One Health Education and Planetary Health: Assessing Knowledge Gaps in Undergraduate Nursing, Education, and Biology Students, and a Pilot Postgraduate Intervention

1. Introduction

The concept of One Health (OH) can be traced officially to 2004, when the Wildlife Conservation Society convened the One World, One Health conference, where the Twelve Manhattan Principles were established. These principles formalised the already recognised linkages between human, animal, and environmental health, underscoring the necessity of interdisciplinary approaches for disease prevention, education, and aligned policymaking [1]. Building on this foundation, in 2008 the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the World Health Organization (WHO) joined forces with UNICEF and other partners to develop a strategic framework for reducing the risk of infectious diseases at the human–animal–ecosystem interface [2].

The operational definition of One Health was subsequently consolidated by the One Health High-Level Expert Panel (OHHLEP), whose members represent a broad spectrum of scientific and policy sectors relevant to the approach. The WHO (2021) [2] formally adopted the following definition: "One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems. It recognises the health of humans, domestic and wild animals, plants and the wider environment (including ecosystems) are closely linked and interdependent." This approach calls upon multiple sectors, disciplines, and communities to work together to promote wellbeing, address threats to health and ecosystems, and respond to shared needs for clean water, energy, and air, safe and nutritious food, and action on climate change, thus contributing to sustainable development [2].

From a European perspective, the Berlin Principles on One Health [3] have further institutionalised the approach across professional, scientific, and academic domains, framing it as a response to anthropogenic environmental change—characterised by climate change and biodiversity loss—which poses unprecedented threats to planetary health and human wellbeing [4]. One Health and planetary health are highly complementary frameworks: while One Health emphasises the integrated management of human, animal, and ecosystem health—particularly regarding zoonoses and antimicrobial resistance—planetary health broadens this lens to encompass the full range of human disruptions to Earth’s natural systems and their consequences for all life [4,24]. Together, they converge on a shared imperative: that human health and the health of the planet are inseparable, and that university education must reflect this systemic interdependence. Unlike classical sectoral approaches, One Health promotes a systemic and holistic vision that positions health professionals as agents of change capable of managing health determinants that medicine and public health cannot adequately capture in isolation [5]. Effective implementation of this philosophy, however, requires robust governance that transcends anthropocentrism and moves towards ecocentrism, prioritising ecosystem integrity and the deep prevention of disease [6].

Despite its relevance for global security and for managing challenges such as zoonoses, antimicrobial resistance (AMR), and food safety, the mainstreaming of One Health faces significant barriers, including institutional bureaucracy, insufficient funding, lack of political will, and cultural differences in professional practice [7]. In this context, One Health education emerges as a foundational pillar. The literature consistently argues that it is imperative to expand academic training to foster systemic thinking, interdisciplinary collaboration, and information sharing from the earliest stages of professional careers [8].

A key development in understanding health determinants is the concept of the exposome—the totality of environmental exposures (external and personal) to which an individual is subjected from conception to death. Unlike genetics, the exposome encompasses factors such as pollution, solar radiation, stress, diet, physical activity, sleep, and education. This has given rise to the concept of the "neuroecological exposome" [9], which underlines the cognitive dimension necessary to address contemporary and cutting-edge health strategies within the OH framework [10].

For One Health to become an operational reality—moving not only towards interdisciplinarity but also towards transdisciplinarity—a systematic impetus from educational models is required. This would enable future professionals to operate within infrastructures of collaborative learning, sustainability, and equity across species and disciplines [5,6].

• One Health Education: A Transdisciplinary University Teaching Model

The imperative to educate educators is as critical as educating clinicians or veterinarians. Without a grasp of the interdependence between human, environmental, and animal health, teachers in training will be unable to transmit these competencies across educational levels, thus breaking the chain of systemic change [11]. Teaching health from a One Health perspective is an urgent necessity in contemporary education, addressing the complex interrelationship among human, animal, and environmental health [12].

A landmark example is the creation of a Bachelor of One Health at a comprehensive Canadian university, spanning multiple faculties and aimed at preparing professionals to face the interconnected challenges of public health, veterinary medicine, and environmental sustainability. The success of such programmes has been linked to factors such as initial institutional support, clarity in learning outcomes, and consistent communication among academic stakeholders [12].

Beyond higher education, Abia et al. [11] highlight the importance of educating children and communities about One Health principles, thereby fostering holistic understanding and equipping younger generations to address critical issues such as climate change and its health impacts. In crisis contexts marked by interconnected environmental and social challenges, Jochem et al. [13] call for a shared vision of One Health Literacy, emphasising the integration of these concepts into formal education and public policy.

Research by Özbaş et al. [14] demonstrates how an interdisciplinary educational approach can enhance Environmental Health Literacy (EHL). Their project, implemented in Italy, Portugal, and Turkey, integrated One Health training for adults, fostering ecological skills and environmental awareness. Pérez-Martín and Esquivel-Martín [15] further argue for a transformative environmental education approach, proposing the integration of Environmental Education within One Health Literacy—alongside established Health Education—to foster critical thinking and sustainable practices.

Antimicrobial resistance (AMR) represents one of the greatest threats to global health, yet also constitutes a significant opportunity to advance integrated One Health training. Nadar et al. [16] developed a One Health-based secondary school curriculum addressing AMR in the United States, demonstrating that even pre-university levels benefit substantially from this approach. Concurrently, McMullen et al. [17] identified structural barriers in universities that limit the development and delivery of One Health programmes, including misperceptions, inconsistent administrative support, and limited community collaboration, while also highlighting opportunities for continuous programme evaluation and greater community engagement.

The review of One Health core competencies by Laing et al. [18] highlights the importance of defining the skills, values, and knowledge required to build a competent workforce. Neboğlu and Kiraz [19] further developed an exemplary curriculum via a Delphi study examining pre- and postgraduate One Health content across diverse academic disciplines. As One Health Education expands, it is increasingly evident that success rests on interdisciplinary—and ultimately transdisciplinary—collaboration, programme adaptation, and awareness-building at all levels of society.

Research Questions

This study addressed the following research questions:

• RQ1. Do undergraduate students in Education, Nursing, and Biology know the term "One Health" and can they define the approach?
• RQ2. What are these students' perceptions regarding the disciplines involved in One Health, the appropriateness of its inclusion in science teaching, the suitable educational level for its incorporation, and the university knowledge field in which it should be situated?
• RQ3. Are there statistically significant differences in curricular perceptions of One Health among the three undergraduate degree groups?
• RQ4. What effect does a brief training intervention produce on knowledge and perceptions of One Health in students of the University Master's Degree in Secondary Education Teacher Training (Biology specialisation)?

2. Materials and Methods

2.1. Study Design

This work adopted a two-phase sequential design. Phase 1 employed a descriptive and inferential cross-sectional approach, analysing scientific knowledge and perceptions of One Health across three undergraduate degree programmes. Phase 2 employed a pre-experimental single-group (cohort) design involving a training intervention with students from the University Master's Degree in Secondary Education Teacher Training, Biology specialisation.

The study was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided informed consent. No personally identifying data were collected. Ethical approval was granted by the Research Bioethics Committee of the University of Extremadura [Nº:62/2025].

2.2. Participants

2.2.1. Phase 1: Undergraduate Students

Participants were recruited by convenience sampling from three undergraduate programmes at the University of Extremadura: Bachelor's Degree in Primary Education (n = 22), Bachelor's Degree in Nursing (n = 45), and Bachelor's Degree in Biology (n = 13). Inclusion criteria were: (a) current enrolment in an undergraduate programme; (b) no prior formal training in One Health; and (c) voluntary participation. The total Phase 1 sample was N = 80.

2.2.2. Phase 2: Master's Students

Phase 2 participants were 18 students enrolled in the University Master's Degree in Secondary Education Teacher Training (Biology specialisation) at the same institution. All held undergraduate degrees in Biology or related biological sciences. Prior to the intervention, all participants confirmed the absence of any prior knowledge of the One Health approach, consistent with Phase 1 findings. The sample size of n = 18, although modest, is consistent with other pilot intervention studies in One Health targeting specialised postgraduate cohorts [20], and is sufficient for the descriptive and comparative purposes of the analysis given the magnitude of the effects observed.

2.3. Procedure

2.3.1. Phase 1: Cross-Sectional Study

The questionnaire was administered during regular in-person class sessions to ensure high response rates. Participation was voluntary and anonymous. The instrument was completed on paper (estimated time: 10–15 min). Data collection took place during the 2024–2025 academic year. Given the cross-sectional design, no pre-intervention measurement was taken; the assumption of no prior One Health exposure was confirmed by item A1 data.

2.3.2. Phase 2: Pilot Intervention Study

The One Health training intervention was delivered to the Master's group within their regular academic activities. The session consisted of approximately 90 minutes covering: (1) the historical origin and institutional evolution of the One Health concept; (2) the scientific foundations of the human–animal–environment interface and selected case studies (COVID-19, antimicrobial resistance, zoonoses, healthy hydration, climate-sensitive diseases and foods); (3) the disciplines involved and the competency framework for One Health professionals; and (4) the educational dimensions of One Health for secondary Biology teachers, including connections with the official Biology and Geology curriculum for compulsory and post-compulsory secondary education. The questionnaire was administered immediately after the intervention session.

2.4. Instrument and Data Analysis

A standardised One Health questionnaire, previously used with similar student samples [21] and adapted from Ercan Şahin and Öner (2024) [21], was employed (Appendix A). Dichotomous responses were coded 0 = No and 1 = Yes. Multiple-choice items were categorised using a coding scheme (Appendix B).

Descriptive (frequencies, percentages, arithmetic means) and inferential (Kruskal–Wallis test with epsilon-squared ε² effect size) analyses were conducted using Microsoft Office Excel 365 and Jamovi. The significance level was set at p = 0.05. Non-normal distributions were verified via the Shapiro–Wilk normality test (p < 0.05). Internal reliability was assessed via Cronbach's Alpha (α = 0.61, moderate-to-acceptable).

3. Results

3.1. Phase 1: Cross-Sectional Study in Undergraduate Students (N = 80)

As shown in Table 1, analysis of the level of One Health knowledge revealed a total absence of conceptual literacy. None of the participants (0%) reported knowing the term or was able to define it correctly, regardless of their degree programme (Education, Nursing, or Biology).

Table 2, Table 3, Table 4 and Table 5 present, jointly, the descriptive statistics (means and percentage frequency distributions) and inferential results (Kruskal–Wallis) for each of the four curricular perception variables.

Regarding the variable Disciplines (Table 2), means ranged from M = 1.462 (Biology) to M = 1.818 (Education). The Kruskal–Wallis test revealed no statistically significant differences between groups (χ² = 0.601, df = 2, p = 0.740, ε² = 0.008).

For the dichotomous variable Bio and Health (Table 3), the proportion of affirmative responses was 54.5% (Education), 62.2% (Nursing), and 69.2% (Biology). The Kruskal–Wallis test confirmed no statistically significant between-group differences (χ² = 0.774, df = 2, p = 0.679, ε² = 0.010).

For the variable Educational Level (Table 4), means ranged from M = 1.538 (Biology) to M = 2.889 (Nursing). The Kruskal–Wallis test confirmed no statistically significant differences (χ² = 1.943, df = 2, p = 0.379, ε² = 0.025).

Regarding the variable University Knowledge Field (Table 5), means ranged from M = 1.222 (Nursing) to M = 1.769 (Biology). The Kruskal–Wallis test confirmed no statistically significant between-group differences (χ² = 2.685, df = 2, p = 0.261, ε² = 0.034).

3.2. Phase 2: Pilot Intervention Study—Master's Students (n = 18)

Table 6 presents the integrated post-intervention results for both the knowledge variables and the curricular inclusion perception variables.

Following the training intervention, 100% of participants (n = 18) reported being aware of the term One Health. The ability to correctly define the term was demonstrated by 94.4% of participants (n = 17); a single participant reported knowing the term but was unable to provide an adequate definition.

Regarding curricular inclusion perceptions, unanimous agreement was reached on inclusion in science teaching (Bio and Health: 100%). For the Disciplines variable, 77.8% of the sample selected "all disciplines" (Code 3). For Educational Level, Code 6 ("all levels") was the most frequent response (50.0%). For the Knowledge Field variable, Code 2 ("more than one field") was the most prevalent response (83.3%).

4. Discussion

The findings of this study provide robust evidence of a structural gap in One Health literacy in higher education, characterised by a total absence of conceptual knowledge among undergraduates and its rapid acquisition following a specific training intervention.

The most striking finding in the diagnostic phase is that none of the 80 undergraduate students—regardless of discipline—was aware of the term "One Health" or could define it correctly. This indicates that the approach is not being effectively incorporated into university curricula and is consistent with prior literature demonstrating that One Health training tends to be confined to specific programmes or advanced levels, without systematic integration into undergraduate education [12,17]. This fragmentation hinders the development of interdisciplinary competencies in global health [18].

The curricular perception variables were statistically homogeneous across all three groups, with negligible effect sizes (ε² < 0.035). This homogeneity suggests that, in the absence of any One Health literacy, students' perceptions of its curricular placement are shaped by disciplinary intuition rather than informed understanding—further confirming the depth of the formative gap.

The finding that Nursing students exhibited the lowest levels of prior knowledge and conceptual understanding is particularly salient, given the critical role of these professionals in public health promotion, disease prevention, and health education [22]. The low literacy observed suggests that current Nursing programmes may lack sufficient content integrating the transdisciplinary perspective of One Health, limiting future professionals' capacity to address complex challenges such as AMR, emerging zoonoses, and environmentally linked diseases [16,17]. Biology education, by contrast, appeared to foster basic One Health competencies through the integration of ecological and biological systems in the curriculum, consistent with the literature [8,12].

The effective implementation of One Health in higher education requires more than the mere inclusion of theoretical content: an integral pedagogical approach is needed, combining active strategies, project-based learning, and practical experiences that connect theory and practice [8,23]. Programmes such as the Canadian Bachelor of One Health demonstrate that clarity in learning outcomes, inter-faculty coordination, and institutional support are decisive factors for transdisciplinary training [12]. Without these elements, One Health education risks remaining fragmented and restricted to specific sectors.

The incorporation of the neuroecological exposome paradigm into educational programmes is equally relevant [10]. This framework enables students to develop critical and systemic thinking skills essential for understanding the interconnection between human, animal, and environmental health, as well as external determinants of chronic and emerging diseases [9,10]. This is especially pertinent for future teachers, who can transmit these competencies to younger learners, promoting systemic change in health literacy [11,13].

The discussion of One Health literacy must also engage with transformative environmental education. Pérez-Martín and Esquivel-Martín [15] argue that traditional environmental education has been insufficient to prepare students for complex socio-environmental problems, and that integrating One Health can strengthen critical and sustainable competencies. In the same vein, Özbaş et al. [14] demonstrate that an interdisciplinary approach can improve environmental health literacy and promote ecological responsibility.

The pilot intervention in Phase 2 produced results of exceptional magnitude: 100% awareness and 94.4% correct definition after a single 90-minute session. This effect size is remarkable and suggests that even minimal structured exposure to One Health content produces substantial conceptual gains in scientifically literate cohorts. These findings are consistent with those of Häsler et al. [20] regarding the feasibility and impact of targeted One Health interventions in specialised graduate cohorts.

Structural barriers must also be addressed. McMullen et al. [17] note that misperceptions, inconsistent administrative support, and limited community collaboration recurrently impede One Health programme integration. Universities must implement strategies that strengthen inter-faculty coordination, promote pedagogical innovation, and facilitate communication between teachers and students across disciplines.

Taken together, the evidence from this study reinforces the urgency of establishing transdisciplinary educational programmes that integrate content from health sciences, education, and environmental science, promoting a holistic approach that prepares students to face complex health and environmental challenges ethically and collaboratively [5,8,15,18]. This imperative is reinforced by the planetary health perspective, which frames the wellbeing of human civilisation as inseparable from the integrity of the natural systems on which it depends [24]. As the journal Challenges—Journal of Planetary Health recognises, addressing the Grand Challenges of the Anthropocene demands educational responses that cross disciplinary boundaries, foster systems thinking, and cultivate a sense of shared responsibility for people, animals, and the planet. The alignment of these goals with the Sustainable Development Goals—particularly SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 15 (Life on Land)—further justifies the prioritisation of One Health literacy as a public good and a sustainability imperative.

5. Conclusions

This study demonstrates the existence of a profound and discipline-independent formative gap in One Health literacy within undergraduate higher education, characterised by the complete absence of conceptual knowledge across Education, Nursing, and Biology degree programmes. Perceptions of curricular inclusion were statistically homogeneous across groups, reflecting a generalised lack of foundational literacy rather than discipline-specific differences.

The brief educational intervention conducted with Biology Master's students produced highly significant gains in One Health knowledge and resulted in more positive, interdisciplinary perceptions of its curricular integration—demonstrating that targeted, structured training can efficiently close this gap even in specialised cohorts.

These findings call for: (1) the systematic and cross-disciplinary integration of the One Health approach in undergraduate curricula across health, biological, and educational sciences; (2) the training of teachers at all levels as active agents of systemic change in health literacy; (3) the development of pedagogical interventions informed by the exposome and neuroecological frameworks; and (4) further research with larger samples, control groups, and longitudinal designs to assess the retention and professional transfer of One Health competencies.

One Health education constitutes an indispensable global public good and a core pillar of health for sustainability. Its integration into university education is not merely desirable—it is a pressing priority for the public health and sustainability of planetary ecosystems, and a direct contribution to the planetary health movement’s goal of safeguarding the flourishing of all life on Earth.

Appendix A. Adapted One Health Questionnaire

The following instrument was adapted from Ercan Şahin and Öner (2024) [21] for use with undergraduate and Master's student samples.

Informed Consent Statement:

I give my Informed Consent to this study and to the possible results of this questionnaire being used anonymously for research purposes, which will at all times comply with the ethical recommendations of the Declaration of Helsinki.

Participant Information:

Full name: _______________ Surname(s): ____________

Undergraduate Degree: ___________ University: __________

Year of Degree Award (if already obtained): __________

Age: ___ Date: ____________

Questions:

• Q1. Are you familiar with the term One Health (One World, One Health)? □ Yes □ No
• Q2. If so, since when have you known this term?
• Q3. How did you learn about it? □ Pre-university/undergraduate education □ University degree □ Scientific conference □ Press article □ Social media □ Internet □ Other: ___
• Q4. How would you define the term One Health?
• Q5. Which disciplines are involved in One Health? (tick all that apply): □ Medicine □ Veterinary Science □ Nursing □ Biology □ Agricultural Engineering □ Pharmacy □ Policy Sciences □ All of the above
• Q6. Should One Health be included in science teaching? □ Yes □ No
• If yes, from what educational level? (tick all that apply): □ Pre-university / compulsory secondary □ Undergraduate □ Master's □ Doctoral □ All levels
• Q7. In which university knowledge field should One Health primarily be included? (tick all that apply): □ Interdisciplinary and multidisciplinary □ Mathematics and Physics □ Chemistry □ Cell and Molecular Biology □ Biomedical Sciences □ Natural Sciences □ Engineering and Architecture □ Social, Behavioural and Educational Sciences □ Economics and Business □ Law and Jurisprudence □ History and Arts □ Philosophy, Philology and Linguistics

Appendix B. Multiple-Choice Item Coding Scheme

Variable (Item)	Code	Coding Criterion
Disciplines (Q5)	0	No discipline selected (non-response or "none")
	1	Exactly one discipline selected
	2	More than one discipline selected, excluding "all"
	3	"All disciplines" selected
Educational Level (Q6)	0	No level selected
	1	Pre-university / compulsory secondary only
	2	Undergraduate only
	3	Master's only
	4	Doctoral only
	5	More than one level (partial combination)
	6	"All levels" selected
Knowledge Field (Q7)	0	No field selected
	1	Exactly one knowledge field selected
	2	More than one field selected (excluding Field 0/Interdisciplinary)
	3	Interdisciplinary and multidisciplinary explicitly selected