Planetary health: increasingly embraced but not yet fully realised
Angie Bone A * , Francis Nona B , Selina Namchee Lo C and Anthony Capon AA
B
C
Abstract
The modern field of ‘planetary health’ was instigated in 2015 by the Rockefeller Foundation−Lancet Commission, which defined it as ‘the health of human civilisation and the state of the natural systems on which it depends’. However, this view of human health in relation to natural systems is not really new at all. Rather, it is (re)emerging as the environmental impacts of human activities and their effects on the health of all life on Earth, now and in the future, become increasingly clear. A planetary health approach requires us to rethink dominant perspectives about how we feed, move, house, power and care for the world, as well as the implications for wellbeing and equity across generations and locations. This shift in understanding of our place as humans in relation to the planet is fundamental to addressing the polycrises of the 21st century. Planetary health approaches are increasingly embraced but not yet fully realised or embedded. More organisations and collaborations, in the health sector and beyond, are incorporating these ideas into their methods, plans and training, including concepts that are part of, but not synonymous with planetary health, such as one health, global health, environmental health, climate health and sustainable healthcare. Yet, we are still far from the collective cultural transformation needed to achieve the promise of planetary health as a movement that puts the health of people and the planet at the centre of all policy and action. Education and training in the Western tradition encourage ‘human-centred’ or ‘colonial’ thinking. There is much to (re)learn from First Nations peoples, and other non-Western worldviews, about the interdependence of all species and what that means for sustainable health and wellbeing. We offer proposals for how public health policymakers, researchers and practitioners, might support the transformation needed and address the conceptual, knowledge and governance challenges identified by the Rockefeller Foundation−Lancet Commission.
Keywords: future generations, health systems, one health, planetary health, public health, Rockefeller Foundation–Lancet Commission.
Introduction
We live in an era of converging and interrelated challenges, including climate change, biodiversity loss, pollution, conflict and increasing inequalities.1 All these challenges are human-induced, although the relative contribution varies enormously by individual, community and nation. Underlying drivers include the unfair and unsustainable exploitation of natural resources and a prevailing culture that promotes human-centredness and dominance over other species.2
In 2015, the Rockefeller Foundation−Lancet Commission on Planetary Health (hereafter the Commission), identified the need for a new field to tackle the health impacts of the harmful human systems we have created and to elevate the protection of natural systems for health.3 The Commission called for a broad-based movement for social change for the scale of impact needed to preserve the biosphere.
Planetary health uses systems thinking to bring together an exploration of human political, social and economic systems, as well as their tangible (e.g. sectors, services, products) and intangible (e.g. beliefs, values, culture) outputs, with an analysis of their impacts on natural systems. This provides a more holistic understanding of the outcomes of human activities over time to design pathways that optimise health and minimise harm for current and future generations.
The discipline places equal value on the health of the planet as on the health of humans, acknowledging their indivisibility. Planetary health encompasses but is broader than, concepts such as one health, global health, environmental health, climate and health, sustainable healthcare, and determinants of health.
Although the definition of a new field has been important in driving different approaches to tackle these threats, several have pointed out that a connection between human and environmental health was recognised in early Western traditions, then largely lost and is now re-emerging.4 Others have noted similarities with the worldviews of First Nations peoples. However, in many current uses of the term ‘planetary health’, the Western model of human-, rather than earth-centredness, often prevails, and Western science should not ‘pick and choose’ Indigenous knowledges to merge with its own worldviews.5
Current situation
In the decade since the Commission defined the field, planetary health has been increasingly embraced both within and beyond the health sector. The Planetary Health Alliance,6 an international consortium of over 400 academic, government and non-government organisations, has played an important role in building a community of researchers, educators and policymakers, curating resources and knowledge and defining actions, for example through the 2021 São Paulo Declaration on Planetary Health and the 2024 Kuala Lumpur Call to Action and Planetary Health roadmap.
Universities have established planetary health initiatives and professorships in many countries. Planetary health research calls are emerging, for example, the Horizon Europe Framework Programme.7 There has been a substantial increase in the absolute and relative numbers of planetary health publications between 2018 and 2021, with a similar pattern observed for ‘one health’.8 Most planetary health publications arise from the US, UK, Australia, Canada and Germany, with The Lancet and its sister journal The Lancet Planetary Health publishing the most.9
Multiple planetary health graduate certificates and master’s degrees are now available. Consensus on the need for undergraduate and postgraduate interprofessional education on the matter is increasingly established10 and slowly being incorporated into health professional education.11 An international student-led evaluation of planetary health education in medical schools saw students from six Australian medical schools participating for the first time in 2023–2024, giving the schools scores of ‘B’ to ‘D minus’.12
Planetary health now explicitly appears in policies and plans of international organisations, governments at all levels, and health services. For instance, planetary health was the theme of World Health Day in 2022. Australia’s National Health and Climate Strategy recognises planetary health and one health as key principles for action.13 Environmentally sustainable healthcare is increasingly accepted as a core function of health systems worldwide. North Sydney Local Health District recently launched its 2024–2027 planetary health framework14 as the mechanism for reducing its environmental footprint, improving population health and providing high-quality patient care. The City of Blue Mountains is using planetary health as the framing for its sustainability efforts.15
More broadly, a planetary health approach resonates with similar social movements arising from other sectors. The Sustainable Development Goals seek to improve human wellbeing alongside eradicating poverty, tackling climate change, while protecting and restorating marine and terrestrial ecosystems. The Inner Development Goals initiative seeks to help people develop and integrate the inner skills needed to catalyse outer change for sustainable development.16 Ecological economics is concerned with the efficient, just and sustainable allocation of resources, and views the economy as ‘a means and not an end’ for wellbeing, counter to the currently dominant neoclassical view of Gross Domestic Product as a measure of progress.17 In law, beyond the important recognition of ‘human’ rights to ‘health’ and a ‘clean, healthy, sustainable environment’, the concept of the rights of nature is increasingly being debated and recognised (for example, the granting of legal personhood to Aotearoa New Zealand’s Whanganui River in 2017).
However, planetary health principles imply and entail deep transformational change in human societies to protect the health of people and the planet. Despite progress, our collective efforts so far can only be described as incremental, with the social movement envisioned by the Commission only fledgling.
Pathways for progress
The Commission identified three sets of challenges that must be addressed: (1) conceptual (including how progress and harms are measured and valued), (2) knowledge (including a need for transdisciplinarity) and (3) governance (including siloed and delayed decision-making).
Using this as a framework, we identify the following priorities for progress and possible actions by public health policymakers, researchers and practitioners.
Conceptual challenges – how we think and how we value
The Commission identified conceptual challenges as failures of imagination and empathy. Dominant worldviews implicitly value nature less than humans and some humans more than others.18 A focus on proximal problems and solutions – temporally, spatially and culturally – leads to the discounting of more distal impacts and responses. Linear cause−effect thinking and ‘pattern-matching’, discourages more systemic and relational thinking, hampering the ability to conceive novel approaches.
To overcome these thinking traps, we must examine our individual and collective public health practices and actively ‘think about our thinking’. This means moving beyond ‘single-loop’ thinking (analysing only the overt problem and whether we are ‘doing something right’) to ‘second-’ and ‘triple-loop’ thinking (examining whether we are ‘doing the right thing’ and being aware of the influence of our worldviews on our perceptions and decisions).19 Changing how we think about a situation can lead us to new insights and pathways for improvement, influencing agenda-setting and discourses.
Knowledge challenges – how we learn and know
How we learn and what knowledge we prioritise is closely linked to our values and beliefs. Our tendency to categorise and classify has resulted in the development of distinct disciplines with their own epistemologies and understandings of what constitutes rigour and relevance, transmitted through training to the next generation. Although this ‘high ground’ is very suitable for simple problems and incremental change, it is less suited to solving complex problems and the ‘swampy lowlands’ of policy and practice.20
Tackling planetary health issues requires pluralist approaches that braid together diverse academic, policy and practice knowledges, including those from First Nations peoples and other traditions. This implies transformation to genuine transdisciplinarity in how we generate, share, and reward knowledge and a need to value, as a recognised skillset, the ability to integrate diverse knowledges.21
Governance – how we organise and decide
Our knowledge and value systems determine our structures and processes for collective decision-making. These have consolidated around a largely positivist and linear worldview, separated into countries and sectors that mostly operate independently, are defined by economic value, competition for resources (within and across) and short-termism. As is increasingly apparent, such structures are not well-suited to solving complex health challenges, such as climate change, pandemics and geopolitical insecurity.
It is hard to see how planetary health will be achieved without radical transformation of our governance structures at all levels. This transformation should enable the pooling of resources to get the best outcomes over the long term for both people and the planet, not supporting harmful industries, the inclusion of voices that are less heard in decision-making, and the rewarding of collaboration over competition.
Such transformation deeply challenges existing power structures throughout our society at all levels, across governments, industry, academia and communities. This power and privilege will not be given up without confrontation and struggle, as we have seen with other social movements.22
We recognise that current approaches are so entrenched that this transformation in our governance structures and processes may be difficult to achieve without first addressing the conceptual and knowledge challenges above. We see the failures but are heartened by numerous examples of international treaties and collaborations, integrated governance, deliberative democracy and legislation, which include assessments of the impacts on future generations.
Actions public health professionals, researchers and policymakers can take
Develop and strengthen our knowledge and skills in planetary health, systems thinking and human ecology and embed these in our practice. Although the expanding body of literature and courses supports this, we must incorporate planetary health approaches systemically into undergraduate and postgraduate training and professional development, creating new courses and reconfiguring existing ones.
Actively consider the distal and non-human impacts of our practice and explore how positive effects might be enhanced and harm minimised. This requires technical capabilities, such as impact assessment methods and effective multisectoral working, and a mindset change about what we value, and thus what we measure and invest in.
Change our structures and processes for funding, executing and evaluating research to incentivise genuinely transdisciplinary and pluralist approaches to tackle planetary health conceptual, knowledge and governance challenges.
Challenge the dominant anthropocentric paradigm in journals, conferences, policy debates, risk management and ethics processes, and encourage the embedding of planetary health approaches in all activities, policies and plans.
Use planetary health evidence and skills, and the power of collective voice and action, to support the transformation of governance and spending towards a view of prosperity as the wellbeing of people and the planet, now and into the future. This requires multisectoral collaboration, coalition-building, creativity, innovation and courage. Key areas include tackling the commercial determinants of health, encouraging and supporting social movements for planetary health and intergenerational equity, learning from approaches of First Nations peoples, and holding our leaders accountable for the impacts of the decisions they make.
Conclusions
Planetary health approaches aim to achieve the highest attainable state of health for current and future generations by protecting the natural systems on which all health depends. Although engagement with the concept is increasing within health systems, decision-making frameworks remain firmly and narrowly focused on the best outcomes for current patients relative to financial cost, as opposed to a more holistic and long-term assessment of outcomes and costs.
More action is needed to overcome the conceptual, knowledge and governance challenges to the collective transformation of culture and mindset to secure planetary health. By applying and extending their skills, experience and networks, public health professionals can be important and influential agents for change. Above all, political and health leadership and allyship with all sectors are vital to build and enact the financial and human resources needed to evolve this field within the timeframe we currently have.
Data availability
Data sharing is not applicable as no new data were generated or analysed during this study.
Conflicts of interest
AC was a Commissioner with the Rockefeller Foundation−Lancet Commission on Planetary Health, and SNL was the handling editor for the Commission report. The authors declare that they have no other conflicts of interest.
Author contributions
AB was responsible for the design, drafting and editing of the manuscript; FN and SNL were responsible for reviewing and editing the manuscript; AC contributed to the design and was responsible for reviewing the manuscript.
Authorship inclusivity and diversity statement
One or more of the manuscript authors self-identifies as a member of an underrepresented culturally and/or linguistically diverse minority.
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