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A Survey on Topics Rating for the Undergraduate and Diploma in Environmental Health:

A Survey on Topics Rating for the Undergraduate and Diploma in Environmental Health: Environmental health (EH) is the study of environment and environmental factors affecting the health of human. Identifying the most relevant and up-to-date and updated teaching topics of EH programs is vital to ensure competent practitioners are nurtured. Thus, this study aimed to attain the view of current content of EH programs for EH professionals and intended to recommend topics necessary for education and practice. The level of importance of current and newly proposed topics for EH courses at diploma and bachelor’s level was assessed using a cross-sectional survey design. Practicing EH programs graduates were invited via social media and e-mails to participate in the survey. The respondents were asked to rank the importance of different EH topics based on 5-point Likert-type scale. Descriptive statistics were employed to report the importance of EH curricula at Malaysian tertiary institutions. It was found that between diploma’s and bachelor’s level, the bachelor’s graduates were expected to have high exposure in existing topics such as vector control management, legislation for EH and safety, health and safety risk assessment, as well as newly proposed topics including critical literature evaluation and innovation in creating awareness activities. The findings from this survey could serve as a guide to improvise EH curricula to ensure the EH programs continue to produce students with the necessary skills, knowledge, and competencies. Keywords higher education, teaching and learning, environmental health, university, environmental education implementation of National Environmental Health Action Introduction Plan (NEHAP), which consists of EH-related programs or According to World Health Organization (2018), environmen- activities, is being implemented by various agencies, stake- tal health (EH) includes all the physical, chemical, and bio- holders, and importantly EH practitioners including EH offi- logical factors related to a human being, and all the related cers, public health inspectors, EH academicians to control and factors affecting the behaviors. It consists of the assessment mitigate the emerging health impacts from EH hazards and control of environmental factors that can potentially affect (Department of Environment, 2018). health, well-being, and sustenance by preventing disease and In 1975, Public Health Instutitions under Ministry of creating health-supportive environments for all living beings. Health, Malaysia, in collaboration with the Royal Society for Similarly, a fundamental element for strong economy of a the Promotion of Health based in London offered a 3-year nation is environmental sustainability. To ensure the sustain- Diploma of the Royal Society for the Promotion of Health. ability and continued growth, health and safety are important aspects in different sectors and the environment is one of the Universiti Teknologi MARA, Bertam, Malaysia determinants of human health (Commission on Social Universiti Teknologi MARA, Shah Alam, Malaysia Determinants of Health, 2008). Malaysian society is increas- University of Tasmania, Hobart, Australia ingly populated and urbanized, resources such as air, water, 4 KPJ Healthcare University College, Nilai, Malaysia and land continue in high demand leading to widespread pol- Universiti Teknologi MARA, Puncak Alam, Malaysia lution (Department of Statistics Malaysia, 2016). National Corresponding Author: Policy on the Environment (DASN) of Malaysia aims to adopt Qi Ying Lean, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), an environmentally sound and sustainable development plan Bertam Campus, 12300 Kepala Batas, Penang, Malaysia. (Department of Environment, 2018). The development and Email: leanqiying@yahoo.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Nevertheless, tertiary education of EH had not made much and with nationwide access by EH practitioners. The ques- progress until 1996, when Universiti Teknologi MARA tionnaire consisted of two main sections providing ques- opened its first diploma in EH and then followed by other tions on public universities such as Universiti Sains Malaysia, Universiti Kebangsaan Malaysia, and Universiti Putra 1. demographic data of respondents, and Malaysia offering their environmental studies and environ- 2. list of current and potential topics deemed important mental sciences programs in relation to health. Lately, private to be included in the EH curricula. universities such as Universiti Selangor, MAHSA University, Universiti Kuala Lumpur also have started to offer diploma The list of topics was compiled from the programs and undergraduate degrees in EH to cater for the increasing (Diploma and Bachelor of EH or Environmental Safety) demand for EH professionals in the country. The programs offered by University of Malaya, Universiti Kebangsaan include all the EH scope such as food quality and safety, Malaysia, Universiti Sains Malaysia, and UiTM. The scope water and air quality, vector and pest management control, and spectrum of EH were very broad; additional listed top- vector and communicable disease control, international ics were proposed to each program. A 5-point Likert-type health, health education, EH impact and risk-based assess- scale from not required (1) to highly required (5) was ment, waste and wastewater management, occupational employed to reflect the importance of each topic. To enhance health and safety, and the global health (Faculty of Health the understanding while filling in questionnaire, brief reflec- Sciences, 2017; Faculty of Medicine and Health Sciences, tions of each Likert-type scale were included in the sub- 2018). These programs address the need for EH students to heading: “not required,” “slightly required (introduction to understand and evaluate the risks posed by the stressors of the the knowledge will be enough),” “uncertain (do not know),” EH, through equipping them with the knowledge, expertise, “moderately required (using a basic concept),” and “highly and skills needed to take on and enhance their role as a profes- required” (with hands-on experience on concept and train- sional in this field (Moldan, Janoušková, & Hák, 2012). ing).” Face and content validity of the questionnaire were Moreover, it is important to determine whether the EH conducted by pilot-testing among five senior lecturers and courses are relevant in term of employability of the graduates members of EH fraternity. The comments and feedback (Dunn et al., 2018). Students often perform well in the class- received were used as a reference to improve the content, room or examinations to earn good grades; however, it is understanding ability, and completeness of the question- uncommon for them to fit in the working environments com- naire. A pilot test was then performed to corroborate the reli- fortably. The advancement of technology and the augmented ability and validity of the questionnaire used in this study. complexity of EH and modern lifestyle point out to the The reliability test was applied to all variables. Internal reli- necessity of EH program reassessment (Ahonen & Lacey, ability was performed on the responses from 20 respon- 2017; Friedman & Lee, 2015; Mujuru & Niezen, 2004). dents. Table 1 shows the Cronbach’s coefficient alpha for These include the need to look at EH curriculum to address each measure for all variables, which suggested a good issues of programmatic improvement and to determine the internal consistency. Nonetheless, the perceived importance outcome measure of professional competencies of EH gradu- of topics could have been affected by the respondents’ dif- ates (Rehfuess & Bartram, 2014). As EH programs have ferent background and varied working environments. been introduced in Malaysia, there are no specific study reported on the need-based education and its current perspec- Respondents and Sampling Method tive in the practice. Therefore, this study was aimed to review the topics covered by EH curricula. Convenience sampling was used to recruit respondents. All graduates of diploma or bachelor’s in EH or environmental safety and health from local or overseas universities were Method invited to participate in the survey. Those who had stopped practicing in this field for the past 2 years and students cur- Study Design rently undertaking their diploma and degree were excluded A cross-sectional survey was conducted from December from the study. Respondents were invited via e-mail and 2016 to May 2017. Ethical approval was granted by the messenger service on social media with a copy of the link to Research Ethics Committee of Universiti Teknologi MARA the survey. The invitation message included an explanatory (UiTM; 600-RM-5/1/6). All the information obtained from statement, the link to informed consent form, and the online the data collection was kept confidential. questionnaire. An e-mail or messenger reminder was sent to all respondents 2 weeks after the initial invitation. A non- probability sampling using convenience sampling was used Questionnaire Design for the study; therefore, no sampling frame and sample size An online questionnaire form was designed using Survey calculation were not performed as suggested in literature Monkey, a platform that allows questions to be posted online (Omair, 2014). Arshad et al. 3 Table 1. Reliability Analysis of Variables. respondents with partial or missing data were excluded in the analysis. Descriptive statistics were employed to report the Number of Cronbach’s respondent demographic variables (n, %) and perceived Variable items coefficient α importance of different topics based on Likert-type scale (M Topics included in diploma in 23 .881 ± SD). environmental health Topics included in the bachelor of 37 .874 Results environmental health Proposed additional topics and 18 .895 Demographic and Working Information feedbacks for diploma and bachelor of environmental health A total of 152 respondents took part in the survey. As shown in Table 2, more than half (61.8%) of the respondents were females and majority of them (93.4%) aged less than 35 Table 2. Demographic Characteristics of Respondents. years old. They worked as an assistant EH officer (44.7%), mostly at District Health Office and Local Authority (59.2%). Variables n (%) In this study, the respondents’ median duration of working Gender experience was, with most had worked less than a year Male 58 (38.2) (44.7%) and majority of them (60.5%) graduated with a Female 94 (61.8) diploma in EH. Age 18-24 62 (40.8) 25-34 80 (52.6) Perception of the Relevance of Curriculums of EH 35-44 7 (4.6) for Diploma and Bachelor 45-54 1 (0.7) The mean scores of the importance of each subject of the 55-64 2 (1.3) diploma and bachelor’s of EH were shown in Tables 3 and 4, Occupations Environmental health officer 6 (3.9) respectively. For diploma in EH, prevention and control of Environmental health officer assistant 68 (44.7) diseases, pest and vector management, and experiential Tutor 31 (20.4) learning were considered the most essential modules and rel- Lecturer 3 (2.0) evant to EH studies (Table 3) as opposed to modules related Others 44 (28.9) to health and safety, vector management and EH legislation, Highest level of education which were marked as top priority for bachelor’s degree Diploma 92 (60.5) level (Table 4). This shows that the migration of interest in Bachelor 52(34.2) diploma graduates evolved consistently as bachelors’ under- Master 7 (4.6) graduates in EH practice. This could be attributed to the stu- PhD 1 (0.7) dents continued understanding and need for EH-related Sector issues facing the local and global community at large. Some Private sector 29 (19.0) topics such as pest and vector management were continu- Regulatory/enforcement office 6 (3.5) ously sought after at higher degrees. This could be due to Academic/university 11 (7.2) emerging public health issues, disease transmission, and District health office or local authority 90 (59.2) research on vectors. Industry 1 (0.7) Others 15 (9.9) Years of experience Feedback of Additional Topics to be Included in <1 68 (44.7) Courses 1-3 25 (16.4) >3-5 12 (7.9) Respondents then rated other new topics to be included in >5-7 14 (9.2) each of the EH-related courses (Table 5). The suggested top- >7-9 18 (11.8) ics were well accepted by respondents (mean score > 4). ⩾10-15 9 (5.9) Critical evaluation of EH information and databases, con- >15 6 (3.9) ducting and evaluating current awareness programs were the top picks of respondents for both discipline of the study. Big data analysis and interpretation on public-related EH issues Data Analysis are being given due consideration and priority as global stud- ies focused on early warning systems and the need for early The data were analyzed using Statistical Package for the detection systems worldwide. EH practice encompasses Social Sciences (SPSS), Version 17.0. Data sets from 4 SAGE Open Table 3. The Level of Importance of Topics for Diploma in Table 4. (Continued) Environmental Health. Subjects M ± SD Subjects M ± SD Health promotion and education 4.5 ± 0.7 Prevention and control of diseases 4.9 ± 0.4 Research methodology 4.5 ± 0.7 Pest and vector control management 4.9 ± 0.4 Final year project 4.5 ± 0.8 Environmental health practical training in district 4.9 ± 0.4 Environmental health ethics 4.4 ± 0.7 health office or local authority Analytical technique and instrumentation 4.4 ± 0.8 Introduction to environmental health 4.8 ± 0.4 Environmental microbiology 4.4 ± 0.7 Water supply 4.8 ± 0.5 Organization management 4.3 ± 0.8 Occupational safety and health 4.8 ± 0.5 Built environment and technology 4.3 ± 0.8 Food hygiene and safety 4.8 ± 0.4 Environmental chemistry 4.3 ± 0.9 Environmental health law and legal procedure 4.8 ± 0.4 Industrial ecology 4.3 ± 0.9 Epidemiology and biostatistics 4.7 ± 0.6 Biochemistry for environmental health 4.2 ± 0.9 Introduction to risk assessment 4.7 ± 0.6 Housing and residential environment 4.2 ± 0.8 Food technology 4.7 ± 0.7 Health psychology 4.1 ± 0.9 Solid waste management 4.7 ± 0.6 Anatomy and physiology 3.9 ±1.0 Environmental pollution and monitoring 4.7 ± 0.6 Environmental health case studies of 4.7 ± 0.6 environmental health issues Table 5. The Level of Importance of Proposed Topics for Fundamentals of environmental health 4.6 ± 0.6 Diploma and Bachelor of Environmental Health. management Diploma in environmental health Environmental health promotion and education 4.6 ± 0.6 Microbiology for environmental health 4.4 ± 0.7 Critical evaluation of online information including 4.3 ± 0.7 Technical documentation in environmental health 4.4 ± 0.7 environmental health information Environmental toxicology 4.4 ± 0.8 Searching the literature using e-databases/library 4.3 ± 0.8 Land use and housing 4.2 ± 0.9 resources Chemistry for environmental health 4.0 ± 0.9 Creating bulletin/newsletters and evaluating 4.3 ± 0.8 Organic chemistry for environmental health 3.9 ±1.0 current awareness programs Applying online applications and Internet 4.2 ± 0.8 technologies to community Understanding national environmental health 4.2 ± 0.9 Table 4. The Level of Importance of Topics for Bachelor of financing Environmental Health. Bachelor of environmental health Subjects M ± SD Critical review and evaluation of environmental 4.5 ± 0.7 Occupational safety and health 4.8 ± 0.5 health information and databases Vector control management 4.8 ± 0.5 Conducting and evaluating current awareness 4.5 ± 0.7 Legislation for environmental health and safety 4.8 ± 0.5 programs Health safety and environment 4.8 ± 0.5 Risk communication 4.5 ± 0.8 Industrial hygiene and safety 4.8 ± 0.6 Applying scientific basis for policy decisions 4.3 ± 0.9 Health and safety risk assessment 4.8 ± 0.5 Behavioral science 4.2 ± 0.9 Disease control 4.8 ± 0.5 Applying online applications and Internet 4.2 ± 0.8 Field experience 4.8 ± 0.5 technologies to community Practical training 4.8 ± 0.5 Applying economics for environmental 4.2 ± 0.9 Water supply and quality control 4.7 ± 0.6 management Environmental health and safety studies 4.7 ± 0.6 Explaining national environmental health financing 4.2 ± 0.9 Environmental impact assessment and auditing 4.7 ± 0.6 and planning Food safety 4.7 ± 0.6 Epidemiology 4.7 ± 0.6 Integrated solid waste management 4.7 ± 0.6 multidiscipline areas of studies that affect the general popu- Epidemiology and biostatistics 4.6 ± 0.7 lation and their daily routine lifestyles. Wastewater management in environmental health 4.6 ± 0.7 Overall, when respondents were asked for their most Occupational ergonomics 4.6 ± 0.7 interested subject area, nature science and social behaviors Pollution control 4.6 ± 0.7 scored the highest, approximately at 45% each (Table 6). Management and safety of toxic substances 4.5 ± 0.7 Most of them agreed that the major challenge (72.3%) faced Environmental toxicology 4.5 ± 0.7 in tackling environmental issue was minimal awareness and ignorance among public. Critical and creative thinking skills (continued) Arshad et al. 5 Table 6. Feedback on Subject Area, Challenges, and Required imparted during class sessions should be applicable during Skills for Environmental Health Education. the practical training and industrial attachment to promote individual understanding and competency (Knechtges & n (%) Kelley, 2015). Similarly, that integration of the flipped class- Preferable environmental health area room and online learning courses could have positive impacts Social behavior: belief, culture, and custom 66 (44.6) on learning and learning experiences in public health educa- Nutrition and diet 15 (10.1) tion (Galway, Corbett, Takaro, Tairyan, & Frank, 2014; Lean Nature science 67 (45.3) et al., 2018). The more interesting and faster information is Challenges faced in tackling environmental issues shared, the more likely education will advance in content and Government policy 10 (6.8) learning effectiveness. Lack of enforcement 18 (12.2) In facing an era of unprecedented changes, it is important Minimal public awareness and ignorance 107 (72.3) to examine the opportunities and threats to EH programs for Limited human and material resources 6 (4.1) sustainable development in Malaysia (Mahat & Idrus, 2017). Budget constraint 11 (7.4) Moreover, the complexity of EH issues increase, which will Essential skill or knowledge required in tackling environmental necessitate a well-educated, competitive, and well-trained issues EH workforce (Ahonen & Lacey, 2017). In line with the Leadership and responsibility 34 (23.0) national goals, universities aim to improvise programs that Productivity and accountability 12 (8.1) educate and prepare the next generation of EH professionals Social and cross-cultural skills 35 (23.6) who are able to develop and implement effective plans for Critical and creative thinking skills 55 (37.2) the communities, thus maximizing the health and well-being Information technology skills 16 (10.8) of the entire public (Foo, 2013). Fresh graduates of EH pro- grams are expected to become skilled in many aspects including environmental monitoring, health promotion, risk (37.2%) were rated as one of the most essential components assessment, emergency preparedness, and industrial hygiene. required in handling the environmental issues. Some subjects involve the application of the tools and tech- niques and thus hands-on experiences during tertiary educa- Discussion tion are deemed essential. For example, it is crucial to This study provides the rating of the importance of each EH conduct field studies such as pollution prevention, manage- topic for the syllabi of diploma and bachelor’s levels. This is ment, and restoration techniques for the subjects of industrial in line with other studies as to evaluate and revise the peda- ecology, occupational safety, and health. Students should be gogy for undergraduate training in EH is essential (Ahonen trained to be familiar to human health risk assessment and & Lacey, 2017; Marion & Sinde, 2015). In EH education, the management including the use of hazard identification, risk programs comprise courses such as public health, food assessment and risk control (HIRARC), chemical health risk safety, workplace health and safety, health and safety in the assessment (CHRA), hazard analysis and critical control home environment, public health, and environmental protec- point (HACCP), health risk assessment (HRA), occupational tion. To identify the skills and capabilities needed by EH pro- safety and health (OSH), international organization for stan- fessionals in different sectors, the research examined existing dardization (ISO), and others (Haimes, 2015). EH priorities of different subjects learned in each program. On the contrary, the new proposed modules aim to equip The results suggested that priority was given to subjects students with a broad understanding of the interrelationship related to prevention and control of vector-borne diseases, between health impacts and the environmental hazards, pub- water and food safety, and safety at work for the courses. On lic health, and well-being. It has been reported that in the contrary, fundamental knowledge in biochemistry and Malaysia, human activities have caused environmental human science such as anatomy and physiology were rela- quality degradation and affected the human health in multi- tively unfavorable subjects of the learning among EH gradu- ple ways (Department of Statistics Malaysia, 2016). ates. This could be due to the nature of those subjects that Contaminated food and water supply cause various types of may seem to be impractical subjects in their daily lives and food- and waterborne diseases such as cholera, typhoid work settings. Also, this might indicate the need for experi- fever, dysentery, viral Hepatitis A, and food poisoning enced EH practitioners who are capable to connect the invis- (Department of Statistics Malaysia, 2016). In 2015, the inci- ible dots of these topics to EH. dence rate of food poisoning was at 47.3 per 100,000 popu- In both diploma and bachelor’s degrees programs, attach- lations of Malaysia (Department of Statistics Malaysia, ment and training were rated highly important to prepare the 2016). Therefore, it is of urgent need to combat the issues by students to environmental and public health workforce, ensuring our EH enforcement officers are capable to over- ensuring them to be good at coordination and integration of come the barriers to the implementation of conservation, multidisciplinary approaches to EH problems (Dunn et al., sustainable development, and continued environment pro- 2018). The theory of fundamental subjects or the knowledge tection. The main challenge that EH practitioners are facing 6 SAGE Open was minimal public awareness and ignorance (72.3%), in advancing the role of community and public health officers. the effort to maintain and protect the environment. Social Hands-on, experiential training and work-integrated learn- behavior is the most challenging portion for any interven- ing are highly valuable to prepare graduates of EH in the tion activity to be successfully carried out and retained. open market, playing a critical role as EH practice Educating the community and community mobilization for workforce. intervention activities requires social behavior changes, which are often anguished and hurdled with skeptics and Authors’ Note ignorance by the public. Kamaruddin Arshad and Qi Ying Lean have contributed equally to Therefore, community-centered programs require experi- this work. enced and skilled EH workers who are able to think strategi- cally across the breadth and wealth of the fabric of EH Acknowledgment (Ferraro & Hanauer, 2014). The ability to critically evaluate The authors would like to express their gratitude to all respondents the associated EH factors and the potential impacts beyond who had contributed to the survey, Ministry of Education, and specific intervention, which must be fully stressed and Universiti Teknologi MARA (UiTM), Malaysia. underpinned by the teaching and learning throughout the EH program. This is important as in line with the District Health Declaration of Conflicting Interests Management in Malaysia, a full range of monitoring, sur- The author(s) declared no potential conflicts of interest with respect veillance programs and sustainable interventions to elimi- to the research, authorship, and/or publication of this article. nate or mitigate stressors could be conducted periodically thereby protecting human health and promoting continued Funding public well-being (Najwa et al., 2016). It is also desirable The author(s) disclosed receipt of the following financial support that the graduates are well equipped with the ability to under- for the research, authorship, and/or publication of this article: This take primary and secondary data obtained through the com- work was supported by Academic and Research Assimilation Grant munities. With a deep conceptual understanding, they can (ARAS), 600-IRMI/DANA5/3/ARAS (0037/2016) from Universiti critically interpret and evaluate the likely impacts on com- Teknologi MARA (UiTM), Malaysia. munity health and well-being, in which later their expert views will be highly required for current and future policy ORCID iD and decision making (Ferraro & Hanauer, 2014). Qi Ying Lean https://orcid.org/0000-0003-0331-8607 Evaluating the level of importance of EH topics could garner vital and critical information, which ensures higher References education providers should continuously provide quality and dynamic EH education. This also helps to revise the teaching Ahonen, E. Q., & Lacey, S. E. (2017). Undergraduate environmental public health education: Developmental evaluation to reframe and learning syllabi and system for meeting the job market a degree in a new school. NEW SOLUTIONS: A Journal of requirement in the future. The suggested topics of knowl- Environmental and Occupational Health Policy, 27, 107-123. edge and skills provided a baseline for syllabus review and Commission on Social Determinants of Health. (2008). Closing assessment of the existing programs, preparing students for the gap in a generation: Health equity through action on the careers in EH in the coming years and beyond. The findings social determinants of health. Final Report of the Commission may serve as important groundwork for a more detailed on Social Determinants of Health. Geneva: World Health meeting and consultation with the program stakeholders to Organization. further advance the emerging field of EH education. The pro- Department of Environment. (2018). National policy on the environ- gressive review and improvised courses with respect to the ment. Ministry of Energy, Technology, Science, Environment implementation of professional accreditation will ensure the & Climate Change. Retrieved from https://www.doe.gov.my/ universities in producing work-ready graduates who meet portalv1/en/tentang-jas/pengenalan/dasar-alam-sekitar Department of Statistics Malaysia. (2016). Compendium of envi- the market demand and public value of today and the future. ronment statistics. Putrajaya, Malaysia. . Retrived from https:// www.dosm.gov.my/v1/index.php?r=column/cone&menu_id= Conclusion dUg2UVgralU4cVluSFFIVG5RVmRpQT09. Dunn, L., Nicholson, R., Ross, K., Bricknell, L., Davies, B., This study identified and determined the importance of EH Hannelly, T., . . . Roiko, A. (2018). Work-integrated learn- topics for both diploma and bachelor’s programs in ing and professional accreditation policies: An environmental Malaysia. All new topics proposed including critical evalu- health higher education perspective. International Journal of ation of Work-Integrated Learning, 19, 111-127. EH information and database management and mining, con- Faculty of Health Sciences. (2017). Centre of environmental health ducting and evaluating health awareness programs, and & safety. Universiti Teknologi MARA. Retrieved from https:// applying online applications and Internet technologies to fsk.uitm.edu.my/en/index.php/academic/centre-of-study/ enviromental-health-and-safety communities were perceived as relevant to the courses in Arshad et al. 7 Faculty of Medicine and Health Sciences. (2018). Department Author Biographies of environmental and occupational health. Universiti Putra Kamaruddin Arshad graduated with bachelor of Health Sciences Malaysia. Retrieved from http://www.medic.upm.edu.my/ (Environmental Health) and master of Environment. He had worked department/department_of_environmental_and_occupational_ for twenty-eight years (1983-2011) in Public and Environmental health-353 Health Units in various District Health Offices, Hospital and State Ferraro, P. J., & Hanauer, M. M. (2014). Advances in measuring the Health Department. He joined UiTM as a lecturer in public and envi- environmental and social impacts of environmental programs. ronmental health. He has interest in water quality monitoring, food Annual Review of Environment and Resources, 39, 495-517. safety and hygiene, epidemiology and communicable disease con- doi:10.1146/annurev-environ-101813-013230 trol, solid waste management and environmental pollution control. Foo, K. (2013). A vision on the role of environmental higher educa- Qi Ying Lean completed her degree in BPharm (Hons.) at University tion contributing to the sustainable development in Malaysia. of Malaya, and started to work as a pharmacist at Penang Hospital. Journal of Cleaner Production, 61, 6-12. She then pursued her master and doctorate degrees at University of Friedman, L. H., & Lee, J. M. (2015). Undergraduate public health Tasmania, Australia and currently the Senior Pharmacy lecturer at education: Is there an ideal curriculum? Frontiers in Public UiTM. Having the passion in research and commitment to the under- Health, 3, Article 16. doi:10.3389/fpubh.2015.00016 standing of human health, she has been involving in several research Galway, L. P., Corbett, K. K., Takaro, T. K., Tairyan, K., & Frank, projects including pharmacy education, public health, prevention E. (2014). A novel integration of online and flipped classroom and management of illnesses and drug discovery. instructional models in public health higher education. BMC Medical Education, 14(1), Article 181. doi:10.1186/1472- Long Chiau Ming graduated with BPharm (Hons) and a master of 6920-14-181 Clinical Pharmacy, worked for three years in a hospital before pur- Haimes, Y. Y. (2015). Risk modeling, assessment, and manage- suing his PhD in Biopharmaceutics. He has a special interest in ment. Hoboken, NJ: John Wiley. translational research and healthcare education. He is actively Knechtges, P. L., & Kelley, T. R. (2015). Educating future environ- engaging with industry as well as supervising postgraduate students mental health professionals. Environmental Health Insights, 9, on projects related to healthcare, support services and pharmaceuti- 23-26. cal sciences. Lean, Q. Y., Ming, L. C., Wong, Y. Y., Neoh, C. F., Farooqui, M., & Muhsain, S. N. F. (2018). Validation of online learn- Sundara Rajan Mahalingam is a senior lecturer with UiTM and ing in pharmacy education: Effectiveness and student insight. has more than 25 years working field experience in environmental Pharmacy Education, 18, 135-142. health and public health. Specific field of interest includes Mahat, H., & Idrus, S. (2017). Education for sustainable develop- Communicable diseases, Vector-borne diseases, Food Safety, ment in Malaysia: A study of teacher and student awareness. Environmental Health Laws and Community related studies. Geografia-Malaysian Journal of Society and Space, 12, 77-88. Chua Say Tiong graduated with bachelor of Health Sciences Marion, J. W., & Sinde, Y. (2015). The need for environmental (Environmental Health) and master of Environment. He had public health professionals and the role of EHAC-accredited worked for twenty-three years (1987-2010) in Public and programs in increasing the pool. Journal of Environmental Environmental Health Units in various District Health Offices, Health, 78, 36-41. Hospital and State Health Department. Since 2010, he joined as a Moldan, B., Janoušková, S., & Hák, T. (2012). How to understand lecturer in public and environmental health field in UiTM. He has and measure environmental sustainability: Indicators and tar- interest in epidemiology and communicable disease control, solid gets. Ecological Indicators, 17, 4-13. waste management and environmental pollution control. He is Mujuru, P., & Niezen, C. (2004). Evaluation of an environmental supervising undergraduate students on projects related to public health education program: Assessing changes in knowledge of and environmental health. health professionals. AAOHN Journal, 52, 436-441. Najwa, Z. L., Ima, Z. N., KWan, M., Haslinda, I. N., Syafinaz, S. Amir Heberd Abdullah graduated with BSc (Hons) and a master I., Hasneezah, N., . . . Manaf, R. A. (2016). The concept of of Occupational Safety and Health Management, has 20 years district health management in Malaysia. International Journal working experience in Ministry of Health and various local authori- of Public Health and Clinical Sciences, 3(1), 1-16. ties before joining UiTM as academician. He has a special interest Omair, A. (2014). Sample size estimation and sampling tech- in management of safety and health. Still actively engaged with niques for selecting a representative sample. Journal of Health industry in terms of supervising practical students. Currently he Specialties, 2, 142-147. doi:10.4103/1658-600x.142783 holds the post as Head of Centre, Faculty of Health Sciences in the Rehfuess, E. A., & Bartram, J. (2014). Beyond direct impact: university. Evidence synthesis towards a better understanding of effec- Farah Ayuni Shafie graduated with PhD in Built Environment and tiveness of environmental health interventions. International during her study, she was involved with Industrial Ecology research Journal of Hygiene and Environmental Health, 217, 155-159. group exploring life cycle assessment and input-output analysis. World Health Organization. (2018). Environmental health. South- She is now supervising postgraduate and undergraduate studies on East Asia Regional Office, World Health Organization. Retrieved organic food, urban metabolism and climate change. from http://www.searo.who.int/topics/environmental_health/en/ http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE

A Survey on Topics Rating for the Undergraduate and Diploma in Environmental Health:

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Abstract

Environmental health (EH) is the study of environment and environmental factors affecting the health of human. Identifying the most relevant and up-to-date and updated teaching topics of EH programs is vital to ensure competent practitioners are nurtured. Thus, this study aimed to attain the view of current content of EH programs for EH professionals and intended to recommend topics necessary for education and practice. The level of importance of current and newly proposed topics for EH courses at diploma and bachelor’s level was assessed using a cross-sectional survey design. Practicing EH programs graduates were invited via social media and e-mails to participate in the survey. The respondents were asked to rank the importance of different EH topics based on 5-point Likert-type scale. Descriptive statistics were employed to report the importance of EH curricula at Malaysian tertiary institutions. It was found that between diploma’s and bachelor’s level, the bachelor’s graduates were expected to have high exposure in existing topics such as vector control management, legislation for EH and safety, health and safety risk assessment, as well as newly proposed topics including critical literature evaluation and innovation in creating awareness activities. The findings from this survey could serve as a guide to improvise EH curricula to ensure the EH programs continue to produce students with the necessary skills, knowledge, and competencies. Keywords higher education, teaching and learning, environmental health, university, environmental education implementation of National Environmental Health Action Introduction Plan (NEHAP), which consists of EH-related programs or According to World Health Organization (2018), environmen- activities, is being implemented by various agencies, stake- tal health (EH) includes all the physical, chemical, and bio- holders, and importantly EH practitioners including EH offi- logical factors related to a human being, and all the related cers, public health inspectors, EH academicians to control and factors affecting the behaviors. It consists of the assessment mitigate the emerging health impacts from EH hazards and control of environmental factors that can potentially affect (Department of Environment, 2018). health, well-being, and sustenance by preventing disease and In 1975, Public Health Instutitions under Ministry of creating health-supportive environments for all living beings. Health, Malaysia, in collaboration with the Royal Society for Similarly, a fundamental element for strong economy of a the Promotion of Health based in London offered a 3-year nation is environmental sustainability. To ensure the sustain- Diploma of the Royal Society for the Promotion of Health. ability and continued growth, health and safety are important aspects in different sectors and the environment is one of the Universiti Teknologi MARA, Bertam, Malaysia determinants of human health (Commission on Social Universiti Teknologi MARA, Shah Alam, Malaysia Determinants of Health, 2008). Malaysian society is increas- University of Tasmania, Hobart, Australia ingly populated and urbanized, resources such as air, water, 4 KPJ Healthcare University College, Nilai, Malaysia and land continue in high demand leading to widespread pol- Universiti Teknologi MARA, Puncak Alam, Malaysia lution (Department of Statistics Malaysia, 2016). National Corresponding Author: Policy on the Environment (DASN) of Malaysia aims to adopt Qi Ying Lean, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), an environmentally sound and sustainable development plan Bertam Campus, 12300 Kepala Batas, Penang, Malaysia. (Department of Environment, 2018). The development and Email: leanqiying@yahoo.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Nevertheless, tertiary education of EH had not made much and with nationwide access by EH practitioners. The ques- progress until 1996, when Universiti Teknologi MARA tionnaire consisted of two main sections providing ques- opened its first diploma in EH and then followed by other tions on public universities such as Universiti Sains Malaysia, Universiti Kebangsaan Malaysia, and Universiti Putra 1. demographic data of respondents, and Malaysia offering their environmental studies and environ- 2. list of current and potential topics deemed important mental sciences programs in relation to health. Lately, private to be included in the EH curricula. universities such as Universiti Selangor, MAHSA University, Universiti Kuala Lumpur also have started to offer diploma The list of topics was compiled from the programs and undergraduate degrees in EH to cater for the increasing (Diploma and Bachelor of EH or Environmental Safety) demand for EH professionals in the country. The programs offered by University of Malaya, Universiti Kebangsaan include all the EH scope such as food quality and safety, Malaysia, Universiti Sains Malaysia, and UiTM. The scope water and air quality, vector and pest management control, and spectrum of EH were very broad; additional listed top- vector and communicable disease control, international ics were proposed to each program. A 5-point Likert-type health, health education, EH impact and risk-based assess- scale from not required (1) to highly required (5) was ment, waste and wastewater management, occupational employed to reflect the importance of each topic. To enhance health and safety, and the global health (Faculty of Health the understanding while filling in questionnaire, brief reflec- Sciences, 2017; Faculty of Medicine and Health Sciences, tions of each Likert-type scale were included in the sub- 2018). These programs address the need for EH students to heading: “not required,” “slightly required (introduction to understand and evaluate the risks posed by the stressors of the the knowledge will be enough),” “uncertain (do not know),” EH, through equipping them with the knowledge, expertise, “moderately required (using a basic concept),” and “highly and skills needed to take on and enhance their role as a profes- required” (with hands-on experience on concept and train- sional in this field (Moldan, Janoušková, & Hák, 2012). ing).” Face and content validity of the questionnaire were Moreover, it is important to determine whether the EH conducted by pilot-testing among five senior lecturers and courses are relevant in term of employability of the graduates members of EH fraternity. The comments and feedback (Dunn et al., 2018). Students often perform well in the class- received were used as a reference to improve the content, room or examinations to earn good grades; however, it is understanding ability, and completeness of the question- uncommon for them to fit in the working environments com- naire. A pilot test was then performed to corroborate the reli- fortably. The advancement of technology and the augmented ability and validity of the questionnaire used in this study. complexity of EH and modern lifestyle point out to the The reliability test was applied to all variables. Internal reli- necessity of EH program reassessment (Ahonen & Lacey, ability was performed on the responses from 20 respon- 2017; Friedman & Lee, 2015; Mujuru & Niezen, 2004). dents. Table 1 shows the Cronbach’s coefficient alpha for These include the need to look at EH curriculum to address each measure for all variables, which suggested a good issues of programmatic improvement and to determine the internal consistency. Nonetheless, the perceived importance outcome measure of professional competencies of EH gradu- of topics could have been affected by the respondents’ dif- ates (Rehfuess & Bartram, 2014). As EH programs have ferent background and varied working environments. been introduced in Malaysia, there are no specific study reported on the need-based education and its current perspec- Respondents and Sampling Method tive in the practice. Therefore, this study was aimed to review the topics covered by EH curricula. Convenience sampling was used to recruit respondents. All graduates of diploma or bachelor’s in EH or environmental safety and health from local or overseas universities were Method invited to participate in the survey. Those who had stopped practicing in this field for the past 2 years and students cur- Study Design rently undertaking their diploma and degree were excluded A cross-sectional survey was conducted from December from the study. Respondents were invited via e-mail and 2016 to May 2017. Ethical approval was granted by the messenger service on social media with a copy of the link to Research Ethics Committee of Universiti Teknologi MARA the survey. The invitation message included an explanatory (UiTM; 600-RM-5/1/6). All the information obtained from statement, the link to informed consent form, and the online the data collection was kept confidential. questionnaire. An e-mail or messenger reminder was sent to all respondents 2 weeks after the initial invitation. A non- probability sampling using convenience sampling was used Questionnaire Design for the study; therefore, no sampling frame and sample size An online questionnaire form was designed using Survey calculation were not performed as suggested in literature Monkey, a platform that allows questions to be posted online (Omair, 2014). Arshad et al. 3 Table 1. Reliability Analysis of Variables. respondents with partial or missing data were excluded in the analysis. Descriptive statistics were employed to report the Number of Cronbach’s respondent demographic variables (n, %) and perceived Variable items coefficient α importance of different topics based on Likert-type scale (M Topics included in diploma in 23 .881 ± SD). environmental health Topics included in the bachelor of 37 .874 Results environmental health Proposed additional topics and 18 .895 Demographic and Working Information feedbacks for diploma and bachelor of environmental health A total of 152 respondents took part in the survey. As shown in Table 2, more than half (61.8%) of the respondents were females and majority of them (93.4%) aged less than 35 Table 2. Demographic Characteristics of Respondents. years old. They worked as an assistant EH officer (44.7%), mostly at District Health Office and Local Authority (59.2%). Variables n (%) In this study, the respondents’ median duration of working Gender experience was, with most had worked less than a year Male 58 (38.2) (44.7%) and majority of them (60.5%) graduated with a Female 94 (61.8) diploma in EH. Age 18-24 62 (40.8) 25-34 80 (52.6) Perception of the Relevance of Curriculums of EH 35-44 7 (4.6) for Diploma and Bachelor 45-54 1 (0.7) The mean scores of the importance of each subject of the 55-64 2 (1.3) diploma and bachelor’s of EH were shown in Tables 3 and 4, Occupations Environmental health officer 6 (3.9) respectively. For diploma in EH, prevention and control of Environmental health officer assistant 68 (44.7) diseases, pest and vector management, and experiential Tutor 31 (20.4) learning were considered the most essential modules and rel- Lecturer 3 (2.0) evant to EH studies (Table 3) as opposed to modules related Others 44 (28.9) to health and safety, vector management and EH legislation, Highest level of education which were marked as top priority for bachelor’s degree Diploma 92 (60.5) level (Table 4). This shows that the migration of interest in Bachelor 52(34.2) diploma graduates evolved consistently as bachelors’ under- Master 7 (4.6) graduates in EH practice. This could be attributed to the stu- PhD 1 (0.7) dents continued understanding and need for EH-related Sector issues facing the local and global community at large. Some Private sector 29 (19.0) topics such as pest and vector management were continu- Regulatory/enforcement office 6 (3.5) ously sought after at higher degrees. This could be due to Academic/university 11 (7.2) emerging public health issues, disease transmission, and District health office or local authority 90 (59.2) research on vectors. Industry 1 (0.7) Others 15 (9.9) Years of experience Feedback of Additional Topics to be Included in <1 68 (44.7) Courses 1-3 25 (16.4) >3-5 12 (7.9) Respondents then rated other new topics to be included in >5-7 14 (9.2) each of the EH-related courses (Table 5). The suggested top- >7-9 18 (11.8) ics were well accepted by respondents (mean score > 4). ⩾10-15 9 (5.9) Critical evaluation of EH information and databases, con- >15 6 (3.9) ducting and evaluating current awareness programs were the top picks of respondents for both discipline of the study. Big data analysis and interpretation on public-related EH issues Data Analysis are being given due consideration and priority as global stud- ies focused on early warning systems and the need for early The data were analyzed using Statistical Package for the detection systems worldwide. EH practice encompasses Social Sciences (SPSS), Version 17.0. Data sets from 4 SAGE Open Table 3. The Level of Importance of Topics for Diploma in Table 4. (Continued) Environmental Health. Subjects M ± SD Subjects M ± SD Health promotion and education 4.5 ± 0.7 Prevention and control of diseases 4.9 ± 0.4 Research methodology 4.5 ± 0.7 Pest and vector control management 4.9 ± 0.4 Final year project 4.5 ± 0.8 Environmental health practical training in district 4.9 ± 0.4 Environmental health ethics 4.4 ± 0.7 health office or local authority Analytical technique and instrumentation 4.4 ± 0.8 Introduction to environmental health 4.8 ± 0.4 Environmental microbiology 4.4 ± 0.7 Water supply 4.8 ± 0.5 Organization management 4.3 ± 0.8 Occupational safety and health 4.8 ± 0.5 Built environment and technology 4.3 ± 0.8 Food hygiene and safety 4.8 ± 0.4 Environmental chemistry 4.3 ± 0.9 Environmental health law and legal procedure 4.8 ± 0.4 Industrial ecology 4.3 ± 0.9 Epidemiology and biostatistics 4.7 ± 0.6 Biochemistry for environmental health 4.2 ± 0.9 Introduction to risk assessment 4.7 ± 0.6 Housing and residential environment 4.2 ± 0.8 Food technology 4.7 ± 0.7 Health psychology 4.1 ± 0.9 Solid waste management 4.7 ± 0.6 Anatomy and physiology 3.9 ±1.0 Environmental pollution and monitoring 4.7 ± 0.6 Environmental health case studies of 4.7 ± 0.6 environmental health issues Table 5. The Level of Importance of Proposed Topics for Fundamentals of environmental health 4.6 ± 0.6 Diploma and Bachelor of Environmental Health. management Diploma in environmental health Environmental health promotion and education 4.6 ± 0.6 Microbiology for environmental health 4.4 ± 0.7 Critical evaluation of online information including 4.3 ± 0.7 Technical documentation in environmental health 4.4 ± 0.7 environmental health information Environmental toxicology 4.4 ± 0.8 Searching the literature using e-databases/library 4.3 ± 0.8 Land use and housing 4.2 ± 0.9 resources Chemistry for environmental health 4.0 ± 0.9 Creating bulletin/newsletters and evaluating 4.3 ± 0.8 Organic chemistry for environmental health 3.9 ±1.0 current awareness programs Applying online applications and Internet 4.2 ± 0.8 technologies to community Understanding national environmental health 4.2 ± 0.9 Table 4. The Level of Importance of Topics for Bachelor of financing Environmental Health. Bachelor of environmental health Subjects M ± SD Critical review and evaluation of environmental 4.5 ± 0.7 Occupational safety and health 4.8 ± 0.5 health information and databases Vector control management 4.8 ± 0.5 Conducting and evaluating current awareness 4.5 ± 0.7 Legislation for environmental health and safety 4.8 ± 0.5 programs Health safety and environment 4.8 ± 0.5 Risk communication 4.5 ± 0.8 Industrial hygiene and safety 4.8 ± 0.6 Applying scientific basis for policy decisions 4.3 ± 0.9 Health and safety risk assessment 4.8 ± 0.5 Behavioral science 4.2 ± 0.9 Disease control 4.8 ± 0.5 Applying online applications and Internet 4.2 ± 0.8 Field experience 4.8 ± 0.5 technologies to community Practical training 4.8 ± 0.5 Applying economics for environmental 4.2 ± 0.9 Water supply and quality control 4.7 ± 0.6 management Environmental health and safety studies 4.7 ± 0.6 Explaining national environmental health financing 4.2 ± 0.9 Environmental impact assessment and auditing 4.7 ± 0.6 and planning Food safety 4.7 ± 0.6 Epidemiology 4.7 ± 0.6 Integrated solid waste management 4.7 ± 0.6 multidiscipline areas of studies that affect the general popu- Epidemiology and biostatistics 4.6 ± 0.7 lation and their daily routine lifestyles. Wastewater management in environmental health 4.6 ± 0.7 Overall, when respondents were asked for their most Occupational ergonomics 4.6 ± 0.7 interested subject area, nature science and social behaviors Pollution control 4.6 ± 0.7 scored the highest, approximately at 45% each (Table 6). Management and safety of toxic substances 4.5 ± 0.7 Most of them agreed that the major challenge (72.3%) faced Environmental toxicology 4.5 ± 0.7 in tackling environmental issue was minimal awareness and ignorance among public. Critical and creative thinking skills (continued) Arshad et al. 5 Table 6. Feedback on Subject Area, Challenges, and Required imparted during class sessions should be applicable during Skills for Environmental Health Education. the practical training and industrial attachment to promote individual understanding and competency (Knechtges & n (%) Kelley, 2015). Similarly, that integration of the flipped class- Preferable environmental health area room and online learning courses could have positive impacts Social behavior: belief, culture, and custom 66 (44.6) on learning and learning experiences in public health educa- Nutrition and diet 15 (10.1) tion (Galway, Corbett, Takaro, Tairyan, & Frank, 2014; Lean Nature science 67 (45.3) et al., 2018). The more interesting and faster information is Challenges faced in tackling environmental issues shared, the more likely education will advance in content and Government policy 10 (6.8) learning effectiveness. Lack of enforcement 18 (12.2) In facing an era of unprecedented changes, it is important Minimal public awareness and ignorance 107 (72.3) to examine the opportunities and threats to EH programs for Limited human and material resources 6 (4.1) sustainable development in Malaysia (Mahat & Idrus, 2017). Budget constraint 11 (7.4) Moreover, the complexity of EH issues increase, which will Essential skill or knowledge required in tackling environmental necessitate a well-educated, competitive, and well-trained issues EH workforce (Ahonen & Lacey, 2017). In line with the Leadership and responsibility 34 (23.0) national goals, universities aim to improvise programs that Productivity and accountability 12 (8.1) educate and prepare the next generation of EH professionals Social and cross-cultural skills 35 (23.6) who are able to develop and implement effective plans for Critical and creative thinking skills 55 (37.2) the communities, thus maximizing the health and well-being Information technology skills 16 (10.8) of the entire public (Foo, 2013). Fresh graduates of EH pro- grams are expected to become skilled in many aspects including environmental monitoring, health promotion, risk (37.2%) were rated as one of the most essential components assessment, emergency preparedness, and industrial hygiene. required in handling the environmental issues. Some subjects involve the application of the tools and tech- niques and thus hands-on experiences during tertiary educa- Discussion tion are deemed essential. For example, it is crucial to This study provides the rating of the importance of each EH conduct field studies such as pollution prevention, manage- topic for the syllabi of diploma and bachelor’s levels. This is ment, and restoration techniques for the subjects of industrial in line with other studies as to evaluate and revise the peda- ecology, occupational safety, and health. Students should be gogy for undergraduate training in EH is essential (Ahonen trained to be familiar to human health risk assessment and & Lacey, 2017; Marion & Sinde, 2015). In EH education, the management including the use of hazard identification, risk programs comprise courses such as public health, food assessment and risk control (HIRARC), chemical health risk safety, workplace health and safety, health and safety in the assessment (CHRA), hazard analysis and critical control home environment, public health, and environmental protec- point (HACCP), health risk assessment (HRA), occupational tion. To identify the skills and capabilities needed by EH pro- safety and health (OSH), international organization for stan- fessionals in different sectors, the research examined existing dardization (ISO), and others (Haimes, 2015). EH priorities of different subjects learned in each program. On the contrary, the new proposed modules aim to equip The results suggested that priority was given to subjects students with a broad understanding of the interrelationship related to prevention and control of vector-borne diseases, between health impacts and the environmental hazards, pub- water and food safety, and safety at work for the courses. On lic health, and well-being. It has been reported that in the contrary, fundamental knowledge in biochemistry and Malaysia, human activities have caused environmental human science such as anatomy and physiology were rela- quality degradation and affected the human health in multi- tively unfavorable subjects of the learning among EH gradu- ple ways (Department of Statistics Malaysia, 2016). ates. This could be due to the nature of those subjects that Contaminated food and water supply cause various types of may seem to be impractical subjects in their daily lives and food- and waterborne diseases such as cholera, typhoid work settings. Also, this might indicate the need for experi- fever, dysentery, viral Hepatitis A, and food poisoning enced EH practitioners who are capable to connect the invis- (Department of Statistics Malaysia, 2016). In 2015, the inci- ible dots of these topics to EH. dence rate of food poisoning was at 47.3 per 100,000 popu- In both diploma and bachelor’s degrees programs, attach- lations of Malaysia (Department of Statistics Malaysia, ment and training were rated highly important to prepare the 2016). Therefore, it is of urgent need to combat the issues by students to environmental and public health workforce, ensuring our EH enforcement officers are capable to over- ensuring them to be good at coordination and integration of come the barriers to the implementation of conservation, multidisciplinary approaches to EH problems (Dunn et al., sustainable development, and continued environment pro- 2018). The theory of fundamental subjects or the knowledge tection. The main challenge that EH practitioners are facing 6 SAGE Open was minimal public awareness and ignorance (72.3%), in advancing the role of community and public health officers. the effort to maintain and protect the environment. Social Hands-on, experiential training and work-integrated learn- behavior is the most challenging portion for any interven- ing are highly valuable to prepare graduates of EH in the tion activity to be successfully carried out and retained. open market, playing a critical role as EH practice Educating the community and community mobilization for workforce. intervention activities requires social behavior changes, which are often anguished and hurdled with skeptics and Authors’ Note ignorance by the public. Kamaruddin Arshad and Qi Ying Lean have contributed equally to Therefore, community-centered programs require experi- this work. enced and skilled EH workers who are able to think strategi- cally across the breadth and wealth of the fabric of EH Acknowledgment (Ferraro & Hanauer, 2014). The ability to critically evaluate The authors would like to express their gratitude to all respondents the associated EH factors and the potential impacts beyond who had contributed to the survey, Ministry of Education, and specific intervention, which must be fully stressed and Universiti Teknologi MARA (UiTM), Malaysia. underpinned by the teaching and learning throughout the EH program. This is important as in line with the District Health Declaration of Conflicting Interests Management in Malaysia, a full range of monitoring, sur- The author(s) declared no potential conflicts of interest with respect veillance programs and sustainable interventions to elimi- to the research, authorship, and/or publication of this article. nate or mitigate stressors could be conducted periodically thereby protecting human health and promoting continued Funding public well-being (Najwa et al., 2016). It is also desirable The author(s) disclosed receipt of the following financial support that the graduates are well equipped with the ability to under- for the research, authorship, and/or publication of this article: This take primary and secondary data obtained through the com- work was supported by Academic and Research Assimilation Grant munities. With a deep conceptual understanding, they can (ARAS), 600-IRMI/DANA5/3/ARAS (0037/2016) from Universiti critically interpret and evaluate the likely impacts on com- Teknologi MARA (UiTM), Malaysia. munity health and well-being, in which later their expert views will be highly required for current and future policy ORCID iD and decision making (Ferraro & Hanauer, 2014). Qi Ying Lean https://orcid.org/0000-0003-0331-8607 Evaluating the level of importance of EH topics could garner vital and critical information, which ensures higher References education providers should continuously provide quality and dynamic EH education. This also helps to revise the teaching Ahonen, E. Q., & Lacey, S. E. (2017). Undergraduate environmental public health education: Developmental evaluation to reframe and learning syllabi and system for meeting the job market a degree in a new school. NEW SOLUTIONS: A Journal of requirement in the future. The suggested topics of knowl- Environmental and Occupational Health Policy, 27, 107-123. edge and skills provided a baseline for syllabus review and Commission on Social Determinants of Health. (2008). Closing assessment of the existing programs, preparing students for the gap in a generation: Health equity through action on the careers in EH in the coming years and beyond. The findings social determinants of health. Final Report of the Commission may serve as important groundwork for a more detailed on Social Determinants of Health. Geneva: World Health meeting and consultation with the program stakeholders to Organization. further advance the emerging field of EH education. The pro- Department of Environment. (2018). National policy on the environ- gressive review and improvised courses with respect to the ment. Ministry of Energy, Technology, Science, Environment implementation of professional accreditation will ensure the & Climate Change. Retrieved from https://www.doe.gov.my/ universities in producing work-ready graduates who meet portalv1/en/tentang-jas/pengenalan/dasar-alam-sekitar Department of Statistics Malaysia. (2016). Compendium of envi- the market demand and public value of today and the future. ronment statistics. Putrajaya, Malaysia. . Retrived from https:// www.dosm.gov.my/v1/index.php?r=column/cone&menu_id= Conclusion dUg2UVgralU4cVluSFFIVG5RVmRpQT09. Dunn, L., Nicholson, R., Ross, K., Bricknell, L., Davies, B., This study identified and determined the importance of EH Hannelly, T., . . . Roiko, A. (2018). Work-integrated learn- topics for both diploma and bachelor’s programs in ing and professional accreditation policies: An environmental Malaysia. All new topics proposed including critical evalu- health higher education perspective. International Journal of ation of Work-Integrated Learning, 19, 111-127. EH information and database management and mining, con- Faculty of Health Sciences. (2017). Centre of environmental health ducting and evaluating health awareness programs, and & safety. Universiti Teknologi MARA. Retrieved from https:// applying online applications and Internet technologies to fsk.uitm.edu.my/en/index.php/academic/centre-of-study/ enviromental-health-and-safety communities were perceived as relevant to the courses in Arshad et al. 7 Faculty of Medicine and Health Sciences. (2018). Department Author Biographies of environmental and occupational health. Universiti Putra Kamaruddin Arshad graduated with bachelor of Health Sciences Malaysia. Retrieved from http://www.medic.upm.edu.my/ (Environmental Health) and master of Environment. He had worked department/department_of_environmental_and_occupational_ for twenty-eight years (1983-2011) in Public and Environmental health-353 Health Units in various District Health Offices, Hospital and State Ferraro, P. J., & Hanauer, M. M. (2014). Advances in measuring the Health Department. He joined UiTM as a lecturer in public and envi- environmental and social impacts of environmental programs. ronmental health. He has interest in water quality monitoring, food Annual Review of Environment and Resources, 39, 495-517. safety and hygiene, epidemiology and communicable disease con- doi:10.1146/annurev-environ-101813-013230 trol, solid waste management and environmental pollution control. Foo, K. (2013). A vision on the role of environmental higher educa- Qi Ying Lean completed her degree in BPharm (Hons.) at University tion contributing to the sustainable development in Malaysia. of Malaya, and started to work as a pharmacist at Penang Hospital. Journal of Cleaner Production, 61, 6-12. She then pursued her master and doctorate degrees at University of Friedman, L. H., & Lee, J. M. (2015). Undergraduate public health Tasmania, Australia and currently the Senior Pharmacy lecturer at education: Is there an ideal curriculum? Frontiers in Public UiTM. Having the passion in research and commitment to the under- Health, 3, Article 16. doi:10.3389/fpubh.2015.00016 standing of human health, she has been involving in several research Galway, L. P., Corbett, K. K., Takaro, T. K., Tairyan, K., & Frank, projects including pharmacy education, public health, prevention E. (2014). A novel integration of online and flipped classroom and management of illnesses and drug discovery. instructional models in public health higher education. BMC Medical Education, 14(1), Article 181. doi:10.1186/1472- Long Chiau Ming graduated with BPharm (Hons) and a master of 6920-14-181 Clinical Pharmacy, worked for three years in a hospital before pur- Haimes, Y. Y. (2015). Risk modeling, assessment, and manage- suing his PhD in Biopharmaceutics. He has a special interest in ment. Hoboken, NJ: John Wiley. translational research and healthcare education. He is actively Knechtges, P. L., & Kelley, T. R. (2015). Educating future environ- engaging with industry as well as supervising postgraduate students mental health professionals. Environmental Health Insights, 9, on projects related to healthcare, support services and pharmaceuti- 23-26. cal sciences. Lean, Q. Y., Ming, L. C., Wong, Y. Y., Neoh, C. F., Farooqui, M., & Muhsain, S. N. F. (2018). Validation of online learn- Sundara Rajan Mahalingam is a senior lecturer with UiTM and ing in pharmacy education: Effectiveness and student insight. has more than 25 years working field experience in environmental Pharmacy Education, 18, 135-142. health and public health. Specific field of interest includes Mahat, H., & Idrus, S. (2017). Education for sustainable develop- Communicable diseases, Vector-borne diseases, Food Safety, ment in Malaysia: A study of teacher and student awareness. Environmental Health Laws and Community related studies. Geografia-Malaysian Journal of Society and Space, 12, 77-88. Chua Say Tiong graduated with bachelor of Health Sciences Marion, J. W., & Sinde, Y. (2015). The need for environmental (Environmental Health) and master of Environment. He had public health professionals and the role of EHAC-accredited worked for twenty-three years (1987-2010) in Public and programs in increasing the pool. Journal of Environmental Environmental Health Units in various District Health Offices, Health, 78, 36-41. Hospital and State Health Department. Since 2010, he joined as a Moldan, B., Janoušková, S., & Hák, T. (2012). How to understand lecturer in public and environmental health field in UiTM. He has and measure environmental sustainability: Indicators and tar- interest in epidemiology and communicable disease control, solid gets. Ecological Indicators, 17, 4-13. waste management and environmental pollution control. He is Mujuru, P., & Niezen, C. (2004). Evaluation of an environmental supervising undergraduate students on projects related to public health education program: Assessing changes in knowledge of and environmental health. health professionals. AAOHN Journal, 52, 436-441. Najwa, Z. L., Ima, Z. N., KWan, M., Haslinda, I. N., Syafinaz, S. Amir Heberd Abdullah graduated with BSc (Hons) and a master I., Hasneezah, N., . . . Manaf, R. A. (2016). The concept of of Occupational Safety and Health Management, has 20 years district health management in Malaysia. International Journal working experience in Ministry of Health and various local authori- of Public Health and Clinical Sciences, 3(1), 1-16. ties before joining UiTM as academician. He has a special interest Omair, A. (2014). Sample size estimation and sampling tech- in management of safety and health. Still actively engaged with niques for selecting a representative sample. Journal of Health industry in terms of supervising practical students. Currently he Specialties, 2, 142-147. doi:10.4103/1658-600x.142783 holds the post as Head of Centre, Faculty of Health Sciences in the Rehfuess, E. A., & Bartram, J. (2014). Beyond direct impact: university. Evidence synthesis towards a better understanding of effec- Farah Ayuni Shafie graduated with PhD in Built Environment and tiveness of environmental health interventions. International during her study, she was involved with Industrial Ecology research Journal of Hygiene and Environmental Health, 217, 155-159. group exploring life cycle assessment and input-output analysis. World Health Organization. (2018). Environmental health. South- She is now supervising postgraduate and undergraduate studies on East Asia Regional Office, World Health Organization. Retrieved organic food, urban metabolism and climate change. from http://www.searo.who.int/topics/environmental_health/en/

Journal

SAGE OpenSAGE

Published: Nov 1, 2018

Keywords: higher education; teaching and learning; environmental health; university; environmental education

References