LETTER TO EDITOR
PLANETARY HEALTH EDUCATION IN LIGHT OF MADELEINE LEININGER'S TRANSCULTURAL THEORY: A CALL TO NURSING
EDUCACIÓN EN SALUD PLANETARIA A LA LUZ DE LA TEORÍA TRANSCULTURAL DE MADELEINE LEININGER: UN LLAMADO PARA LA ENFERMERÍA
EDUCAÇÃO EM SAÚDE PLANETÁRIA À LUZ DA TEORIA TRANSCULTURAL DE MADELEINE LEININGER: UMA CONVOCAÇÃO PARA ENFERMAGEM
https://doi.org/10.31011/reaid-2025-v.99-n.3-art.2601
1Iel Marciano de Moraes Filho
2Elionara Teixeira Boa Sorte Fernandes
3Giovana Galvão Tavares
1Universidade Evangélica de Goiás, programa de pós-graduação em Sociedade, Tecnologia e Meio ambiente. Anápolis, Goiás, Brazil. ORCID: https://orcid.org/0000-0002-0798-3949
2Universidade do Estado da Bahia, departamento de Enfermagem. Guanambi, Bahia, Brazil. ORCID: https://orcid.org/0000-0001-8302-6887
3Universidade Evangélica de Goiás, programa de pós-graduação em Sociedade, Tecnologia e Meio ambiente. Anápolis, Goiás, Brazil. ORCID: https://orcid.org/0000-0001-5959-2897
Corresponding Author
Iel Marciano de Moraes Filho
Programa de Pós-graduação stricto Sensu em Sociedade, Tecnologia e Meio ambiente. Av. Universitária, s/n - Cidade Universitária, Anápolis – GO, Brazil. CEP: 75083-515. E-mail: ielfilho@yahoo.com.br contact: +55 (62)98484-3593.
Submission: 14-06-2025
Approval: 28-06-2025
The pressure resulting from the unchecked growth of the capitalist economy and a consumption-driven market, sustained by an intensive industrial model, has imposed a pace of production and exploitation that is incompatible with natural cycles and, consequently, with the very cycles of life on Earth. This development logic contributes significantly to climate change by intensifying environmental degradation and greenhouse gas emissions (1).
As a consequence of this imbalance in the relationship between humans and nature, numerous environmental impacts have intensified at both local and regional levels (such as prolonged droughts and rainfall; floods; heatwaves; and an increase in the frequency and intensity of forest fires), as well as at a global level (such as global warming and ozone layer depletion). These environmental transformations have triggered unprecedented effects on human health through the emergence of epidemics, demanding an urgent and coordinated response from the health sector, particularly nursing, which represents the largest health workforce (1-2).
Supported by these factors, the concept of Planetary Health emerged in 2015 as a transdisciplinary approach that seeks to understand how human activities affect the planet and how these changes impact human health (3).
In this context, nursing must assume a central role in transforming care practices in times of planetary crisis. Nursing holds the science of care, consolidated over centuries across various settings, and has the capacity to reach diverse populations, especially those facing vulnerability, climate injustice, environmental injustice, and environmental racism (4).
Therefore, for this role to be effective, nursing teams must develop distinct skills and competencies to meet the needs of different populations, considering regional and cultural differences, which encompass the epidemiological, geographical, and cultural singularities that influence lifestyle, health, and well-being across the world (4).
To achieve this, it is essential that these teams be adequately trained to act with respect toward different peoples and possess the wisdom to identify and align care with sociocultural differences. This enables positive interactions through spaces for communication and mutual understanding between populations and professionals. However, in practice, such spaces are becoming increasingly scarce due to the predominance of a standardized collective vision. Thus, a paradigm shift in the profession is urgently needed in this era of climate crisis, in order to seize meaningful opportunities for growth, learning, redefinition, awareness, and environmental conservation (5).
This practice, however, was already taught to us. In 1991, nurse Madeleine Leininger published the Sunrise Model, which represents her theory called the Theory of Culture Care Diversity and Universality, as illustrated in Figure 1. The model presents human beings as inseparable from their cultural background, social structure, worldview, history, and environmental context. In other words, it offers care that is culturally congruent with the person's way of life (6).
Figure 1 – Sunrise Model.
Source: Leininger & MacFarland (2006, p. 25)
Reproduced without authorization. Free translation
This reinforces the importance of understanding cultural values and individual and collective experiences as the foundation for nursing care, since these elements are directly related to the health-disease process, allowing for more precise and effective interventions (4,6).
Especially in the context of the twenty-first century, marked by recurring environmental and climate disasters, it is urgent to develop Planetary Health Education practices aimed at populations from different territories. Nursing must embrace these practices and principles to foster among citizens a sense of interconnectedness with the environment, grounded in the recognition of the triad society, environment, and health (3).
The imbalance of this triad leads to the emergence of numerous diseases, negatively affecting the health-disease process, as well as individuals’ quality and life expectancy. In other words, the greater the environmental degradation, the higher the incidence of disease and the more intense the suffering of populations, which in turn increases the workload of health professionals (2-3).
In light of this, the development of health education is essential. When linked to socio-environmental factors, it becomes a fundamental tool for transcultural care, integrating popular knowledge with professional technical knowledge. This approach values sociocultural and environmental aspects and strengthens individuals' protagonism in care practices (7).
Accordingly, health care and care assessment models, such as Madeleine Leininger’s (1991), which advocates for the preservation and variety of cultural factors in contrast to the hegemonic model centered on disease symptoms, are vital for a population paradigm shift and for understanding the lived premises. These models also facilitate health professionals’ understanding of each population’s way of life (4-5).
Thus, it is essential that nursing professionals possess knowledge of the practical application of such nursing theories. This enables the delivery of care that is more coherent with the individual’s needs, as it allows for a better understanding of the environment, the health-disease process, and the professional’s role in addressing demands, while fostering action grounded in critical thinking (5).
Therefore, nursing must urgently create opportunities for care actions, whether through preservation, standardization, or accommodation, to determine the most appropriate way to intervene and change each population’s reality, ultimately reducing disease incidence (6).
Given the complexity of the current reality, it is assumed that in all cultures, care is fundamental to sustaining health and human life. For this reason, it is essential to implement care practices grounded in cultural awareness. To be effective, such practices must respect each population’s existential time and be sensitively adapted to the socio-environmental aspects of each era.
In this scenario, a paradigm shift that integrates ecological, social, and cultural assumptions in an interdependent manner is urgently needed, in accordance with the principles of Planetary Health. However, this approach must always respect the values, beliefs, and needs of each population, accompanying them from birth through the end of life.
Therefore, once again, nursing, as a field of knowledge, demonstrates its forward-thinking nature by recognizing the importance of valuing culture in the context of the health-disease process and, consequently, in health promotion. Cultural care refers to the recognition of values, beliefs, and expressions that are relatively well-known and shared within specific groups, contributing to well-being, improving living conditions, and assisting in the processes of death and physical incapacity (6).
Given the above, it is worth directing a reflection not only to nurses but also to other health professionals regarding the ways in which care and assessment are conducted in light of the new challenges posed by climate change. Therefore, we call on the nursing community to take the lead in building care practices focused on health promotion, mitigation of the impacts resulting from these changes, and the recognition of the relevance of Planetary Health and Planetary Health Education principles in promoting care and raising awareness among populations. As long as the degradation of planet Earth continues, climate events will intensify, along with the burden of diseases associated with them.
REFERENCES
1. Ballivián JMP, organizador. Guia do professor – cultura, ambiente e biodiversidade. Belo Horizonte: UFMG; 2006.
2. Moraes Filho IM de, Tavares GG. Current and future nursing in promoting planetary health: actions for sustainable development. Texto contexto - enferm [Internet]. 2024;33:e20230415. Available from: https://doi.org/10.1590/1980-265X-TCE-2023-0415en
3. Moraes Filho IM de, Amaral ECLR do, Tavares GG, Spiess MAR. Saúde Planetária: distribuição de casos de dengue, zika e chikungunya em Goiás (2017-2021) e fatores socioambientais. Saúde E Pesquisa. 2025;18:e13079. Doi: https://doi.org/10.17765/2176-9206.2025v18e13079
4. Costa AMS, Gomes VO, Reis DA, Esteves AVF, Furtado MAS. Transculturalidade das tecnologias da informação e comunicação utilizadas pelo enfermeiro no cuidado à pessoa idosa. REVISA. 2025;14(2): 1421-8.
5. Lima AFS, Santos CEB, Alves NR, Lima Júnior MCF, Jorge JS, Tigre HWA, et al. Nursing care for the Warao people: an experience report based on transcultural theory. Rev esc enferm USP [Internet]. 2023;57:e20230035. Doi: https://doi.org/10.1590/1980-220X-REEUSP-2023-0035en
6. Silva ER, Alencar EB, Dias EA, Rocha LC, Carvalho SCM. Transculturality in nursing based on Madeleine Leininger’s theory. REAS/EJCH. 2020;13(2): e5561. doi: https://doi.org/10.25248/reas.e5561.2021.
7. Freitas RJM, Bessa MM, Fernandes SF, Barreto FA, Trigueiro JG. Enfer(i)magem: espaço potente para o exercício da transdisciplinaridade no cuidado em saúde. Revista de Educação Popular. 2021;20(2):230–44. doi: https://doi.org/10.14393/REP-2021-55413.
Funding and Acknowledgments:
Own funding.
Authorship Criteria (Author Contributions)
• Iel Marciano de Moraes Filho: 1. Contributed substantially to the conception and/or planning of the study; 2. Obtained, analyzed, and/or interpreted the data; 3. Contributed to the writing and/or critical review and final approval of the published version.
• Elionara Teixeira Boa Sorte Fernandes: 2. Obtained, analyzed, and/or interpreted the data; 3. Contributed to the writing and/or critical review and final approval of the published version.
• Giovana Galvão Tavares: 2. Obtained, analyzed, and/or interpreted the data; 3. Contributed to the writing and/or critical review and final approval of the published version.
Declaration of Conflict of Interest
"Nothing to declare."
Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519
Rev Enferm Atual In Derme 2025;99(3): e025105
Atribuição
CCBY