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. 2020 Sep 10;36(3):895–904. doi: 10.1093/heapro/daaa100

Introducing Ecohealth education in a Teacher Training Institute in Lao PDR: a case study

Sachi Tomokawa 1,2,✉, Takashi Asakura 3,4, Ngouay Keosada 5, Vannasouk Bouasangthong 6, Vanthala Souvanhxay 7, Phetnoy Navamal 8, Kethsana Kanyasan 9, Kimihiro Miyake 10,11, Shohei Kokudo 12, Ryuichi Watanabe 13, Sithane Soukhavong 14, Khamseng Thalangsy 15, Kazuhiko Moji 16
PMCID: PMC11255412  PMID: 32911534

Summary

This paper argues the effectiveness of Ecohealth education for improving the quality of health and environmental education and for achieving sustainable development in developing countries. To illustrate the need for Ecohealth education, we review the transitions in health education, environmental education and Education for Sustainable Development (ESD) in various developing countries. Moreover, we discuss issues relating to these disciplines and consider the possible roles that Ecohealth education can play. Then, drawing on a case study conducted in Lao PDR, we propose a concrete example of the teaching content of Ecohealth education. We conclude that Ecohealth education can embody the concepts of ESD with respect to health and environmental issues, and thus can contribute to improvements in the quality of health and environmental education, and of ESD. In addition, we propose the following five actions for implementing Ecohealth education in developing countries: (i) promote research based on the approaches of public health and anthropology, and develop teaching materials that use the research results, (ii) empower school-aged children, (iii) encourage the active involvement and sharing of problems among communities, (iv) strengthen participatory teaching and learning methodology and (v) build a training system and train relevant teachers.

Keywords: health education, sustainable development goals, teacher training institution, developing country

INTRODUCTION

We have been engaged in development of Ecohealth education in Lao PDR since 2009. As of the year 2020, Laos is the only country that has introduced Ecohealth education in teacher training institutions (TTIs). However, introduction of Ecohealth education may be helpful for improving the quality of health education, environmental education and Education for Sustainable Development (ESD) in other developing countries. Against this backdrop, this paper aims to show the effectiveness of Ecohealth education for improving the quality of health and environmental education and for promoting ESD in developing countries. To this end, we critically reviewed the historical transition of school health, health education, environmental education and ESD in developing countries, to illustrate the differences among them and to illuminate effectiveness and the necessity of Ecohealth education. In addition, we clarified the possible roles that Ecohealth education can play for improving school health, health education, environmental education and ESD in developing countries. We share a concrete example of teaching content and challenges of introducing Ecohealth education in developing countries by presenting a case study in Lao PDR.

Historical transition of school health and health education in developing countries

It is widely recognized that improvement in children’s health status is essential to enable children to optimize limited educational opportunities (United Nations Educational, Scientific and Cultural Organization, 2000). Previous studies have revealed that health activities in school are effective in coping more efficiently with children’s issues both for health and education in developing countries (Jukes et al., 2008; Bundy, 2011). In 2000, against this backdrop, several international organizations co-developed the Focusing Resources on Effective School Health (FRESH) framework (United Nations Educational, Scientific and Cultural Organization, 2000). After the launch of FRESH, developing countries had recognized again the effectiveness of the school health activity. Then, several Asian and African developing countries created a national school health policy (NSHP) and implemented activities for disseminating comprehensive school health based on the NSHP. Recently, school health activities have been recognized for their contribution to the improvement of both the quantitative expansion of educational opportunities through the improvement of children’s health status, and educational quality.

FRESH stipulates that children must acquire basic knowledge and life skills for disease prevention through health education in school (United Nations Educational, Scientific and Cultural Organization, 2000). As for school-based health education in developing countries, a number of health education and health promotion activities, such as child-to-child and child-to-adult dissemination of health information, have been organized, and their efficiency and effectiveness have been greatly appreciated (Onyango-Ouma et al., 2005; Okabayashi et al., 2006; Nonaka et al., 2008; Ayi et al., 2010). As the FRESH concept has been acknowledged more widely, the importance of health education in schools has been increasingly recognized; health education, moreover, has been incorporated into national policies on school health and official educational curricula, facilitating its practice and development in schools (WHO, 2017). To reduce future risk of diseases, children must acquire skills and knowledge so they can control their own health. However, schools in developing countries continue to cling to a simple transfer of scientific knowledge or rote memory work without sufficiently educating students about appropriate health behaviours, pro-environmental behaviours, or health problems that might occur in a child’s growth process (Asakura and Tomokawa, 2014). Furthermore, the current health education is entirely focused on identifying the causes of diseases, and more specifically communicable diseases and their elimination; indeed, health education content in schools is focused on providing knowledge about cause-and-effect relationships (Asakura and Tomokawa, 2014). Nevertheless, a World Health Organization report has emphasized the importance of the following factors: establishing a health education curriculum as a home for all relevant topics; a mandatory health education and/or life skills education curriculum; increasing the time available for health education curricula; and improving the teaching quality in classrooms through pre-service and in-service training (WHO, 2017).

Promoting environmental education and education for sustainable development

The Belgrade Charter, a global framework for environmental education, was adopted in 1975 (United Nations Educational, 1975). Then, as the concept of Sustainable Development was disseminated, ESD was also being advocated as an approach for realizing sustainable development. United Nations Educational, Scientific and Cultural Organization defines ESD as ‘a holistic and transformational education that addresses learning content and outcomes, pedagogy, and the learning environment’ (United Nations Educational, Scientific and Cultural Organization, 2017). ESD is not a specific programme or project, but rather an umbrella concept for many existing and yet-uncreated forms of education (United Nations Educational, Scientific and Cultural Organization, n.d.). ESD consists of learning and activities that aim to create a new sense of values and actions by connecting daily life with real societal issues. It also aims to facilitate learning about coexistence with other persons and nature, and about diverse ways of life. In developed countries, the necessity of keeping a balance between exploitation and environmental protection has been recognized internationally and considered at the level of practice. However, developing countries still have a genuine enthusiasm for economic-growth-oriented exploitation and tend not to practise ESD-based concepts (Asakura et al., 2015). Meanwhile, the FRESH framework stipulates the need for safe learning environments and suggests improvements in sanitary facilities in schools, which also act as models of sanitary improvement for the surrounding communities (United Nations Educational, Scientific and Cultural Organization, 2000). However, the environments described in the FRESH framework address only the sanitary situation relating to children at school and home; unfortunately, the content and role of environmental education is not specified adequately. In addition, health education in schools generally tends to focus on providing knowledge about environmental problems related to the natural environment (Asakura and Tomokawa, 2014). Reports also indicate that the uniform content comprising the lessons of environmental education has neglected the sociocultural context and the specific circumstances relating to a given area, even though the nature of environmental problems strongly depends on the unique circumstances in each area (Asakura and Tomokawa, 2014).

PARADIGM CHANGE IN HEALTH AND ENVIRONMENTAL EDUCATION: INTRODUCING ECOHEALTH EDUCATION IN DEVELOPING COUNTRIES

Why is Ecohealth education effective and necessary in developing countries?

Most developing countries have promoted economic-growth-oriented development and have experienced rapid modernization and urbanization during the associated hasty exploitation and economic development. As a result, excessive burdens on the self-restoring potential of the natural environment have affected natural ecosystems so adversely that the environment has lost its balance. Consequently, local people’s natural and socio-economic environments, or the surrounding ecosystem, have been degraded. As the collapse of local ecosystems worsens, daily human life and health are increasingly exposed to harmful influences caused by the collapse.

Against such a backdrop, the importance of health education and environmental education has been recognized amongst the both developed and developing countries. However, further improvements in education quality and quantity are required, especially in developing countries. Indeed, many developing countries have never established health and environmental education as independent subjects but rather have incorporated them into other subjects such as science education and physical education; they are, moreover, typically taught in a cross-curricular way. Thus, the curriculums of health education and environmental education are liable to lack the coherence, comprise simple memory work and/or to be inadequately delivered because of a shortage of lesson hours. In addition, teaching materials for the relevant lessons are generally lacking and the guidance for health and environmental education in teacher training courses tends to be insufficient. Furthermore, the content of health education in schools is inconsistent with that provided in teacher training, and schoolteachers lack awareness of the importance of health education and environmental education (Asakura and Tomokawa, 2014). Moreover, the inconsistencies between school health activities and health education, and the absence of an official integration of health and environmental activities into school education have complicated educational practices in schools (Asakura and Tomokawa, 2014).

The challenge for developing countries in such a situation is the promotion of both economic-growth-oriented development and health promotion rooted in the socio-ecological approach mentioned in the Ottawa Charter (WHO, 1986). To meet this challenge of maintaining a balance between the two, an educational approach must be developed that considers the view of health in modern Western countries, the model of social development based on the progress of aetiology and technologies, and the criticism directed toward the political situations (Asakura et al., 2015).

Charron stated that ecosystem approaches to health, (i.e. Ecohealth approaches) take into account the dynamic nature of and interconnectedness among health determinants, and between those determinants and human health consequences (Charron, 2012). Ecosystems are the planet’s life-support systems for the human species and for all other life forms; they are interdependent and function dynamically as a unit (Millennium Ecosystem Assessment, 2005; Charron, 2012). Stable ecosystems and sustainable resources are the fundamental determinants of the population’s health and well-being (Hancock, 2011). In contrast, Butler argued that an Ecohealth approach recognizes that human health and well-being are the result of complex and dynamic interactions between the determinants and among people, social and economic conditions, culture and natural environments (Butler and Friel, 2006). Ecohealth education is an educational approach that applies the ideas of Charron and Butler, which advocate an ecological approach to human health (Millennium Ecosystem Assessment, 2005; Charron, 2012). The philosophy of Ecohealth education shares certain concepts with ESD; for example, the way in which ‘connections’ and ‘relationships’ occupy important positions, the idea of creating new values and practical actions by connecting daily life with real societal issues, and learning about diverse ways of life and coexistence with other persons and nature (Ministry of Education, Culture, Sports, Science and Technology, Japan, n.d.). Thus, Ecohealth education can be seen as education that tries to embody the philosophy of ESD while focusing on health and environmental issues. Ecohealth education, therefore, should be introduced into school education as a means of pushing further forward with FRESH and ESD. In the context of developing countries, it is effective and necessary to address their specific challenge.

Characteristics of Ecohealth education

Ecohealth education aims to make learners understand the importance of harmonious relationships among socio-economic development, ecosystem sustainability, lifestyle and human health (Ministry of Education and Sports, Lao PDR and National University of Laos, 2018). The goal is to educate children, adolescents, youths and adults to be responsible citizens, not only for their health but also for the environment around them (Ministry of Education and Sports, Lao PDR and National University of Laos, 2018). In the context of school education, Ecohealth education is a comprehensive subject that includes environmental and health education and extends them. The following six characteristics of Ecohealth education comprise its principal concepts.

Ecosystem-thinking

Ecohealth education is based on systems thinking focused on ecosystems; that is, ‘ecosystem-thinking’, which emphasizes an understanding of the whole ecosystem from multiple perspectives that considers mutually dependent relationships. Human health and livelihood are embedded in an ecosystem. Thus, on the basis of systems thinking, Ecohealth education presumes that factors influencing human health do not work independently but rather interdependently. Ecohealth education strives to help individuals become capable of taking action to maintain the soundness of the ecosystem in which they live and to empower the society to which they belong. This purpose implicates the approach to teaching taken in Ecohealth education, which facilitates understanding of the close relationships among development, environment, lifestyle and human health. Ecohealth education aims to enable learners to get healthy and maintain their immediate ecosystem so that, ultimately, they can take necessary actions.

Transdisciplinary learning

Ecohealth education is a comprehensive subject that comprises environmental education and health education. It aims to teach the necessary knowledge, skills, attitudes and values that can lead to desirable changes in the ecosystem, while considering the potential of the ecosystem and keeping a balance between its exploitation and protection. Therefore, issues in health and the environment are not taught separately but rather in a way that links these issues to promote understanding of the interdependent relationships.

Participatory learning

Ecohealth education applies participatory approaches with the underlying assumption that learners are the main actors. In this education, learners are encouraged to consider and analyse the causes of ongoing problems on health and environment in the community so that they can take necessary actions to deal with the problems, managing their surroundings for a harmony between the environment and the development. Following this approach, learners can become capable of good practices that promote a balance between the environment and its development. In addition, through learning and practice, their self-confidence and efficacy rises (Simovska and Jensen, 2009; Jourdan et al., 2011; Simovska, 2012; Griebler et al., 2017), allowing them to more easily maintain and promote their own health, prevent diseases and develop self-confidence from their self-prevention of disease.

Global and localized perspectives for ensuring sustainability

Ecohealth education can be a countermeasure for assuring sustainable development (Asakura and Tomokawa, 2014). Both global and local perspectives on health and environmental issues are essential for achieving sustainable development because these issues spread beyond national borders and change dynamically in the balance of social development and environmental protection on a regional scale. This interpretation is important for helping citizens cope better with the recent globalization of health and environmental problems. Therefore, learners in Ecohealth education are expected to comprehensively address not only the visible problems in the near-term but also, with a long-term perspective, potential problems in their home and neighbouring countries. More specifically, Ecohealth education leads learners to: deal with their own health issues on the basis of the health and environmental concepts inherent in their local area; identify the environmental and social factors related to the issues and take necessary actions to reduce the incidence of diseases. To understand the mechanisms driving the incidence of environmental problems, it is necessary to consider the background of health and environmental problems specific to the country. This can be achieved by learning which problems are attributable to the living activities of local residents, relative to the larger context of environmental problems. According to the principles of Ecohealth education, each location and each ecosystem has its own ‘proper’ view of health; ideal views of health and environment vary with the society.

Gender and social equity

Ecohealth education also focuses on gender and social equity issues. In less developed countries, women, ethnic minorities, disabled people and people living in rural areas face unequal and unfair access to economic, education and social activity opportunities. This imbalance is reflected in their relationships with ecosystems. In addition, they are exposed to various health risks, which often results in poor health (WHO, 2011). A reduction in gender and social inequality through Ecohealth education can contribute to achieving a sustainable society.

Knowledge to action

One of the aims of Ecohealth education is to structure the knowledge that is necessary for taking action. To promote desirable actions, learners are expected to nurture and acquire mature values and norms about health and the environment. Ecohealth education aspires to develop human capabilities which will engage in creating a healthy community, not for an economic-growth-oriented lifestyle, but for a healthy and environment-friendly lifestyle.

CASE STUDY ABOUT THE INTRODUCTION OF ECOHEALTH EDUCATION IN TEACHER TRAINING IN LAO PDR

Introduction and promotion of Ecohealth education in Laos

After the Lao PDR established NSHP in 2005 (Ministry of Education and Ministry of Health, Lao PDR, 2005), the government of Laos conducted some pilot projects regarding NSHP implementation. On the basis of the lessons learned from these pilot projects, NSHP was revised in 2010 (Ministry of Education and Ministry of Health, Lao PDR, 2010). In the process of implementing NSHP, the government had recognized the necessity to strengthen teacher training on school health to promote NSHP implementation. At the same time, the government undertook curriculum reform in TTIs to improve the quality of education in TTIs. In this context, the Faculty of Education at the National University of Laos (FOE-NUOL) proposed the introduction of Ecohealth education into the teacher-training course that would contribute to improving student teachers’ abilities related to school health and for health and environmental education. Then, in 2009, FOE-NUOL started several empirical studies for developing a curriculum of Ecohealth education in collaboration with Japanese researchers.

The goal of Ecohealth education set by the government is to realize a form of nation-building that maintains harmony between the protection and exploitation of the environment, while developing human resources for Ecohealth education.

The objectives of Ecohealth education in Laos are to help children understand: (i) interrelationships among social development, livelihood, human behaviour, ecosystems and human health; (ii) that human health is influenced by livelihood and human behaviours; (iii) that daily human activities generate environmental loads and uncontrolled human activities often destroy ecosystems and (iv) that ecosystem change influences human health. Learners are expected to consider and take actions to maintain a balance among the environment, ecosystems, social development and human health and life. On the basis of these objectives, FOE-NUOL and the Ministry of Education and Sports in Lao PDR collaboratively developed a textbook to introduce Ecohealth education into teacher training courses in TTIs (Ministry of Education and Sports, Lao PDR and National University of Laos, 2018). In the process of developing the textbook, FOE-NUOL had conducted several surveys for investigating health conditions of school children and teachers’ awareness, behaviours and beliefs related to health and the environment between 2009 and 2014. In addition, FOE-NUOL had carried out several iterations of lesson studies for modifying contents of teaching and teaching methods from 2015 to 2018. With consideration of the results of the surveys and feedback from lesson studies, FOE-NUOL completed the development of the first version of the Ecohealth education textbook in April 2018. Then, FOE-NUOL conducted a 1-year trial of the developed textbook in the TTIs in Luangprabang, Savannakhet and Pakse to confirm the quality of the textbook in 2018–19. As a result of the trial, the Department of teachers’ education in the Ministry of Education and Sports of Laos authorized Ecohealth education as an official subject in TTIs at the end of 2019. In 2020, we revised the textbook based on the lessons learned from the trial and published a second version of the textbook (Ministry of Education and Sports, Lao PDR and National University of Laos, 2020a). Content regarding the concept and importance of Ecohealth education, family planning and a section on mental health were added into the second version of the textbook. All TTIs in Laos started teaching Ecohealth education in 2020. In addition, responding to the requests from teachers in TTIs, teachers’ guide books and teaching materials were developed in 2020 to ensure the quality of teaching (Ministry of Education and Sports, Lao PDR and National University of Laos, 2020b). As of 2020, Ecohealth education has been introduced only in TTIs in Lao PDR. However, several themes similar to those in the Ecohealth education in TTIs are taught in relevant subjects such as ‘World Around Us (integrated subjects of science, sociology, moral education, health education)’ in primary school and science in secondary school. Table 1 shows the content of the Ecohealth education curriculum in TTIs and the themes that include learning content at primary or secondary schools.

Table 1:

Ecohealth education curriculum content in TTIs in Laos

Chapter 1: Concept of Ecohealth
1 Concept and importance of Ecohealth education
2 Ecosystem and human healtha
Chapter 2: Ecosystem and human health
3 Ecosystem and water-related diseases and food-borne diseasesa
4 Endemic diseases and ecosystema
5 Water and human healtha
6 Soil pollution, forest and human healtha
7 Waste management and human healtha
8 Climate change and human healtha
Chapter 3: Gender equality and child health
9 Gender equalitya
10 Family planning, childcare and child rightsa
Chapter 4: Modern lifestyle, health and safety
11 Oral healtha
12 Food educationa
13 Lifestyle-related diseases
14 Substance use and healtha
15 AIDS, other sexually transmitted diseases and tuberculosisa
16 Safety education and disaster-prevention educationa
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a

Topics that include learning content at primary or secondary school.

Multiple sociocultural aspects are considered in the descriptions and examples of all the themes in the textbook. For example, culture-related content including the life habits and norms of Laotian people are included as particular lessons, along with other lessons on gender equality (Lesson 9), learning about family planning (Lesson 10), childcare and child rights (Lesson 10) and food education (Lesson 12).

Learning in an Ecohealth education approach

Taking the lessons about water in primary schools in Laos as an example, the lessons are organized by science subject, namely, ‘World around Us’, and focus only on the transfer of knowledge such as water’s composition and physical features (Ministry of Education and Sports, Lao PDR, 1997). In contrast, an Ecohealth education approach to learning about water first draws attention to and increases awareness of daily ways of using water; then, teachers introduce related topics such as how water circulates in local and global ecosystems and the roles of water in the ecosystem. After these topics have been covered, teachers deal with environmental problems associated with dysfunctional water circulation (e.g. desertification and extreme weather), and health problems (e.g. diarrhoea and malnutrition) caused by environmental problems (Ministry of Education and Sports, Lao PDR and National University of Laos, 2018). As a result of such comprehensive learning—understanding a series of interrelated and interdependent topics—learners’ motivations for, and ability to practise favourable actions to save water and avoid water pollution are expected to strengthen.

Taking the lessons about Opisthorchis viverrini (an endemic disease in Laos) as another example, these lessons are taught in primary schools only as prescribed in the existing curriculum of ‘World around Us’. Students are taught that eating raw fish (of any species) is prohibited to prevent the spread of the disease (Ministry of Education and Sports, Lao PDR, 1997), even though disease-causing fish species are limited (Tomokawa et al., 2012). In contrast, the Ecohealth education approach in primary schools first describes the route of infection with explanations about the O.viverrini hosts, the contact points between the hosts and humans (i.e. via excretion), and the mode of human infection; then, the health effects caused by the infection are explained. Second, in lower and upper secondary schools, students may be in charge of fishing and cooking fish in their family, and they learn that not all fish are the source of infection but that the risk of infection is higher in certain fish than in others, depending on the species and characteristics of the fish. They also learn other relevant topics such as the living conditions of the hosts and the seasons in which the risk of infection increases. In addition, they will understand how to maintain their traditional way of eating while avoiding the risks of raw fish, by learning the relationship between infections and traditional habits of eating (Ministry of Education and Sports, Lao PDR and National University of Laos, 2018).

As aforementioned, the Ecohealth approach enables the learning and understanding of one’s specific health problems and the related social and environmental factors relative to the health and environmental concepts specific to one’s local area, and the capability to decrease the incidence of diseases. The approach also facilitates an understanding of (and the need to understand) problems that are attributable to the living activities of local residents as part of the larger context of environmental problems. Table 2 compares Ecohealth education with traditional health and environmental education in Laos.

Table 2:

Differences between traditional health and environmental education and Ecohealth education in Laos

Health and environmental education Ecohealth education
Framework of etiological epistemology Reductionism/simplified and linear causality /focus on reducing risk at the micro level Complex ecological thinking/interdependent/big picture or meso- and macro-level
Goals Risk factor reduction by sanitation, infrastructure or individual behaviour change. Solve health problems under the leadership of professional experts Create a healthier ecosystem. Solve health problems in collaboration with professionals and community members
Perspective Short-term Long-term
Scope Teaching and learning Teaching, learning and practical action
Learning objectives Acquire standardized knowledge, attitudes and skills for good health and environment Understand mutually dependent relationships among human livelihoods, health and environment
Active participation in practice for maintaining ecosystem in local contexts
Learning style Knowledge dissemination/passive learning Knowledge sharing/learners’ active participation
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CHALLENGES IN DEVELOPING AND PROMOTING ECOHEALTH EDUCATION IN DEVELOPING COUNTRIES

Based on the experience in Lao PDR, described above, the following points should be accounted for when promoting Ecohealth education in developing countries.

Promoting research that is based on public health and anthropological approaches and developing teaching materials using results from Ecohealth education research

The objective of Ecohealth education is to help learners recognize health problems and understand the related social and environmental factors on the basis of location-specific health and environment concepts. It is also important in Ecohealth education that learners understand the country-specific background of health and environmental problems by learning about problems that are attributable to local residents’ living activities as part of the larger context of environmental problems. However, to facilitate such an understanding, it is essential to accumulate research results using public health and anthropological approaches and thereby understand, as much as possible, the reality of each situation. Participatory research in Ecohealth is also highlighted as an essential factor (Charron, 2012; Asakura et al., 2015). Furthermore, it is necessary to develop teaching materials that make the best use of the accumulated research results.

Empowering school-aged children

Issues related to maternal and child health remain the primary challenges in the health sectors of developing countries; however, school health policy formulations have contributed to raising awareness of health problems among school-aged children in developing countries. Despite increasing recognition of the need to address children’s health problems in view of improving school attendance, the need to empower children through education has not yet been sufficiently recognized. When leading roles are given to children and community people in Ecohealth education, children can perform well in health promotion and environmental improvement activities. Encouraging learners’ initiatives in education is an important investment in the future. The Ecohealth approach, moreover, is effective as a means to empower children with respect to fostering independence, imagination, the ability to act, critical thinking and problem-solving abilities.

Active involvement and sharing problems among community members

Generally, Ecohealth education is implemented at home and in the community where children spend much of their daily lives. With respect to developmental stages, children’s behaviour changes and learning improvements can hardly be achieved without active support from their guardians and other community members (Simovska and Jensen, 2009). Thus, learning in school should be demonstrated for, and shared with, people in the community so those people will understand and become involved in the learning process. The active involvement of community people encourages practical action that can maintain the health of the local ecosystem to which the children belong (Charron, 2012; Asakura et al., 2015).

Strengthening participatory teaching and learning methodologies for health and environmental education

Ecohealth education aims to foster a mindset that helps learners conduct themselves in an appropriate manner that accounts for the relationship between health and environment. Therefore, children’s voluntary participation and learning are essential for its successful implementation. It is also necessary to adopt appropriately flexible educational content and teaching methods that correspond to the health and environmental issues, which differ according to the area. However, currently, in the school education of developing countries, teachers place great value on a top-down teaching style, which simply conveys the content of textbook to students. As a result, teachers can make use of provided teaching materials but cannot create original teaching materials. Furthermore, teachers tend not to pay attention to students’ understanding, and neither do they give students enough time to think for themselves (Asakura and Tomokawa, 2014). Therefore, to implement Ecohealth education in developing countries, educational content must be changed from the current theory-oriented materials to those related to daily living, using a participatory approach. Moreover, teachers should understand the importance of encouraging students’ diverse thinking and creativity and sharing of such understanding among them. In other words, the educational philosophy relating to teaching and learning should be changed. Teaching materials and training manuals for developing teaching materials should also be provided.

Building a teacher training system and training teachers to implement Ecohealth education

The following steps are required to build an appropriate teacher training system and implement Ecohealth education in schools of developing countries: (i) position Ecohealth education as a cross-disciplinary area in elementary and secondary schools; (ii) train Ecohealth education specialists at TTIs; (iii) establish standards for the qualities and professional skills of teachers in charge of Ecohealth education and (iv) consider the curriculum of teacher training for future teachers in charge of Ecohealth education (Asakura and Tomokawa, 2014).

Limitation

This study did not address the quality of teaching in Ecohealth Education. Providing quality lessons is one of the main challenges for Ecohealth education in Laos. Therefore, it is necessary to conduct further research considering the teaching quality of Ecohealth education and applying a framework such as Understanding by Design (Wiggins and McTighe, 2005) to improve lesson design.

CONCLUSION

The following issues are critical when contemplating the challenges for Sustainable Development Goals in developing countries: improving the quality of health and environmental education; strengthening relevant training systems and promoting research activities. This paper has sought to show the importance and effectiveness of Ecohealth education for addressing those issues. In conclusion, Ecohealth education can embody the concept of ESD while focusing on health and environmental issues. Moreover, the promotion of Ecohealth education can contribute to improving the quality of health education and environmental education generally. In addition, we clarified the following challenges in implementing Ecohealth education in developing countries: (i) promoting research based on public health and anthropological approaches, and developing teaching materials that use results from Ecohealth education research; (ii) empowering school-aged children; (iii) encouraging active involvement and sharing of problems among community people; (iv) strengthening participatory teaching and learning methodology for health and environmental education and (v) training teachers who are capable of implementing Ecohealth education and of specialists who can building a training system.

ACKNOWLEDGEMENTS

The authors would like to thank staff and teachers of the Faculty of Education, National University and teachers and students in teacher training institutions in Lao PDR, as well as relevant staffs in Ministry of Education and Sports in Lao PDR.

FUNDING

This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Number [JP 23653287, JP 25301007], and Grant from National Centre for Global Health and Medicine [30-4].

ETHICS INFORMATION

This study was approved by the Ethical Committee of Tokyo Gakugei University (No. 158) and the National Ethics Committee for Health Research, Lao PDR (No. 172).

Contributor Information

Sachi Tomokawa, Department of Sports and Health Sciences, Faculty of Education, Shinshu University, 6-Ro Nishi Nagano, Nagano City, Nagano 380-8544, Japan; Japanese Consortium for Global School Health and Research, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.

Takashi Asakura, Japanese Consortium for Global School Health and Research, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; Department of Education, Tokyo Gakugei University, 4-1-1 Nukuikita-machi, Koganei-city, Tokyo 184-8501, Japan.

Ngouay Keosada, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Vannasouk Bouasangthong, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Vanthala Souvanhxay, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Phetnoy Navamal, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Kethsana Kanyasan, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Kimihiro Miyake, Department of Sports and Health Sciences, Faculty of Education, Shinshu University, 6-Ro Nishi Nagano, Nagano City, Nagano 380-8544, Japan; Department of Education, Tokyo Gakugei University, 4-1-1 Nukuikita-machi, Koganei-city, Tokyo 184-8501, Japan.

Shohei Kokudo, Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada, Kobe 657-8501, Japan.

Ryuichi Watanabe, Department of Sports and Health Sciences, Faculty of Education, Shinshu University, 6-Ro Nishi Nagano, Nagano City, Nagano 380-8544, Japan.

Sithane Soukhavong, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Khamseng Thalangsy, Faculty of Education, National University of Laos, PO Box 7332, Dongdok, Campus, Vientiane Capital, Lao PDR.

Kazuhiko Moji, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 1-2-4 Sakamoto, Nagasaki 852-8523, Japan.

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