There is a long and established tradition of research irrefutably linking the environment with human health (Charron, Reference Charron2012; Wilson, Reference Wilson1984). A burgeoning field of research has propelled climate change into this arena, with urgent imperatives for action to prevent catastrophic global health impacts (Kovats & Butler, Reference Kovats and Butler2012). In this complex arena, ‘environmental sustainability’ is the authors’ preferred term for encompassing action on climatic variation, environmental degradation and pollution.
The principles of public health practice have a history in seminal charters — such as the Ottawa Charter for Health Promotion — that explicitly link human health and wellbeing with the natural environment (WHO, 1986). This blueprint identified ‘sustainable resources’ and ‘a stable ecosystem’ as prerequisites for health and stated that the ‘protection of the natural and built environments and the conservation of natural resources should be integral to any health promotion strategy’ (WHO, 1986, p. 3). Kickbush (Reference Kickbush2012), a prominent public health spokesperson, has named the environment (along with political, commercial, social, and behavioural determinants of health) as one of five key foci for health in the 21st century.
Public health practitioners have important roles to play in addressing environmental sustainability (Brown et al., Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005; Bunch et al., Reference Bunch, Morrison, Parkes and Venema2011; Fleming et al., Reference Fleming, Tenkate and Gould2009). Public health practitioners working at a community level are ideally placed to plan for, and respond to, the various mental, social, spiritual, and physical health impacts of environmental change in local contexts (Fünfgeld, Reference Fünfgeld, Rance, Millin, Wallis, Bosomworth and Lonsdale2013). Further, public health has the ability to draw on interdisciplinary competencies and strategies (e.g., health education) to tackle environmental sustainability (Brown et al., Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005; Patrick, Capetola, Townsend, & Nuttman, Reference Patrick, Capetola, Townsend and Nuttman2011). This is critical when numerous public health-related disciplines are already working at the nexus of environment sustainability and health, such as environmental psychology, human ecology, environmental health, and ecosystem medicine (Pretty, Reference Pretty2011)
A report on climate change adaptation in the primary health and community welfare sector in Australia found that many organisations in this sector are well positioned to ‘appraise local differences, identify those most in need and deliver just and equitable support programs’ for climate change adaptation (Fünfgeld et al., Reference Fünfgeld, Rance, Millin, Wallis, Bosomworth and Lonsdale2013, p. 7). The report urged further research, partnership and workforce development (including pre- and inservice training) to facilitate awareness raising and capacity building across the public health sector. This sentiment has been supported in a recent text titled Climate Change Adaptation for Health and Social Services (Walker & Mason, Reference Walker and Mason2015). Bentley (Reference Bentley2013) also calls for a reimagining of public health in the 21st century, whereby humans are considered an essential part, but not central, to a viable ecosystem.
Capacity building, which involves partnership building and workforce development, is a strategy that is common to both health and environmental sustainability practice. Capacity building in public health and environmental sustainability practice involves enhancing the potential of the system to prolong and multiply positive health effects, to address underlying determinants of health, and to broadly tackle ecological issues (Brown et al., Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005; Department of Human Services [DHS], 2003; Patrick & Kingsley, Reference Patrick and Kingsley2015). In the context of environmental sustainability work, capacity-building efforts involve developing systems that protect the environment and mitigate against the underlying causes of environmental problems (Leonardi, Reference Leonardi, Griffiths, Rao, Adshead and Thorpe2009). Action areas for capacity building developed by the State Government of Victoria's Department of Human Services (DHS, 2003) identified organisational development, workforce development, partnerships, leadership, and resources are a useful framework for considering both the implications of environmental challenges for public health workforce development and strategies for action.
According to Brown et al. (Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005) and Patrick et al. (Reference Patrick, Capetola and Nuttman2012), education for sustainability (EfS) is a strategy that can support workforce development of new and existing public health practitioners. EfS is a process that engages people in decision making and action taking for a socially just, economically sound, and ecologically responsible future (Scott et al., Reference Scott, Tilbury, Leith and Deane2012). The intent of EfS is to challenge students to consider how society can reorient itself to influence problematic social, economic and environmental constructs while implementing systemic change within the community, government, and industry (Scott et al., Reference Scott, Tilbury, Leith and Deane2012).
This EfS approach has strong appeal for higher education and sectors undergoing rapid transformation (Scott et al., Reference Scott, Tilbury, Leith and Deane2012). Paradoxically, an Australian investigation of university health educators and health care providers found that engagement with environmental sustainability is currently low, and practical engagement is confined to workplace efforts to reduce, reuse, and recycle (Masterman-Smith, Sheahan, Dunphy, & Harvey, Reference Masterman-Smith, Sheahan, Dunphy and Harvey2010). Masterman-Smith et al. (Reference Masterman-Smith, Sheahan, Dunphy and Harvey2010) also found that the literature on health-related EfS is a small subfield of broader scholarship that requires considerable growth.
However, there has been a recent injection of funding from the Office of Learning and Teaching, and several EfS initiatives have emerged that provide nationwide repositories for EfS resources (Learning and Teaching Sustainability, 2015), as well as specific support for sustainability education practitioners (Sustainability Handbook For Sustainability Education Practitioners, 2015) and a centralised network, the Australia-wide Practitioner-Led Action Network for Sustainability Educators Across the Tertiary Sector, recently named SUSTAINed (Sustainability Education Practitioner Network, 2015). While these initiatives promise a nationwide coordinated network for shared EfS resources and communities of practice, there is to date a lack of focus for health-related EfS.
Similarly, while the National Centre for Sustainability has provided projects for workforce development through the establishment of guideline competency standards for sustainability, these are focused on vocational education and training (National Centre for Sustainability, 2015). Other initiatives, also funded by the Office of Learning and Teaching, include the Learning and Teaching Academic Standards for Environment and Sustainability courses and subjects (Learning and Teaching Standards for Sustainability, 2015). While these standards provide welcome nationwide-agreed benchmarks, they are focused on traditionally offered environment and sustainability courses and do not address the need for health-related EfS and/or cross-disciplinary offerings.
That students from all discipline backgrounds are in need of EfS is evident in numerous research reports. For instance, Evans, Whitehouse, and Hickey (Reference Evans, Whitehouse and Hickey2012) found that preservice teachers have limited understanding of EfS and identified the need to more adequately prepare educators to implement EfS. Similarly, in their study of student teachers’ views on education for sustainable development competencies, Cebrian and Junyent (Reference Cebrian and Junyent2015) reported an absence of EfS learning, such as the promotion of ethical values, positive attitudes towards sustainability, and affective domain development.
Therefore, in a nascent field of research, when investigating the synergies between public health practice and environmental sustainability action, key questions arise: What are the capacity-building needs of public health professionals for addressing environmental sustainability and human health issues? What role does higher education have in EfS for public health professionals? To answer these questions, data from two qualitative studies involving public health and sustainability professionals were examined.
Methodology
The investigation was guided by the constructivist paradigm in that the authors recognise ‘there are multiple realities’ (ontology), the ‘knower and responder co-create realities’ (epistemology) and ‘knowledge is context- and time-dependent’ (Denzin & Lincoln, Reference Denzin and Lincoln2005, p. 22). This paradigm provided the framework for the exploration of a contemporary, interdisciplinary topic from an ecological perspective of health (McLaren & Hawe, Reference McLaren and Hawe2005). Consistent with the notion that research is not produced from any one ‘pure’ use of a strategy, a combination of strategies from within qualitative research traditions (e.g., qualitative description, ethnography, and case study) were advantageously combined in this project (Sandelowksi, Reference Sandelowski2000; Denzin & Lincoln, Reference Denzin and Lincoln2005; Creswell, Reference Creswell2007).
This article is based on data derived from two qualitative research projects conducted by public health and sustainability researchers from Deakin University, Australia. Both studies explored public health responses to environmental challenges to inform the development of research, teaching, and service strategies at the university level. Study 1 considered public health capacity-building needs from the perspective of academics and practitioners (including policy makers and managers). Study 2 examined existing exemplars of community-level health promotion practices that address environmental sustainability. The studies were conducted with approval from the Deakin University Human Research Ethics Committee.
Data Collection
To address the research questions considered in this article, sections of data from each study that explicitly assessed the capacity-building needs of public health practitioners and the role of higher education in EfS were combined, analysed, and key themes identified. Table 1 provides a summary of the two studies’ design features and demonstrates that there was sufficient commonality in research design to warrant combining and reanalysing the data.
Overview of Participants and Data Source
Both studies were concerned with complex issues that cross disciplinary boundaries; hence, purposeful sampling — in particular, maximum variation samplings — were used to select participants with varied experiences and knowledge of the research topic (Creswell, Reference Creswell2007; Patton, Reference Patton2002). All participants were selected based on their years of experience of working at a community level and/or their capacity to comment on the implications of environmental sustainability for practice and workforce preparation.
Interviewees represented diverse perspectives and included: public health and sustainability professionals operating as state and local government employees, managers and service providers working at a community level, and academic staff from several universities in Australia. Table 1 demonstrates multiple data collection strategies were advantageously combined within and between the studies. To achieve the aim of canvassing a broad range of perspectives, data were primarily collected using semi-structured interviews. Study 1 also utilised focus group interview techniques to leverage the shared experiences of academics and to test new ideas and/or verify themes generated within individual interviews (Patton, Reference Patton2002). Study 2 used paired and group interviews among practitioners from the same agency to build a more complete picture of their practice and to cross-check individual accounts of practice (Creswell, Reference Creswell2007).
Interview topic guides in both studies featured 8–10 open-ended questions divided into topic-specific questions (refer Table 1). Each interview was audio-recorded and transcribed verbatim. Interviews and focus groups were deemed complete once no new themes emerged, that is, saturation was reached (Patton, Reference Patton2002).
Data Analysis
The analysis for this paper was guided by Cronin, Alexander, Fielding, Moran-Ellis, and Thomas's (Reference Cronin, Alexander, Fielding, Moran-Ellis, Thomas, Alasuutari, Bickman and Brennan2008) approach to integration of qualitative data sources (characterised by an iterative interrogation of all data sets) and Wolcott's (Reference Wolcott and Creswell1994) ethnographic techniques for data analysis (including a description, analysis and interpretation stage). The description stage was data familiarisation, and involved reading all the transcripts and generating descriptions of the participants, their settings, and practices (Creswell, Reference Creswell2007; Wolcott, Reference Wolcott and Creswell1994). The analysis stage involved the identification and subsequent analysis of relevant sections of data that explicitly addressed this paper's questions. This stage pinpointed ‘promising threads’ between data sets (Cronin et al., Reference Cronin, Alexander, Fielding, Moran-Ellis, Thomas, Alasuutari, Bickman and Brennan2008), specifically drawing on ethnographic procedures for identifying ‘patterned regularities’ and ‘rich points’, such as differences, contradictions, departures from expectations, repackaging of ideas, and repetition (Agar, Reference Agar1999; Wolcott, Reference Wolcott and Creswell1994). The DHS (2003) capacity-building model was used to guide theme development, and Waterfors, Akerstrom, and Jacobsson's (Reference Waterfors, Akerstrom, Jacobsson and Flick2014) principles for reanalysing qualitative data helped to crystallise emergent themes. The last step was to interpret the data with relevance to existing public health and EfS literature and, in turn, identify opportunities for higher education to make a contribution in this space.
Several methods for ensuring rigour were used. Strategies for credibility included ensuring multiple perspectives, member checks, and peer debriefing. Transferability was ensured through purposeful sampling and two studies involving different contexts and participants. Dependability was supported through data triangulation and a lead researcher's journal. Confirmability of interpretations was enabled through a data analysis audit trail and prepublication reviews by two academic peers (Denzin & Lincoln, Reference Denzin and Lincoln2005; Siegle, Reference Siegle2011).
Results
The results confirmed that environmental sustainability should be core business for public health practitioners. All participants testified to the significance of ‘environment as a key determinant of health, now and into the future’ (Health and Sustainability academic) and that ‘we need to build capacity of the sector to respond’ (Government representative). As such, four major themes were identified: environmental sustainability incorporated into university curriculum, competencies required within the workforce, partnerships, and the role of the university sector in workforce development.
Environmental Sustainability Incorporated Into University Curriculum
The overarching theme from both studies was that ‘environmental sustainability content should be integrated into all university-level health courses’ (Health and sustainability academic). Participants emphasised that all university programs need to explore the impacts of environmental changes, and each discipline has a responsibility to address such issues.
Several participants advocated increased integration of environmental sustainability into public health courses because ‘it is the biggest problem facing modern society’ (Government representative). Other participants acknowledged some understanding was required but qualified this with: ‘not a substantial deep knowledge’ and ‘I am not totally sure that it needs a whole unit on it’ (Health agency manager). Irrespective of their level within the public health or higher education sectors, participants stated there was a need for generic competencies (e.g., ‘project management skills’) to support action on environmental sustainability.
The predominant view of participants was to develop multiskilled public health practitioners with generic and transferable competencies who are able to work across sectors as well as collaboratively with other disciplines. The following quotes are illustrative of these points and the subsequent need for university curriculum to support this approach:
I think it's important to look across disciplines . . . you really need to have a big picture outlook, particularly for climate change. (Government representative)
We are thinking more about cross-sector collaboration and working within multidisciplinary teams . . . it's about working with other sectors to get them to think about health as well as in relation to sustainability . . . and for environmental groups to think about including the skills that health services bring to the table. (Health promotion practitioner)
I think some climate change and environmental sustainability content needs to be embedded within the undergraduate and postgraduate health promotion courses, because there's nothing like that at present. (Health promotion manager)
The overarching sentiment was that content that supports health and environmental sustainability practice needs to be incorporated into university-level public health curriculum. When asked about knowledge and skills that public health practitioners would require, participants indicated that basic awareness, generic capabilities, and skills for tackling environmental sustainability issues would be important. This idea is articulated in the following quote:
There has to be some basic understanding of what climate change and environmental sustainability is and what that means to communities and individuals. . .I think the actual skills probably don't need to change much from what they are. (Health agency manager)
One participant identified the need to overcome existing problems of the theory to practice nexus as part of the solution, noting: ‘It's extraordinarily complicated. Graduates still don't have the tools and I think so much of it gets imbedded in rhetoric . . . operationalising theoretical concepts is a huge gap’ (Government representative). Several participants spoke of the need for graduates, for example, ‘to be able to understand the complexity of the issues and apply multiple models and frameworks’ (Health and sustainability academic).
In contrast, other participants believed that health practitioners would require new competencies; for example, the ability to apply ‘climate change communication strategies’ and conduct ‘ecological footprint assessments’ (Health promotion practitioner). Other participants felt that what is required are ‘new professions and degrees’ (Government representative) because these skills need to be integrated effectively. Several participants identified the conundrum of integration versus specialisation in curriculum and teaching of new graduates; for example, ‘It's always the balance between the expertise, the capacity to do work and to have technical expertise or knowledge [in climate change and sustainability] . . . you want mixtures of teams that have all of that’ (Government representative). Further, other remarks signalled the need for more thinking about the development of competencies: ‘the types of the skills that we need in graduates are quite different to what we have previously’ (Government representative).
Competencies Required Within the Workforce
In relation to workforce development needs, participants identified a number of generic and core competencies required (refer to Table 2).
Competencies Required Within the Workforce
This combination of generic and new core competencies was considered an important platform to support current practice as well as enable future workforce skills and knowledge acquisition. As one participant stated: ‘We can't wait for the new graduates because climate change and environment sustainability is too critical’ (Government representative).
High level communication as a generic skill for public health practitioners was commented on often in relation to environmental sustainability ‘because people look to their health professionals to provide the advice that they don't have . . . but it [environmental sustainability] is not actually traditionally part of the way health workers perform’ (Government representative). Several participants identified knowledge related to ‘a community development approach’ and the impact of climate change because ‘we're going to have lots of people needing help and not very many adequately trained people available to help 20 years from today’ (Social services representative). Competencies to support interdisciplinary collaboration and partnership development — for example, to ‘know how to work in partnership with a variety of other organisations’ and ‘networking capabilities’ (Health agency manager) — were also highlighted and are discussed in the next section.
Partnerships
Participants saw potential for partnerships in environmental sustainability research and education. There was a willingness to work together in a coordinated, non-competitive way, the overarching theme being that working together across disciplines was a solution for addressing environmental sustainability dilemmas. The participants identified partnerships for: ‘advocacy and lobbying’, ‘community projects’, ‘evaluation and policy research’, ‘teaching and training’, and ‘funding and network development’. Participants emphasised the need and potential for: ‘collaboration’, ‘coordination’, ‘multifaceted approaches’, ‘capacity building’, and ‘coalition development’ in the development of curriculum, research partnerships, and policy development.
Several participants spoke of obstacles to partnerships, such as working in silos; for example, ‘I think all of us still work very much in silos and don't necessarily think about cross-sector’ (Health promotion practitioner). Other participants spoke about funding and time constraints, or otherwise felt it ‘sometimes comes down to personal obstacles. . .people wanting their own agenda’ (Health agency manager). With respect to solutions to obstacles, one participant offered the idea of alliances as a way of ‘stepping a bit outside of the square’ (Health and sustainability academic). Some participants considered university sector–community networks as the key to building capacity. Many participants saw multiple entry points for collaboration between universities and the sector, namely through university core business of research, teaching, and service to the community.
The Role of the University Sector in Public Health Workforce Development
Participants identified obstacles to workforce development in environmental sustainability and population health; namely, it is difficult to include climate change and environmental training in existing work programs because of time and money. Some participants commented on the difficulty of knowing what competencies existing practitioners require and how to ascertain what training programs may look like because it is an emerging field. It was in the context of this discussion about obstacles that participants highlighted the role of the university sector across all levels of public health workforce development; for example, in further vocational training for current practitioners and in the preparation of future graduates.
Participants’ statements confirmed that workforce development in the form of training is required for all public health practitioners. One participant highlighted how ‘there is really a need for a university auspiced course or training which includes climate change, environmental sustainability and human health because we just need to get that information out quickly’ (Health agency manager), though participants stressed that training content and delivery needs to be ‘embedded within the realities of the field’ (Health promotion practitioner). One participant identified the limitation of agency-based or informal training with respect to long-term sustainable education outcomes:
We've done some training sessions and people get really fired up . . . I keep coming back to that sense of helplessness, but that's what I feel like people kind of get inspired, start trying to do stuff and then just feel a bit helpless. (Health agency manager)
This comment and associated ideas of participants infer the need for a more rigorous approach to workforce development to support capacity building within the public health sector. Some participants mentioned that they need assistance with identifying key issues and ‘constituency’ in the environmental sustainability space. Others felt that the existing workforce needed access to, and education on, different perspectives in environmental sustainability and this is where the university sector could contribute. The overarching theme was that the university sector was a ‘conduit for health and sustainability information’ (Government representative) and best placed to provide undergraduate and postgraduate up-skilling to the existing workforce.
Discussion
Keeping in mind the questions guiding this article, the following section focuses on the findings associated with two of the DHS (2003) capacity-building actions, namely workforce development and partnerships. Central to workforce development is the goal of enhancing professional competencies and knowledge for effective practice and is considered a key strategy for preparing health practitioners to address health and sustainability imperatives (DHS, 2003; Masterman-Smith et al., Reference Masterman-Smith, Sheahan, Dunphy and Harvey2010). It is also a strategy that can support lifelong learning and the development of new competencies required for cross-disciplinary engagement (Patrick et al., Reference Patrick, Capetola and Nuttman2012).
This study emphasised competency development and a number of workforce development issues for preparing new and existing public health practitioners in tackling environmental sustainability. The value of mutually reinforcing skills and knowledge associated with health promotion, health education, community development, and EfS were recognised throughout. Participants also highlighted a discord in opinions about the depth of competencies required and a seemingly ad hoc approach to workforce development in this area. Despite these conflicting opinions, all participants were able to articulate a role for universities in supporting EfS within the public health sector.
The results concurred with several themes in the literature that emphasise that universities have the potential and capacity to equip students and professionals with the competencies required to address environmental sustainability (Evans et al., Reference Evans, Whitehouse and Hickey2012; Fleming et al., Reference Fleming, Tenkate and Gould2009; Patrick et al., Reference Patrick, Capetola, Townsend and Nuttman2011; Smith, Collier, & Storey, Reference Smith, Collier and Storey2011). Scott et al. (Reference Scott, Tilbury, Leith and Deane2012) argue that universities should integrate environmental sustainability into their curricula across disciplines and within multiple curriculums. Accordingly, EfS has emerged as the preferred framework to educate and empower students around complex issues associated with environmental sustainability (Evans et al., Reference Evans, Whitehouse and Hickey2012; Scott et al., Reference Scott, Tilbury, Leith and Deane2012). The findings of this current study concur with EfS philosophy: rethinking curricula and content; collaborative, field-based learning; dealing with complexity; and the use of multi- and interdisciplinary approaches. While not explicitly named as health-related EfS, the study participants were inferring this approach.
Unfortunately though, as Masterman-Smith et al.’s (2010) study illustrates, there is currently a lack of health-related EfS scholarship and capacity within Australia. The current study concurred with these findings, illustrating a lack of articulation for the value of the EfS approach to public health workforce development. The findings also resonated with the idea that future practitioners would need new and different skills to be confident and competent to work in this emerging area of public health practice (Brown at al., Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005; Patrick & Kingsley, Reference Patrick and Kingsley2015; Walker & Mason, Reference Walker and Mason2015).
Beyond a few textbooks and commentaries, and the authors’ own publications (Patrick et al., Reference Patrick, Capetola and Nuttman2012; Patrick et al., Reference Patrick, Capetola, Townsend and Nuttman2011), there is little guidance about competencies required to be effective in the public health and environmental sustainability space. Dunphys’ (Reference Dunphy2013) work on EfS for the Australian health care sector is perhaps the only other empirically based framework available in the literature. Like the current study, Dunphy (Reference Dunphy2013) identifies relevant domains of EfS, including: knowledge, for example, healthcare impacts on the environment; skills, including community engagement and advocacy skills; and professional modelling, such as social justice. However, its focus on health care means that it only tells part of the public health story. Likewise, Bell's (Reference Bell2010) commentary on Australian medical practitioners identifies non-clinical competencies, including: surveillance of disease trends and vulnerability within local communities, communicating prevention messages related to climate change, facilitating health impact assessments, and working with community partners. However, this framework is limited in that it is for medical practitioners working in rural contexts.
Competencies identified in the Australian National Centre for Sustainability's Sustainability Related Competencies list (Swinburne University of Technology, n.d.) fit well with the views of the study participants. This document outlines community-level competencies for sustainability professionals, including: developing community development strategies; establishing partnerships with government, business and community; supporting community participation; and leading community/organisational change. All of these provide hints for essential competencies required to support community-level public health practice but nothing specific. Perhaps what would be timely and valuable is a nationally agreed competency framework that would guide the public health sector and the development of university-based, health-related EfS programs. That there has emerged in recent times various nationally funded networks and centralised resource repositories focused on EfS, with a practitioner focus, recognises both an increasing awareness for the need for sustainability literate graduates and a resource commitment at a national scale. This is promising for both the provision of health-related EfS, as well as fertile ground for the emergence of a paradigm shift in the scale and scope of public health practice in an environmentally challenged world.
A central theme within the results was that partnerships are critical to identifying problems and generating solutions within environmental sustainability work. The suitability of public health practice to facilitate partnerships for addressing environmental challenges to mental, social, spiritual, and physical health, as well as participating in the necessary paradigm shifts, was emphasised. These views were consistent with literature that highlights interdisciplinary and cross-sector partnerships (Brown et al., Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005; Charron, Reference Charron2012) as being pivotal to the development of a new paradigm in public health. Implied was the idea that public health practice is already oriented towards multidisciplinary and intersectorial approaches and therefore existing or new partnerships and collaborations could readily be mobilised. Study participants illuminated examples of where individual practitioners and/or agencies were initiating or could see the need for partnerships with universities to support training, research, and community-level practice. These sentiments resonate with the emergent, dynamic and nationally networked context of EfS communities of practice.
The study findings regarding obstacles to change, including formation of new cross-sector partnerships, also concurred with previous studies by Olaris (Reference Olaris2007) and public health commentators such as Brown et al. (Reference Brown, Grootjans, Ritchie, Townsend and Verrinder2005). Like Patrick et al. (Reference Patrick, Capetola, Townsend and Nuttman2011), the study also identified opportunities for partnerships between health and environmental sciences. Trans-disciplinarity was inferred notionally as ‘integration’ and ‘participation’ (Wilcox & Kueffer, Reference Wilcox and Kueffer2008), but not identified explicitly. Furthermore, the ideas expressed by the participants tended to be anthropocentric in nature, with limited reference to broader understandings of ecosystem services and non-human health and wellbeing. However, it is anticipated that a national network of practitioners committed to EfS will deliver new possibilities for teaching and training for health that can only emerge from cross-pollination of ideas, resources and good will.
One of the strengths of this study was the sampling of participants from a variety of agencies spanning the health, education, social services, and sustainability sectors in Victoria, Australia. Together, the data elicited a broad range of opinions about current and future workforce development needs as well as obstacles to, and opportunities for, partnership development between universities and the sector. However, the use of recombined data and the variable sampling strategies across the two studies may have compromised the ability to identify all factors that are critical for building capacity within the public health sector. The findings are therefore limited to a broad overview of factors in Victoria and are not directly transferable to all other states and territories of Australia.
Conclusion
Drawing on the voices of practitioners and academics, the study demonstrated that universities have an important role as agents of change and in building capacity of the public health sector to address environmental imperatives within Victoria, Australia. The university sector is and/or should act as a conduit for information exchange and knowledge creation. However, it also supported previous research findings that health-related EfS is currently underdeveloped and/or undervalued within Australia universities and the public health sector. Perhaps the most valuable aspect of the study was that it gave voice to the idea that:
Universities that want to act as change agents have to thoroughly consider collaborative ways of research and education in informal learning environments so that knowledge demand, knowledge transfer and knowledge generation can be negotiated and jointly determined between local and regional societies and universities. (Peer & Stoeglenher, Reference Peer and Stoeglehner2013, p. 85).
Such an idea is implicit in EfS, and one that calls for a paradigm shift in the way universities traditionally deliver their services to the community. Two recommendations stemming from this research include:
1. Inservice training and professional development for existing public health practitioners (including informal short courses). To enact this, the public health sector can forge strong cross-disciplinary partnership with recently established nationwide networks of EfS practitioners and establish a Public Health Hub.
2. Preservice training for future practitioners in higher education (including undergraduate programs in sustainability that are coupled with majors in public health) involving multiple faculties and disciplinary EfS experiences with education, arts, environmental sciences, and business students.
This will require sustained effort from higher education institutes, organisations, and individuals working at the nexus between health and environmental sustainability.
Acknowledgments
The authors would like to acknowledge Sue Noy and Sonia Nuttman for their contributions to the research and the anonymous reviewers for their generous feedback on the manuscript.
Financial Support
The program of research was funded by Deakin University and Sustainability Victoria.
Author Biographies
Rebecca Patrick is a Lecturer in the School of Health and Social Development at Deakin University, Australia. She teaches into various Public Health and Health Promotion courses and coordinates majors in Health and Sustainability. Within the Health, Nature and Sustainability research group (http://www.deakin.edu.au/health/hsd/research/niche/hns/index.php) she leads the agenda on public health responses to climate change and sustainability. Her service activities span work-integrated learning, community and women's health, program evaluation, and health-related education for sustainability.
Jonathan Kingsley is a Research Fellow within the Melbourne School of Population and Global Health at The University of Melbourne, Australia. He has more than a decade of experience working with culturally diverse Aboriginal and Torres Strait Islander communities across Australia. He has published extensively in international health, policy and environmental journals with a focus on Aboriginal and Torres Strait Islander health and wellbeing.
Teresa Capetola is a Lecturer in the School of Health and Social Development at Deakin University, Australia. She teaches into various Health Promotion and Public Health courses and co-chairs a cross-faculty unit titled Creating Sustainable Futures. Within the Health, Nature and Sustainability research group she leads research into the scholarship of teaching Education for Sustainability. She is Course Director of the Masters of Health Promotion.
