knowing and understanding how different ecosystems work and the interactions between them and human beings from a physical, chemical and biological point of view to decision-making aspects including knowing how to generate changes at the personal level, and the generation of policies and legislation with an equitable and ethical approach. Hybrid and face-to-face based education programs appear to be more commonly implemented, although fully online alternatives are also available. However, it has not been possible to identify which teaching methods are the more effective ones. Therefore, there is a need for further research to evaluate the effectiveness of different teaching methods.

Systematic scoping reviews have certain limitations. First, they produce a synthesis of an existing and evolving body of literature to determine gaps in and identify areas for future work. However, as this includes studies of various types, including both primary and secondary sources, this means that a systematic and in-depth review is not performed and thus it is not possible to delve into all the selected articles in the same way and that it is not sought to arrive at a specific answer to a specific research question. One of the most relevant challenges is the selection of a search which is sufficiently broad while at the same time allowing for a meaningful analysis. Given that Planetary Health is a relatively new term, it was considered necessary to examine potentially relevant information from other, related, concepts. This required a more detailed examination of titles, summaries and full texts to identify how articles describing concepts such as Global Health, One Health, or environmental health, related (or did not relate) to Planetary Health. All three concepts recognize the interconnectedness of human, animal, and environmental health and emphasize the need for collaborative, interdisciplinary approaches to address health challenges. Health focuses more on the direct interactions between humans, animals, and their environments, particularly in the context of zoonotic diseases. Ecohealth takes a broader view, incorporating social and ecological interactions and emphasizing sustainability and social justice. Planetary health encompasses the widest scope, addressing global environmental changes and their impacts on all life on Earth. This aspect added additional complexity and, to some extent, increased subjectivity when selecting these articles.

An additional limitation was that the title and abstract screening was performed by only a single reviewer, with instead the decision being made to focus paired reviews on the full-text selection. Finally, in panoramic reviews, unlike systematic reviews, a risk of bias assessment is not carried out. Instead, the aim of this review was mainly to identify and collect competencies, conceptual frameworks, content and learning methodologies that have been used so far in Planetary Health training. We did identify a small number of experimental studies, all of which had very small sample sizes, and used instruments such as ad-hoc questionnaires when identifying their impact. We therefore did not formally evaluate these studies’ reports of satisfaction, effectiveness, or impact.

This scoping review identifies existing frameworks, competencies, content, and teaching methods in Planetary Health education, providing essential insights to co-design a community-driven training framework. By aligning education with local needs, it empowers communities to address environmental and health challenges, promoting sustainable practices and enhancing health outcomes. This approach fosters a more equitable and resilient healthcare system, responsive to the global health impacts of environmental changes.

Conclusion

The urgency of the planetary health crisis demands a swift response from every stakeholder, including educational institutions by creating and delivering sustainable PHE. This systematic scoping review underlines the interest in Planetary Health education, evidenced by a growing body of literature on diverse educational interventions. However, it also reveals a lack of standardization in conceptual frameworks, competencies, content, and teaching methods, particularly for health professionals. This heterogeneity, while reflective of the field's nascence and interdisciplinary nature, poses challenges for curriculum development and quality assurance. This review also highlights inequities in the development and deployment of Planetary Health education, with very few studies involving LMIC. We encourage educators and policy makers to collaborate in an interdisciplinary way to integrate diverse perspectives and expertises, fostering a holistic understanding of Planetary Health and to advocate for policy support at micro, meso and macro level to promote integration of Planetary Health education into standard curricula. Future research should also prioritize the development and rigorous evaluation of evidence-based educational models that address the evolving complexities of Planetary Health, ensuring they are accessible, inclusive, and effective in empowering health professionals to become agents of change in this critical arena.

Data availability

The data that supports the results and findings of this systematic review can be found in either the main paper or the additional supporting files. Any other data from the current study are available from the corresponding author upon reasonable request.

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