The research team, led by Jennifer Kallenbach of MSH Medical School Hamburg and the University of Bayreuth, set out to answer a deceptively simple question: what does it actually mean for a doctor, nurse, or public health worker to be literate about planetary health? Despite a growing chorus of international bodies calling for climate-competent health workforces, no systematic review of the existing literature had ever been conducted. The Intergovernmental Panel on Climate Change in 2023 and the World Health Organization in 2023 both emphasized the importance of equipping health professionals with competences to address environment-related health risks, yet studies consistently show that clinicians often lack the knowledge needed to connect environmental change to the patients in front of them.

Conducted in accordance with the Joanna Briggs Institute methodology and reported under the PRISMA-ScR checklist, the review searched MEDLINE, CINAHL, and Web of Science, supplemented by manual searches of Google Scholar and publisher platforms. The final search on 31 January 2025 retrieved 1,599 references from the electronic databases and 99 more through manual searches, for a total of 1,698 records. After removing duplicates, 1,399 titles and abstracts were screened, 220 studies underwent full-text review, and 28 articles ultimately made the cut. Two reviewers independently screened the studies, with a third resolving discrepancies, and the team registered the protocol in the Open Science Framework repository before analysis began.

The analytical approach was as important as the search itself. Rather than simply cataloging definitions, the researchers applied a deductive-inductive content analysis following Kuckartz’s typification approach, building a feature space from an established health literacy typology and then inductively assigning determinants that did not fit predefined categories. This process yielded eight typological clusters: knowledge; competences, skills, and abilities; competence attributes; competence dimensions; actions and outcomes; context; development process; and individual and contextual antecedents. The clusters became the skeleton of the new framework, ensuring that every component could be traced back to the literature through an Evidence-to-Framework Matrix the authors created for transparency.

What the review revealed was a field in conceptual flux. The 17 identified concepts span climate health literacy, environmental health literacy, One Health literacy, planetary health literacy, eco-medical literacy, carbon health literacy, ecological care, and sustainable food literacy, among others. The studies came from an interdisciplinary mix of public health, medicine, nursing, psychology, nutrition, education, and policy sciences, though the authors noted that research institutions from the Global North dominated the literature. Fourteen of the 28 studies targeted health professionals directly, six also included students and trainees, four focused exclusively on health professional students, and the remaining ten addressed the general public or occupational groups working alongside clinicians in transdisciplinary settings.

Perhaps the most striking finding was the evolution in how researchers understand the relationship between environment and health. Earlier concepts, particularly environmental health literacy approaches, framed the environment as a unidirectional influence on health—pollution exposure leads to disease, full stop. Newer system-based concepts such as ecological care, planetary health literacy, and One Health literacy emphasize reciprocal interdependence: healthy ecosystems are prerequisites for health, but healthcare activities themselves shape ecosystems. The planetary health approach integrates these perspectives into a transdisciplinary, holistic view that considers the entire socio-ecological basis of human health, addressing global challenges such as climate change, biodiversity loss, and environmental pollution through adaptation and mitigation.

The review also exposed considerable terminological heterogeneity. Even the six environmental health literacy concepts identified were based on different theoretical foundations, each involving different skills and competences. Some terms were used interchangeably without clarification, and a few definitions remained vague or incomplete, making it difficult to operationalize and integrate the concepts in research and practice. Despite these inconsistencies, most definitions shared core determinants: health literacy in the environmental context is generally understood as the knowledge, skills, attitudes, and competences needed to access, understand, appraise, and apply information to make judgments, decisions, and actions regarding healthcare, disease prevention, and health promotion, while sustainably balancing the health of humans, animals, and the environment.

From this synthesis, the authors distilled a new definition and framework. Professional planetary health literacy describes the ability of health professionals to access, understand, and appraise planetary health-related information in order to derive decisions for health-promoting, sustainable, and transformative professional action, to communicate professionally, and to apply this information appropriately in their everyday work. The framework embeds four core competence dimensions—access, understand, appraise, and apply—each associated with cognitive, emotional, and behavioral attributes relating to critical reasoning, collaboration, leadership, advocacy, ethical practice, and systems thinking. These dimensions align with three health literacy levels: functional, interactive, and critical, adapted from established learning theories including Bloom’s Taxonomy and the WHO Global Competency Framework.

Crucially, the framework treats PROF-PHL not as an individual characteristic but as a product of systems. It identifies proximal antecedents from the health professional themselves, such as motivation, awareness, self-efficacy, and emotional resilience, alongside distal contextual antecedents including economic, social, and cultural factors. Even if health professionals have the necessary knowledge and competences, they may be unable to act due to a lack of time or resources, insufficient institutional support, cultural norms that discourage critical thinking, or economic interests that hinder implementation. The framework divides professional actions and outcomes into three levels—individual, organizational, and policy—and uses double arrows to illustrate that each determinant is closely intertwined with the others, triggering chain reactions at several levels simultaneously.

The authors are candid about the framework’s limitations. As a conceptual synthesis, PROF-PHL requires empirical validation before its utility in real-world educational, clinical, and policy contexts can be demonstrated. The review’s restriction to English- and German-language publications and databases that primarily reflect Global North research may underrepresent perspectives from the Global South, particularly relevant in planetary health where environmental risks and solutions depend heavily on regional, cultural, and ecological contexts. The authors also acknowledged potential overlap between the research team and three of the foundational publications included in the review. Still, they present the framework as an open, evidence-informed synthesis rather than a definitive endpoint, welcoming validation, adaptation, and expansion by the broader research community. If validated, the framework could inform interdisciplinary curricula, training programs, and interprofessional education initiatives, and facilitate policy dialogue by highlighting the interplay between individual, organizational, and policy factors—helping decision-makers align institutional conditions with the goals of climate-resilient and sustainable health systems.

Subject of Research: Planetary Health Literacy

Article Title: A holistic understanding of literacy approaches at the environment-health-nexus: a scoping review and framework for health professionals

Article References: Kallenbach, J., Reismann, L., Pfeffer, I., & Jochem, C. (2026). A holistic understanding of literacy approaches at the environment-health-nexus: a scoping review and framework for health professionals. Frontiers in Public Health, 14, Article 1960284. https://doi.org/10.3389/fpubh.2026.1960284

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1960284

Keywords: planetary health, health literacy, scoping review, environmental health, health professionals, climate change, PROF-PHL, medical education, holistic, understanding, literacy, approaches