WONCA Air Health Train the Trainer Program.

From March 2019 to October 2020 members of the WONCA Working Party for the Environment ran the WONCA Air Health Train the Trainer Program. We were motivated by the numbers: WHO reports that air pollution, both outdoor and household, causes an estimated 7 million deaths annually, and is the second leading cause of deaths from noncommunicable diseases (NCDs) after tobacco smoking. However, it is yet to be established in the curriculum of health-care students, with an estimated 11% of the 2817 medical schools surveyed around the world having formal education on air pollution and health.We had 178 health professionals from 52 different countries apply for the program and we selected 73 funded trainers based on factors such as the impact of air pollution in their country, geographical spread, diversity in health profession, and ability to be successful in engaging other health professionals on air pollution. After completing two self-directed online training courses, educational videos, and a webinar with presentations from existing trainers and air pollution teaching slides, trainers were ready to take their training to their local communities.

The depth and breadth of the training delivered by trainers was astonishing. Some trainers impressed us by the number of health professionals, school students, workers, and other community members they reached through face-to-face training. Several trainers spoke about the health effects of air pollution on television, radio, and podcasts. Others improved local and national knowledge and evidence by installing low-cost air pollution sensors around community health clinics and conducting air pollution research projects, particularly in vulnerable communities, such as pregnant women exposed to household air pollution and inmates exposed to air pollution in a penitentiary. Trainers also built air pollution into school programs, medical guidebooks and one developed a massive open online course. All-in-all, 370 unique training activities were delivered, with an estimated direct reach of 20,940 people and a potential indirect reach estimated in the millions. The number and variety of trainings delivered clearly demonstrates what can be achieved by primary care and other health professionals when combining passion and motivation with a small amount of funding. And this was achieved while all trainers responded to the COVID-19 pandemic, which affected them partway through the program.

Reflecting on the training program, there are several lessons that we have learned around the recruitment and retention of trainers, the training that was delivered to trainers, and the types of activities delivered by trainers. We presented these findings in an article recently published in The Lancet Planetary Health (https://doi.org/10.1016/S2542-5196(22)00218-2). We now hope to take these lessons we have learned and apply them to a new round of training. We are working with WHO to develop a comprehensive training program for healthcare practitioners in air pollution and health, and hope to participate in training our colleagues with this training package. To this end, the WONCA Working Party for the Environment is currently seeking funding to support this effort.

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