Planetary Health: a framework linking global conversations about the environment, sustainability, planetary boundaries and health

The term ‘planetary health’ was purported by the Rockerfeller foundation and Lancet in 2014 and a Lancet commission report on the topic followed in 2015 (Whitmee et al.). A team at Harvard were granted funding in 2016 to progress planetary health, and have chosen to focus on supporting and developing: (1) a global community of practice for planetary health, (2) integration of planetary health into education in all disciplines and at all levels, (3) interdisciplinary planetary health research collaborations, and (4) translation of planetary health research into action. The second Planetary Health Alliance (PHA) Annual Conference was held from 28^th May to 1^st June 2018 in Edinburgh, UK.

Defining Planetary Health

An opening panel on the first morning discussed ‘different lenses towards one overarching goal’. It concluded that EcoHealth, One Health, GeoHealth and Planetary Health have arisen for different purposes in different time settings (see Buse et al. 2018 for further discussion), but can effectively be used interchangeably. In a later small group session, it emerged that many participants were averse to the term sustainability, preferring a term that focuses on environmental issues over and above financial and social dimensions of sustainability.

My own personal conclusion was that the term ‘sustainability’ has its place, particularly in the UK in line with the terminology used by the NHS’s Sustainable Development Unit; nevertheless, recognising that what SHE does is planetary health education provides further advantages. Planetary health is a good descriptor of our focus topics, and using this term may be clearer for some audiences, particularly in global fora, thus making the SHE network more accessible and facilitating communication with a wider audience.

That planetary health, and indeed sustainability, are such wide and cross-cutting disciplines is part of their import, yet also raises a challenge for us as we try to define them and communicate their importance. Conference sessions addressed topics including health impacts of pollution (based on the Landrigan et al. 2018 report), non-communicable diseases, mental health, food and nutrition, infectious diseases, agriculture, economics, ‘blue planet health’ (sea, freshwater and water cycles) and urban planning. Sessions explored the development of science, policy and discourse related to these topics, highlighting the importance of these topics within the planetary health framework and for the health of humanity.

‘Pollution is an NCD’ in the words of Philip Landrigan, who highlighted that pollution is responsible for more mortality than tobacco smoking or than AIDS, malaria and tuberculosis combined. He also pointed out that the pollution-associated mortality and morbidity that we can measure is only the tip of the iceberg – there are further health impacts that we have some awareness of but for which we have not fully identified mechanisms of impact, pathways and approaches to measurement, and there are further health implications that we are as yet unaware of.

Figure 3, Lancet commission on pollution and health

Thinking beyond science: Other forms of knowledge, indigenous voices, philosophy and activism

A feature of the PHA is that they aim to facilitate not only interprofessional but also interdisciplinary dialogue. Attendees at the conference included lawyers, business people, artists, religious leaders and social scientists, as well as members of a range of scientific and health professional groups. An esteemed speaker was Elder Francois Paulette, who is a Canadian First Nations advisor and brought an indigenous perspective. Other speakers drew on Maori indigenous wisdom; the concept of guardianship (Kaitiakitanga), where communities take responsibility for care for and protection of the environment.

A session explored innovations for planetary health, and highlighted cross disciplinary partnerships, for example facilitated by the BRIDGE collaborative bridgecollaborativeglobal.org. Another panel was about ‘Economic and business solutions to planetary health problems’ and focused on how socially responsible businesses can support environmental developments. The importance of a ‘circular economy’ where waste is avoided or recycled was raised, yet questions about whether we should advocate for a steady state economy over continued economic growth and how we should prevent harm arising from companies’ focus on profit remained unanswered.

Next steps – What could planetary health mean to SHE?

PHA is currently functioning as an umbrella organisation, or in the words of one member, like the trunk and branches of a tree that supports the growth of leaves and fruit, which are members and affiliates. Among their priorities, the PHA are keen to support engagement of clinicians in planetary health, and would like to draw on CSH’s experience.

Regarding health professional education, the PHA have stated that this is among their priorities, and they have published principles for planetary health education across all disciplines (Stone et al. 2018). In an education side-session, a group focusing on medical education comprised about 20 people from at least five continents and identified four challenges: faculty development, the need to link learning to practice (i.e. we need to develop PH in practice if we are to teach it successfully and thus teach solutions and not just problems), how to generate interprofessional learning, how to make courses accessible (including open access for download) to avoid only preaching to the converted. We also identified three aims: (1) share existing teaching on planetary health through an online platform, (2) develop one internationally applicable online or outline learning event for use in diverse settings (any health professional), and (3) develop approaches, pedagogies and assessments for embedding PH across the curriculum. Towards the first aim, the PHA have created an online, open-access platform where they plan to collate materials for planetary health education: https://planetaryhealthalliance.org/education. The SHE network has already contributed some teaching materials. Work will need to be done to disseminate information about this platform and ensure that it is accessible and user friendly. The second is already underway, with at least two groups working on MOOCs on planetary health for global audiences. The third aim requires ongoing collaboration to build on existing efforts.  

Around the world, twenty ‘planetary health clubs’ have already been established by students and emerging researchers to encourage and support development of research groups and mentorship on planetary health issues. Another side-session explored the roles of these clubs, and planetary health education (including SHE) is likely to be part of their work, which presents another opportunity for us in the SHE network to identify new colleagues and collaborate to enhance medical education.

References

Stone SB, Myers SS, Golden CD. Cross-cutting principles for planetary health education. Lancet Planet Heal. 2018 May;2(5):e192–3:

https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30022-6/fulltext

Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet [Internet]. 2015 Nov;386(10007):1973–2028:

http://linkinghub.elsevier.com/retrieve/pii/S0140673615609011

Buse CG, Oestreicher JS, Ellis NR, Patrick R, Brisbois B, Jenkins AP, et al. Public health guide to field developments linking ecosystems, environments and health in the Anthropocene. J Epidemiol Community Health. 2018: http://jech.bmj.com/lookup/doi/10.1136/jech-2017-210082

Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu N, et al. The Lancet Commission on pollution and health. Lancet. 2018 Feb;391(10119):462–512:

http://linkinghub.elsevier.com/retrieve/pii/S0140673617323450