Science|Environment|Health, One Health, Planetary Health, Sustainability, and Education for Sustainable Development: How Do They Connect in Health Teaching?

Abstract

In this paper, we explore Science|Environment|Health, One Health, Planetary Health, and Sustainability/Education for Sustainable Development in the context of the 2030 Agenda as four major frameworks that take a step toward investigating health from different angles to tackle the grand challenges that lie ahead of humanity. In most of these frameworks, the topic of health is no longer limited to the health of humans; it also encompasses the health of ecosystems and planetary systems. Therefore, our ways of teaching and discussing health in science education may need to be adjusted. To this aim, we first shortly characterize the four frameworks and then analyze the concepts of health, the contributing sciences, and the role of values in the frameworks. In our opinion, three main questions have to be settled: (1) Which concept of health lies at the root of each framework? (2) Which sciences should be considered when teaching about health, and what role will they take in an interdisciplinary, integrative approach and under complexity restraints? (3) What is the role of values in these frameworks, and how can the is–ought fallacy be avoided? We finally discuss our findings in light of the concept of two-eyed seeing in science education. This concept helps us disentangle and sharpen the three main questions and draw implications for teaching about health in school science.

1. Introduction

The COVID-19 pandemic brought health issues back to the center of science instruction [1,2]. Discussions about health increasingly involve debates related to the grand challenges [3] of our time, such as improving vaccines, controlling vector-borne diseases, and monitoring global health. The Anthropocene turns out to be an era when dramatic changes in natural systems will lead to new (grand) challenges, many of which will be directly related to health [4,5]. In this context, the topic of health is no longer limited to the health of humans; it also encompasses the health of ecosystems and planetary systems [6]. Therefore, our ways of teaching and discussing health in science education may need to be adjusted. In this paper, we explore Science|Environment|Health [7,8], Education for Sustainable Development in the context of the 2030 Agenda [9], One Health [10], and Planetary Health [11] as four major frameworks that take this step forward, investigate health from different angles, and hope to provide fruitful opportunities for repositioning health teaching in the science classroom.

The abovementioned four frameworks are rooted in different disciplines and thus use different narratives of health. So far, they have existed in parallel; viewed from a science education perspective, they are still poorly linked. To fill this gap, this article compares and contrasts the four frameworks and identifies their potential for (re)positioning teaching about health in school science. For this purpose, we will first briefly characterize the four frameworks. Adopting the methodological approach of Lerner and Berg [12], we then analyze the concepts of health, the contributing sciences, and the role of values in the frameworks. Finally, we discuss our findings in light of two-eyed seeing in science education [13], drawing implications for health teaching in schools. This article is mainly directed at science education researchers interested in health, but it can also be of interest to a wide range of readers concerned with one health, planetary health, and sustainability education.

2. Theoretical Background

2.1. A Look Back: Teaching about Health in Science Education

Science education, especially biology education, has a long tradition of addressing health through different perspectives, of which the biomedical, the holistic, and the health literacy ones seem to be the most common [14]. For many years, a biomedical and pathogenic view dominated the way science educators taught health. However, based on the World Health Organization’s [15] definition of health, more holistic approaches are also important. These approaches stress the multifaceted nature of health promotion and well-being, including the cognitive, affective, and social aspects of health, and they give priority to a salutogenic view of health [14]. Since the beginning of the 2000s, the concept of health literacy has emerged [16]. A variety of definitions and models have been published on this concept, often influenced by a public health perspective [17,18]. The main focus of this work has typically been on human health (e.g., primary prevention at the individual level). Harrison [19] and Zeyer et al. [20] have noted the mutual benefits of teaching health for both science education and health education. Thanks to health teaching, students’ motivation to learn science can be improved and, at the same time, their scientific literacy is empowered. However, despite all these insights and the obvious interdisciplinary character of health issues [21], the mainstream perspective on health in science education remains disciplinary (e.g., in school, health issues are often left to biology teachers [14]).

Another important point is that while health is increasingly considered a key topic in science education [14,20,22], the role of medicine education within science education still goes widely unnoticed [23,24]. This is the case even though, in the classroom, science education could strongly benefit from embracing the wide range of topics regarding non-communicable and communicable diseases (e.g., cancer, allergies, vaccination [24,25]). While contemporary health education is focused on well-being and health promotion [14], medicine education aims to teach future citizens to become informed patients in contexts of shared decision-making [26].

During the (long) history of health in schools, teaching has been situated at the intersection of science education, health education, medical education, and public health. Today, newly emerging frameworks offer cross-disciplinary inspiration to teach about health from a wider theoretical perspective.

2.2. Science|Environment|Health

Science|Environment|Health (hereafter S|E|H) is a new science pedagogy that has been developed over the past decade by a special interest group at the European Science Education Research Association conference [8,27]. The basic concern of this new approach is to establish a genuinely transdisciplinary dialogue between science education, environmental education, and health education, thus creating a win–win situation. Four main issues are considered important in S|E|H: (1) informed citizenship and the question of how science education can help future citizens deal with the big questions and challenges of our time, (2) the motivation to learn science and how S|E|H interdisciplinarity can foster students’ interest in science, (3) scientific literacy and how it may change in environmental and health contexts, and (4) critical approaches to science and how the limits of science can be demonstrated and discussed in environmental and health contexts.

The S|E|H approach is decisively a science pedagogy. Yet it assumes that both environmental education and health education can benefit from scientific inputs [20]. Conversely, environmental and health issues can motivate many students to engage with the natural sciences. For example, medicine fascinates all students, girls in particular [28]. These issues can be better understood and interpreted with the help of scientific knowledge and, in turn, they can make scientific knowledge more desirable and attractive.

In the S|E|H movement, complexity has become a core issue [29,30]. Living organisms are non-linear, self-organizing systems that are involved in open exchanges of energy and matter with the environment. Successfully dealing with these systems requires a science that is very different from the natural sciences as they are still predominantly taught in schools and universities. This classical approach is linear and deterministic. However, complex systems always produce structural uncertainty, which is sometimes nicely described by the expression “unknown unknowns”. In S|E|H contexts in particular, the conflict between life and predictability is inescapable [31]. S|E|H notes that classic science education often conveys a false picture of how to deal with the living world successfully. It suggests to students that the scientific approach always leads to deterministic explanations, which in turn allow for complete prediction and control in a primarily predictable and controllable world. The COVID-19 pandemic has shown how wrong this view is. This approach must be balanced with strategies characterized by pairs of terms such as “prediction and adaption”, “goals and affordances”, and “evidence and preference” [31,32]. Each of these pairs signals that an exclusive focus on a scientific image of the world may fail to understand life and health and so must be combined with an approach that looks at people’s lifeworld [29]. This is why two-eyed seeing has recently become a point of interest in S|E|H [33].

2.3. The Concept of Sustainability and Education for Sustainable Development/2030 Agenda

Sustainability can be described as an umbrella term to subsume multifaceted approaches, strategies, and normative frameworks relating to what needs to be done to protect people and the planet [34]. Two prominent examples are sustainability science and (education for) sustainable development. The multifaceted nature of sustainability results in difficulties in defining what sustainability means, and its interpretations differ depending on the discipline [34,35]. In general, the term “sustainability” is often described as an “ethical idea for the economics of natural resources” [36] that tries to balance the needs of the present and the future. The concept of sustainability—as many scholars and practitioners understand it and apply it today—goes back to the 1987 definition by the World Commission on Environment and Development (WCED), which became known as the Brundtland definition: “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [37], p. 6.

Many other definitions exist [34,35]. In several of these, researchers combine a set of values (e.g., conservation), recognize the multidimensionality of sustainability (e.g., ecological, social, and economic dimensions), and consider different temporal perspectives (e.g., the needs of the present and those of future generations). In 2015, Guidotti tried to integrate these different aspects into a more nuanced definition of sustainability:

“Sustainability” is the state achieved when an activity, action, operation, enterprise, or product (1) can be maintained over a long period, with an aspiration to last at least several generations; (2) conforms to a set of expectations and goals such that it achieves at least one or more of the following objectives and does not interfere with the others: (a) enhance social progress, (b) conserve resources, (c) preserve the natural environment, (d) enhance the built or human-made environment, (e) comply with and exceed legitimate regulations and rules, (f) avoid destructive influences on society, and (g) be controlled by a coherent sense of ethics and social responsibility; (3) is responsive to community values; and (4) does not require constant external oversight and organized opposition to remain aligned with these goals while it endures.” [34], p. 5.

In science education, sustainability has evolved from its origins in environmental education [9,38] and aims to change the way problems and challenges related to the planet’s future are discussed in the school context [39]. More recently, it has been mainly discussed in the context of education for sustainable development (ESD) [40]. Among other goals, the ESD concept aims to encourage students to address sustainability issues at the intersection of science and society, to reflect on these issues, and to learn to undertake sustainable actions. Thus, ESD can be seen as an action-oriented transformative pedagogy [41]. In school contexts, between 2005 and 2014, ESD has been strongly promoted by the United Nations Educational, Scientific, and Cultural Organization’s (UNESCO) agenda on education for sustainable development. Agenda 21, which was based on the UN’s 1992 Rio Summit, had already provided an essential basis for education on environment and sustainable development [42]. In 2015, the UN adopted the 2030 Agenda as the successor to Agenda 21. Contextually, it introduced 17 sustainable development goals (SDGs) as a catalog and a pragmatic approach to reaching a global sustainable future [43].

The SDG agenda goes beyond the traditional aims of ESD. In particular, in the school context, it demands the co-contribution of all the subjects involved, which is known as the whole-institution approach [41]. The 2030 Agenda promotes lifelong learning for everyone, regardless of their cultural or socioeconomic background. It includes issues at local, regional, national, and global levels, and it acknowledges that satisfying the needs of one level may have consequences and implications for the others. The 2030 Agenda-inspired ESD, therefore, encompasses integrative educational concepts (e.g., critical thinking and systems thinking) and summarizes a set of competencies so that every individual can make their contribution to achieving the SDGs [41,44].

2.4. The Concept of One Health

The One Health (OH) Concept can be seen as a response to the increased occurrence of infectious zoonotic diseases, such as avian flu, Zika virus, and most recently COVID-19, as well as to the rise of antibiotic resistance due to, for example, intensive livestock farming [12,45]. The OH concept is premised on the fact that humans and animals are ever more closely intertwined as an undesirable side effect of globalization, industrialization, population growth, and ecosystem degradation (e.g., through deforestation) [46,47]. OH describes a set of collaborative approaches across disciplines, sectors, and stakeholders from public health, veterinary medicine, ecology, human medicine, biology, health economics, and environmental health, which are necessary to effectively tackle the abovementioned problems [10,48]. In this regard, OH can be seen as a way of looking at the complex and cross-disciplinary nature of zoonoses and antibiotic resistance. However, many more topics have been explored from the OH perspective, including the resilience of health systems and ecosystems, ecosystem dynamics, urbanization and health, recurrence of infectious diseases and their dissemination, and extinction in natural habits [47].

The OH concept emerged around 2004, when the world faced the H5N1 avian influenza and many countries invested in preventive measures to avoid the disease becoming a pandemic. At that time, the World Health Organization, together with others, implemented OH as an institutional program to foster interdisciplinary collaboration and to seek solutions to prevent future pandemics [45]. In the beginning, OH was defined in a narrow sense, that is, as a combination of human medicine and veterinary medicine (“one medicine”). However, over time, other disciplines have been included in the concept to address the complex nature of zoonotic diseases and antibiotic resistance [12]. In a recent statement, the [49] defined OH as follows: “One Health is a collaborative, multisectoral, and trans-disciplinary approach—working at local, regional, national, and global levels—to achieve optimal health (and well-being) outcomes recognizing the interconnections between people, animals, plants and their shared environment.”

This definition makes it clear that OH is now conceptualized more broadly and affects different organizational levels (i.e., global, national, local, individual, and population). Thus, OH can be seen as an umbrella term that combines the efforts of multiple health science professions and related disciplines [10]. Inevitably, this broad definition entails conceptual similarities to other approaches, such as Planetary Health [50,51]. Therefore, OH has also been criticized for being a “theory of everything” [12]. The current definition by the [49] strengthens the ecological perspective of health that was missing in previous conceptualizations. This definition now considers the particular importance of biodiversity for the health of humans, animals, and ecosystems [52,53].

With its zoonotic origin, the recent COVID-19 pandemic has shown the need for more education on pandemic preparedness. Since it is not enough to break down complex systems into their components and, for example, apply isolated biological or medical knowledge [12,54], OH asks for education policies that successfully overcome transdisciplinary boundaries and pursue intersectional perspectives [47,55].

Considering OH for educational purposes is not new [56]. For example, Frankson et al. [54] outlined a core competency framework of skills and behaviors necessary for successful performance within the OH concept. Their suggestions move beyond discipline-specific knowledge, and range from competencies in the field of communication to systems thinking. With regard to science education, the OH concept has not yet been thoroughly investigated. Still, OH has been considered a powerful approach for responding to students’ recent interests at the intersection of health, biodiversity, and sustainability [57].

2.5. The Concept of Planetary Health

The term Planetary Health (PH) came to the public’s attention thanks to the 2015 seminal Lancet article “Safeguarding human health in the Anthropocene epoch: Report of The Rockefeller Foundation-Lancet Commission on planetary health” [11]. In this article, the authors illustrated the necessity of promoting the concept of PH by recourse to four main arguments. (1) There is currently a large degradation of natural systems that is primarily caused by human action. (2) Environmental threats are rapidly increasing and require urgent and transformative action to protect present and future generations. (3) There is a need to integrate knowledge from social, economic, and environmental dimensions. (4) The necessary environmental change can be reached by promoting sustainable and equitable patterns of consumption, reducing population growth, and harnessing the power of technology [11]. The concept of PH emphasizes that the material, biological, social, and cultural aspects of health must be seen holistically and that the complex and nonlinear nature of natural systems must be considered.

Important voices have noted that the concept of PH is much older, dating back to the environmental and holistic health movements of the 1970s and ’80s [58]. By the 1990s, PH was already a core element of the integrative medicine approach, before the Lancet paper made it mainstream in academia and medicine. The same voices strongly emphasize the holistic character of the integrative medicine movement, and they stress the important role played by traditional knowledge and wisdom in its beginnings, which tend to be neglected by the recent mainstream approach. Thus, the concept of PH is conceptually very similar to the frameworks of integrative conservation medicine, OH, and Eco Health, but it follows a more coherent method that integrates a variety of concepts [6].

Although the PH movement has become increasingly prominent in recent years, an educational framework based on it has been lacking. Such a framework was recently presented by a specially convened task force of the Planetary Health Alliance [59]. It includes five key domains that, according to the task force, represent “the essence of planetary health knowledge, values, and practice”. Most notably, at the center of the framework are transformative educational strategies that combine personal, cognitive, social, and emotional aspects of PH education. Special consideration is given to the diversity of human knowledge that teaches the deep interconnectedness with nature. The other domains of the framework highlight the holistic approach of the PH concept. These include focusing on the role of human interventions and how they affect natural systems (“The Anthropocene and health”), emphasizing systems-based understandings of the characteristics of complex adaptive systems (“System thinking and complexity”), calling for educational efforts that promote the right to achieve full vitality for humans and ecosystems based on human rights and the rights of natural systems (“Equity and social justice”), and aiming to empower students and future professionals to build movements that support systems change and the larger transition to a just future (“Movement building and system change”).

3. S|E|H, ESD, OH, and PH Compared and Contrasted

The discussion of S|E|H, ESD, OH, and PH shows that the four frameworks share essential aspects while differing from each other in important ways. Following the approach by [12], we aim to compare and contrast the frameworks by analyzing the role of health, the contributing sciences, and the role of values against the background of teaching about health in science education.

3.1. Concepts of Health

Health plays a critical role in each of the four frameworks. However, the entity that health refers to is different. The S|E|H approach understands health education traditionally, as it focuses on human health. It highlights the benefits of introducing health to the science classroom [20] and points out the conceptual relationship with medicine education [24,60]. However, health is not an isolated area in S|E|H, and interdisciplinary and interlinked perspectives (e.g., environmental health [31]) are an important aspect of the framework [61].

In ESD and the 2030 Agenda, health is an important but often underrated aspect of the debate about sustainability [34,62]. This is surprising since ESD and the 2030 Agenda have been praised for their potential to transform discussions about health. While health has its own SDG (SDG 3: Ensure healthy lives and promote well-being for all at all ages [43]), health is rarely at the center of the sustainability debate. Health in ESD and the 2030 Agenda goes beyond a traditional emphasis on diseases [52], but still focuses on human health. In their model of the duality of health and sustainability, Kjærgård, Land, and Pedersen [62] conceptualize a mutual relationship between health and sustainability: health creates the conditions for and is conditioned by sustainability, which, in turn, creates health and is conditioned by it. In a similar vein, Guidotti [34] stated that sustainability and health are linked so that improving one leads to improving the other. However, the SDGs, which aim to integrate health, environment, and climate protection through a sustainability perspective, cannot be limited to human health.

In OH and PH, in contrast to S|E|H and ESD, the role of health is explicitly stated. OH has a unique focus on health that considers three levels: the individual, the population, and the ecosystem [12]. Therefore, in contrast to traditional definitions of health, such as that of the World Health Organization [15], health in OH refers not only to human health but also to the health of animals and ecosystems [10]. Since it links health to sustainability, OH has the potential to become a pathway to sustainability. This approach values wildlife and agricultural health in terms of intact and balanced systems [63]. PH extends the concept of health to the global dimension [11]. In this approach, health is defined by adherence to planetary boundaries and by the management of the consequences for everyone on the planet of exceeding such boundaries. With this extended notion of health, fine-grained views can be developed that allow diverse perspectives, from the health of individual humans to public or population health and the health of ecosystems and planetary systems.

What does this comparison of S|E|H, ESD, OH, and PH tell us? Traditionally, the concept of health in science education focused on individual human health and followed a biomedical approach [14]. While there have been changes to this approach in recent years, underlining the role of health in the frameworks of S|E|H, ESD, OH, and PH may offer new ways of moving forward. To keep up with the world’s grand challenges [3], the understanding of health in science education needs to be extended. The role of health in science education should not be limited to individual health and the health of humans. The four frameworks discussed here offer rich opportunities to address health from different perspectives. For science education, this is an opportunity rather than a challenge, given that the concept of health demands an interdisciplinary approach, and this is well-established in science education.

3.2. Contributing Sciences

Interdisciplinarity plays a significant role in all four fields. In S|E|H, there is an overlap between the subjects of science education (i.e., physics, chemistry, and biology), health education, and environmental education [61]. The latter two bring in the perspectives of health and environmental sciences, which advances the S|E|H pedagogy beyond the perspective of science education. Yet, clearly, the focus of S|E|H as a new science pedagogy is on science education.

This is not the case in OH and PH, both of which focus on health in the broadest sense and rely on scientific disciplines as providers of knowledge. In OH, the sciences on the spectrum of the human, environmental, and animal spheres are integrated [64]. The OH concept, therefore, is based on the perspectives of medicine (e.g., veterinary science), public health, biological sciences (e.g., zoology), and social sciences (e.g., anthropology and rural development [12]). The framework of PH adds the planetary perspective to health and emphasizes the contribution of systems sciences and complexity sciences [65]. Other authors argue that PH itself represents a form of science [66]. For ESD and the 2030 Agenda, interdisciplinarity arises from the contribution of the economic, ecological, and social dimensions of sustainable development. The science disciplines involved in this approach have been summarized under the umbrella term “sustainability sciences” [36].

Overall, the four frameworks emphasize the contributions of different sciences. However, there seems to be substantial overlap. In each framework, the interplay of the sciences serves different purposes. For example, it can be used for providing context (e.g., health sciences as the context for S|E|H [20]), opening a new perspective on teaching and learning about an established health issue (e.g., embracing the interconnection of human, animal, and environmental habitats when teaching about antibiotic resistance in OH [45]), and providing new approaches to teaching about complex systems (e.g., analysis of systems’ complexity and humans’ role in it in the case of PH [67]).

In the four frameworks, addressing the grand challenges of our time is associated with an interdisciplinary perspective [3]. Science education research has tried to emphasize the productiveness of interdisciplinary perspectives by including, for example, issues located at the intersection of science, society and technology (STS) to transform the learning of basic natural sciences [68]. However, traditionally, when health issues have been taught in science education, a disciplinary point of view has still mostly been adopted. Repositioning health teaching in science education, therefore, raises the difficult question of how to embrace interdisciplinarity without neglecting the role of basic natural sciences.

3.3. Values and Health

The question of values and facts in science education has been widely discussed [69]. This question seems even more important and difficult when considering S|E|H, ESD, OH, and PH.

Health can be considered a value in itself; as such, it affects decision-making and behavior [70]. For this reason, teaching about health is always a value-laden activity. People should be empowered to maintain, reflect or improve their health status. At the same time, teaching about health should avoid the is–ought fallacy. This is particularly important in science education, which is not primarily concerned with promoting a specific type of healthy behavior; rather, it fosters the ability to reflect and act in line with scientific knowledge and personal health values [71]. This approach avoids health indoctrination and instrumentalization of students in the science classroom. The pedagogy of S|E|H is very much in line with this strategy, as Zeyer and Dillon write:

“The label Science|Environment|Health is not meant to suggest that health and environmental education should be swallowed up by science education. Rather, there is a role for both beyond a reimagined science education. The label highlights a situation of mutual benefit between science education, environmental education and health education, three educational dimensions that have yet to be established in a transdisciplinary dialogue.”

[61], p. 1406.

In the frameworks of ESD/2030 Agenda, OH, and PH, the situation seems slightly different. These approaches put sustainability, as a value-laden idea, at the center of their considerations [36]. In particular, ESD, OH, and PH are normatively oriented as they essentially want to promote a positive vision of an encompassing notion of sustainability [44]. How to avoid the is–ought fallacy in this endeavor (and not push students in a specific direction) seems a rather neglected issue in the literature and science education. The challenge increases when health, as a value, is accompanied by the value of sustainability.

4. Discussion and Synthesis

4.1. Three Important Questions

This article wants to characterize, compare, and contrast the concepts of S|E|H, ESD, OH, and PH in order to analyze their potential role in repositioning teaching about health. Our analysis shows many similarities in the four frameworks, but it also reveals clear differences between S|E|H and the other approaches.

First, the S|E|H framework is the only genuine pedagogical framework among the four, insofar as its main commitment is good science education. The other approaches are all chiefly committed to the values of health (in its broadest sense) and sustainability. Pedagogy is then seen as an instrument for addressing and changing peoples’ attitudes as well as acting toward these two values.

Second, as a science pedagogy, S|E|H is mainly concerned with the three classic sciences of the school curriculum—physics, chemistry, and biology—and their interdisciplinary application to health and environmental contexts. The other frameworks, depending on their focus, involve also other sciences (and not necessarily the natural ones) or they interpret their characteristics as being scientific in and of themselves. All the frameworks underline the role of complexity in understanding health issues. Importantly, S|E|H points out that complexity and systems theory have been unduly neglected in traditional science education [30].

Third, and not least, the challenge of the is–ought fallacy in health and environmental contexts has been constantly discussed not only in S|E|H but also generally in the science education literature (e.g., [13]). However, this discussion seems to be missing in the other frameworks. For example, both PH and S|E|H point to the role of empathy when it comes to health education. However, S|E|H sees the role of empathy as a factor motivating students, particularly girls, to learn science, while PH conceives it as indispensable for saving our planet. Concerning the positioning of S|E|H, the three points above raise the three questions below.

First, is S|E|H a science pedagogy or does it want to evolve into something else, for example, a movement for installing a sustainable society and promoting planetary health in its broadest sense? Being a science pedagogy, and nothing else, would certainly sharpen the profile of S|E|H.

Second, does S|E|H want to limit interdisciplinarity to the three natural sciences traditionally taught in school—physics, chemistry, and biology? Or should it be inspired by the other frameworks, which seem to have a much broader understanding of interdisciplinarity? Is S|E|H still a science pedagogy if it includes other sciences, for example, the health sciences? In this case, S|E|H would get into a situation of competition with the other frameworks, which might hamper the intended mutual benefit. Again, a transparent limitation to the three classic natural sciences would distinguish the S|E|H profile. An interesting question is also whether S|E|H is a genuinely interdisciplinary pedagogy, that is, whether it could include only one subject (e.g., a pedagogy in physics or chemistry education). In any case, the four frameworks agree that interdisciplinarity in health issues raises complex issues and that this aspect of the public understanding of science has been unduly neglected so far.

Third, should S|E|H be primarily committed to values, such as health or sustainability, or to scientific facts? An explicit answer to this question would also clarify whether S|E|H wants to consistently avoid the is–ought fallacy, that is, the tendency to directly derive values from facts. In the other frameworks, starting with values and then taking scientific facts into account to support value-oriented actions is an important approach. Again, S|E|H could sharpen its profile by focusing on its competency to deal with scientific facts without neglecting value issues.

4.2. Two-Eyed Seeing as a Heuristic

These delicate questions are also intertwined at the philosophical and pedagogical levels. In this subsection, we would like to provide a heuristic that might help to disentangle and clarify the three questions, thus giving some preliminary hints regarding possible answers [13,33].

Two-eyed seeing, or the stereoscopic view, are metaphors that lie at the intersection of two important streams of thought in Western philosophy (e.g., [72]) and in Canadian Indigene sapience [73] that share the conviction that it needs “two eyes”, a holistic one and a scientific one, to navigate the world. The view of the two eyes results in two complementary images, which we call the life-world image and the scientific image. As the metaphor suggests, we need to have a “stereoscopic view” ([74] (Figure 1)).

Figure 1 is seen as an educational model of two-eyed seeing (TES). It is intended as a heuristic for creating and analyzing science teaching and not as a contribution to philosophical discourse. Its basic assumption is that we use “eye switches” to move from one image to the other and back, and that this approach is the best procedure to realize TES in our work with students and teachers [13]. We call the switch from the lifeworld image to the scientific image scientific explanation and the opposite switch holistic interpretation (both terms are initial suggestions).

Figure 1 also indicates that the core difference in the stereoscopic view is ontological. This difference consists of a “things-orientation” and a “people-orientation”, which are labels often used in psychological research and science education [75]. The actual positioning of S|E|H can be sketched out as follows (Figure 2):

The three questions presented above can be reformulated and refined in terms of Figure 2.

First, while many aspects of Figure 1 suggest interesting questions and problems, the main concern for a pedagogy seems to lie in the two switches. In S|E|H, considerable research has been done on both switches. We suggest that the focus in the three other frameworks lies primarily on the images themselves. In PH and ESD, the emphasis is mainly on the lifeworld image, while in OH it is on the scientific image. This would explain why only S|E|H is conceived from scratch as a genuine science pedagogy framework.

Second, the question concerning the involved sciences is situated in the scientific image part of Figure 2. It contains only the three classic sciences of biology, chemistry, and physics. This is the original conception of S|E|H. ESD would certainly add economics and the social sciences, while OH would probably add more disciplines from the natural and medical sciences. PH seems not to explicitly discuss disciplinary questions. If PH and other possible frameworks are conceived as new sciences, then Figure 2 collapses into the traditional image of interdisciplinarity with only one scientific image.

Third, in Figure 2, values can be conceived in terms of the scientific image as moral and ethical sciences to be added following question 2. Alternatively, they can be seen as value issues in the lifeworld image. Note that the TES model does not give priority to one of these positionings. Belonging to the scientific or the lifeworld image is in no sense better, truer, or more important. In its original formulation, S|E|H would position values in the lifeworld image of people (i.e., students). They would then be discussed not in a scientific but in a lifeworld context, an approach that seems adequate for a science pedagogy. Figure 2 helps to make this distinction; it also highlights the scientific character of the sciences in question. This explicit distinction is what prevents science teaching from the often (unconsciously) propagated is–ought fallacy in science education.

4.3. Repositioning Health Teaching

The previous subsection was mainly concerned with clarifying the differences between the four frameworks and indicating the crucial points that may decide the positioning of S|E|H and sharpen its profile. Our findings, though, can also be used to think about the various challenges and perspectives presented in this article and how to unify them, which is a much vaster but no less important challenge. TES may help also in this endeavor by disentangling the perspectives and pointing out the impact of various aspects.

In the scientific image, the question of the contributing sciences may be the most important. As can be seen above, Figure 2 conceives the integration of the sciences in terms of a holistic understanding. In other words, the inclusion of different sciences in different frameworks will result in a different view of health in lifeworld contexts and lead to extended questions and issues, which will be tackled in science classrooms. This effect will probably be less prominent when an interdisciplinary approach that focuses on the scientific image is used.

Conversely, the perspective from inside the lifeworld image may suggest new ways of thinking beyond traditional health education. Possible examples include the mutual relationship between health and environmental issues (S|E|H); the integral perception of human, animal, and environmental health for solving complex health problems, such as antibiotic resistance (OH); and the framing of health problems in terms of sustainability (ESD). These issues will then ask for scientific explanations.

TES requires that we always complete the cycle of explanation and interpretation (doing so several times, if necessary), and that we do not overemphasize one of the two images, remaining aware of which eye is “open” at a given moment. This becomes particularly difficult when the two eyes produce conflicting images. In complex situations (e.g., the COVID-19 pandemic), this is a frequent challenge. Given that all four frameworks highlight complexity as a core quality of health issues, TES may become an important instrument for handling these conflicts in a pragmatic, consensus-oriented way. The task of science teaching would then be not to convince students of an epistemological superiority of the sciences, but to familiarize them with these inevitable tensions between the scientific image and the lifeworld image. Science teaching also needs to help them not to shy away from these disputes, but to negotiate solutions that avoid the is–ought fallacy. Once again, this means that a truly pedagogically oriented framework must focus on the switching process rather than on the two images and their priority.

Finally, in our opinion, the 2030 Agenda may be the framework best suited to bringing the four approaches under one umbrella. Many ideas of S|E|H, PH, OH, and ESD may be integrated into this framework. Figure 3 shows how the 2030 Agenda could be incorporated into the educational TES model.

In Figure 3, the 2030 Agenda is conceived as belonging to the lifeworld image. Any of the 17 SDGs would then ask for a scientific explanation, and every scientific explanation would have to be interpreted again in the context of these goals. The resulting cycle and its iterations do not represent a hermeneutic circle. As noted by Sellars [74] and more recently by Roher et al. [73], finding one’s way around the world requires the lifeworld image and the scientific image to be on a level playing field.