Public health practitioners have long been aware of the close connection between human health and the environment. In the past several decades this connection was disrupted by human-driven changes, such as depletion of land and water resources, climate change, ocean acidification and biodiversity loss.
Man-made systemic changes to Earth’s life-supporting systems are now directly and indirectly affecting our health and well-being, climate change being the clearest example. These negative trends are also accelerated by social and economic drivers, such as poverty, inequality and conflict. Clearly, we need coordinated action to reduce the risks global environmental change imposes on global health and well-being.
This is the essence of the Planetary Health – an emerging concept that broadens the notion of health from systems within the body to the external systems that sustain or threaten human health on a planetary scale. Planetary Health acknowledges the fact that while human health and well-being have tremendously improved over the last 50 years, the earth’s natural systems have considerably deteriorated over the same period of time. This state of affairs does not give our children and grandchildren a chance to have the same opportunities to good health and well-being as we do. Maintaining high quality of Planetary Health forces us to re-think the current way of development.
But how do we move from the concept to practice?
This and other important questions related to Planetary Health were the motivation of the workshop titled “Planetary health in practice: Understanding the health impacts of environmental change on water, food and air”. The workshop was organised by SEI, SIANI, Institute of Environmental Medicine at Karolinska Institutet and Stockholm County Council during the 10th European Public Health Conference in Stockholm.
Recognizing the silent salient
Prof. Mark Maslin (University College London), a keynote speaker at the event, explained just how huge and profound humanity’s impact on the planet is. The fact that our presence can now be seen everywhere, even on geological scale, clearly attests that we have entered the Anthropocene.
While recognising how important it is to reduce the effects of climate change on planetary health, Mark Maslin cautioned against doing so at the expense of other global issues. Population growth, water and food security, all act together with climate change. Neglecting these issues can create “a perfect storm” for public health.
This type of silo thinking manifests in different areas of environment and health. For instance, a lot of attention has been paid to traffic and other outdoor sources of pollution. However, in low and middle-income countries, most of the air pollution problems arise from household energy use.
Silo thinking in the field of diets and nutrition can be illustrated by the issue of obesity – a huge health concern worldwide. While interventions to prevent obesity mostly focus on adults, the best treatment effects can be delivered by tackling childhood obesity. Potential cholera epidemics in Europe that can be caused by climate change related impact on bacteria species in the Baltic is yet another example of an ignored health hazard. Another case in point is water scarcity in Sweden.
Apart from mitigating silo-like thinking, Planetary Health can also help us understand the interaction between health, environment and development. For example, Mark Maslin pointed out that global physical labour capacity have decreased by around 5.3% between 2000 and 2016 due to heat and humidity. He continued: “There will be months when people in some regions of the world will not be able to work outdoors at all.” This is likely to have high economic impact on agrarian economies. How do we plan for and adapt to such change? This will be a big challenge in the future.
Another issue to deal with will be about negative trade-offs of our actions. For instance, while air pollution interventions in China proved to be effective in cleaning up the air, they resulted in a shutting down of industries and had major implications for jobs and social well-being. Planetary Health is a conceptual framework that can help us to balance health and development, ensuring that gains in one sector won’t lead to problems in another.
The Planetary Health approach is transdisciplinary by nature, meaning scientists are not only working together and exchanging methods, but they also involve people from outside of academia in their research. This way of working can help bring salient issues forward, and bridge the gap created by the current interdisciplinary approaches to health, where there is no collaboration with wider society.
Operationalising planetary health
Planetary health is rooted in science, so it is the scientists who need to play a key role in advancing this concept forward, mainstreaming and promoting successful examples of its implementation. Currently, Planetary Health is implemented with no academic partnership and has no baseline data for assessing impact. This means it can’t be used to inform public health policy for example, since it requires a strong evidence base.
We must not take too long to act though. The recent Lancet Commission report brought forth the chilling reality of the current development path: we have improved our health at the expense of the health of the future generations. This means involving young people into development of this new discipline is of particular importance.
At the end of the day, Planetary Health is still an emerging concept. It may take a while for it to be widely-used and many might think it is just another new theory and terminology. However, there are already actors who are applying Planetary Health without even being aware of it. The Diet for a Green Planet programme in Södertalje that grows, prepares and promotes locally produced organic school meals, and a government initiative to shift away from fossil fuels in public transport in Stockholm, are two examples that already integrate the Planetary Health concept in practice. And there will be more to follow. So, the issue is not how we define concepts, but how act on our problems.