Planetary health: a new science for exceptional action

Abstract

“We have lived our lives by the assumption that what was good for us would be good for the world. We have been wrong. We must change our lives so that it will be possible to live by the contrary assumption, what is good for the world will be good for us. And that requires that we make the effort to know the world and learn what is good for it.” Wendell Berry, From The Long-Legged House (1969) What is planetary health? In the final report of The Rockefeller Foundation–Lancet Commission on Planetary Health, we define it this way: “the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic, and social—that shape the future of humanity and the Earth's natural systems that define the safe environmental limits within which humanity can flourish. Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends”.1Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; (published online July 16.)http://dx.doi.org/10.1016/S0140-6736(15)60901-1Summary Full Text Full Text PDF Scopus (1122) Google Scholar Why might the idea of planetary health be useful? There are two dimensions that planetary health seeks to bring to human health. First, it situates human health within human systems. The threats that our species faces are not abstract physical risks, such as disease, climate change, ocean acidification, or chemical pollution. The risks we face lie within ourselves and the societies we have created. When we consider climate change, the main metric of danger is greenhouse gas emissions. But that measure should also include the capacity of human systems to monitor the threat, understand its importance, and act on that knowledge. Second, planetary health concerns the natural systems within which our species exists—for example, the health and diversity of the biosphere. Human beings live within a safe operating space of planetary existence. If the boundaries of that space are breached, the conditions for our survival will be diminished. Currently, natural systems are being degraded to an extent unprecedented in history, with known and as yet unknown and unquantified effects on human health. For example, although evidence for causality between environmental change through deforestation and Ebola virus disease outbreaks is inconclusive, loss of forest land has brought people and wildlife into closer contact—with the inherent risks of zoonotic disease. There is surely an intergenerational responsibility to do no further harm and to create the systems to allow future generations to thrive and prosper—mentally, physically, and materially. We have previously tried to set out the minimum conditions for planetary health.2Horton R Offline: Planetary health—a new vision for the post-2015 era.Lancet. 2013; 382: 1012Summary Full Text Full Text PDF Scopus (11) Google Scholar, 3Horton R Beaglehole R Bonita R Raeburn J McKee M Wall S From public to planetary health: a manifesto.Lancet. 2014; 383: 847Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar, 4Horton R Offline: Progress towards planetary health.Lancet. 2015; 385: 314Summary Full Text Full Text PDF Scopus (6) Google Scholar As Stephen Boyden wrote in his book, The Biology of Civilisation, “While the main threats to humankind today are the consequence of the human aptitude for culture, our only hope for overcoming them lies in this aptitude”.5Boyden S The biology of civilisation. University of New South Wales Press, Sydney2004Google Scholar Human cultures contain both the threat and opportunity for human flourishing. Civilisations come and civilisations go, typically over 300–500 year cycles.6Butzer K Collapse, environment, and society.Proc Natl Acad Sci USA. 2012; 109: 3632-3639Crossref PubMed Scopus (259) Google Scholar One should not be surprised by this time-bound civilisational history. Our museums are replete with artifacts from once great and dominant human cultures. Why should our civilisation be any different from the Assyrians, Mesopotamians, or Mayans? But, as Karl Butzer notes in his survey of the science of civilisations, “Much of the current alarmist literature that claims to draw from historical experience is poorly focused, simplistic, and unhelpful…Undue attention to stressors risks underestimating the intricate interplay of environmental, political, and sociocultural resilience in limiting the damages of collapse or in facilitating reconstruction”. Butzer prefers to focus instead on the importance of “leaders, elites, and ideology”. In other words, governance and stewardship. Here is where human history meets current human predicaments. What is abundantly clear today is that the dangers facing our species will demand “urgent collective action at both local and global levels”.7Dasgupta P Ehrlich PR Pervasive externalities at the population, consumption, and environment nexus.Science. 2013; 340: 324-328Crossref PubMed Scopus (71) Google Scholar Cooperation will be indispensable for our survival. But every day we see the limits of our ability to collaborate with one another—conflict, nationalism, competition. One active area of research that is not obviously mainstream for global health, but which is core to the idea of planetary health, is understanding what helps or hinders human cooperation. Is it binding democratic voting?8Hauser OP Rand DG Peysakhovich A Nowak MA Cooperating with the future.Nature. 2014; 511: 220-223Crossref PubMed Scopus (193) Google Scholar Or “mutual coercion, mutually agreed upon”?9Levin SA Public goods in relation to competition, cooperation, and spite.Proc Natl Acad Sci USA. 2014; 111: 10838-10845Crossref PubMed Scopus (63) Google Scholar Or universal education?10Lutz W Muttarak R Striessnig E Universal education is key to enhanced climate adaption.Science. 2014; 346: 1061-1062Crossref PubMed Scopus (102) Google Scholar Or independent accountability? The recent Lancet Commission on Health and Climate Change will use an accountability mechanism over the next 15 years to track, support, and communicate progress and success in addressing the connections between health and climate.11Watts N Adger WN Agnolucci P et al.Health and climate change: policy responses to protect public health.Lancet. 2015; (published online June 23.)http://dx.doi.org/10.1016/S0140-6736(15)60854-62Google Scholar The Rockefeller Foundation–Lancet Commission on Planetary Health first met in Bellagio, Italy, in July, 2014. Chaired by Andy Haines of the London School of Hygiene & Tropical Medicine, the Commission is a diverse group of global experts in environmental health, medicine, biodiversity, and ecology who reached a powerful consensus around key messages and the urgency of planetary health as an idea in jeopardy. The Commission's report1Whitmee S Haines A Beyrer C et al.Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health.Lancet. 2015; (published online July 16.)http://dx.doi.org/10.1016/S0140-6736(15)60901-1Summary Full Text Full Text PDF Scopus (1122) Google Scholar outlines three challenges that must be addressed to enhance human health in the face of unprecedented environmental challenges. First, a conceptual challenge to account for the future health and environmental harms to development and prosperity that many countries face. Second, knowledge and information challenges, including lack of transdisciplinary research and a failure to identify the social and environmental drivers of ill health. Finally, governance challenges. Planetary health is a new science that is only beginning to draw the coordinates of its interests and concerns. It demands new coalitions and partnerships across many different disciplines to meet the pervasive knowledge failures identified by this Commission. It demands new attention to governance and implementation. And, perhaps most of all, it demands more creative imagination among scientists and practitioners working in health—redefining the meaning of human progress, rethinking the possibilities for human cooperation, and revitalising the prospects for the health of human civilisations. This online publication has been corrected. The corrected version first appeared at thelancet.com on July 21, 2015 This online publication has been corrected. The corrected version first appeared at thelancet.com on July 21, 2015 We thank The Rockefeller Foundation for their generous financial support to The Rockefeller Foundation–Lancet Commission on Planetary Health and for hosting meetings in Bellagio, Italy, and New York, USA. We thank Andy Haines for his chairing of the Commission and Sarah Whitmee for her lead authorship. We thank Tim Shorten for project management of the Commission and Micheline Kennedy of GMMB for leading communications around global launches. We thank Commissioners for their commitment to this Commission report and its dissemination, and peer reviewers for their thoughtful contributions to the process. We also thank the participants of The Rockefeller–Economist Visionaries Unbound Planetary Health workshop for providing Commissioners with a broad background discussion to focus the first Commissioners meeting. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary healthFar-reaching changes to the structure and function of the Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature's resources, human civilisation has flourished but now risks substantial health effects from the degradation of nature's life support systems in the future. Full-Text PDF Human and planetary health: towards a common languageWith less than 5 months until the Conference of the Parties to the UN Framework Convention on Climate Change is held in Paris, France, the world has a unique but fast-closing window of opportunity. It is vital that the global community recognises that human and planetary health are two sides of the one climate coin, and that together they present a critical road for comitigation. But as we enter the second half of 2015—a year that will bring a new global development agenda with the Sustainable Development Goals, a World EXPO on Feeding the Planet, Energy for Life, and a defining juncture for climate action—it is the intersections of sustainability and health and their effect on climate mitigation that must be recognised, prioritised, and leveraged. Full-Text PDF The need for a global health ethicIn the 1940s, the renowned Wisconsin, USA, conservationist Aldo Leopold wrote “The Land Ethic” as the culmination of his now celebrated work, A Sand County Almanac.1 In his essay, Leopold articulated the need for, and the ethical basis of, a new relationship between people and the land. He imagined the awakening of an ecological conscience that redefines humanity as part of nature, rather than its external conqueror. The dire conservation challenges he observed—soil erosion, water pollution, and wildlife loss—required solutions based not merely on ecological expediency, but on ethical conviction. Full-Text PDF Governance for planetary health and sustainable developmentThe landmark report of The Rockefeller Foundation–Lancet Commission on Planetary Health 1 is a clear and compelling articulation of the inextricable link between human health and environmental change. The report explores an array of complex, interlinked elements of concern, from environmental tipping points to the impacts of invasive species and the importance of protected areas. The United Nations Development Programme (UNDP) recognises planetary health as critical to achieving sustainable development across the economic, social, and environmental spheres—this ethos underpins our Strategic Plan for 2014–17. Full-Text PDF Department of ErrorHorton H, Lo S. Planetary health: a new science for exceptional action. Lancet 2015; 386: 1921—In this Comment, the second sentence of the penultimate paragraph should have read: “Chaired by Andy Haines of the London School of Hygiene & Tropical Medicine…”. This correction has been made to the online version as of July 21, 2015, and the printed Comment is correct. Full-Text PDF