The health of humanity is inextricably tied to our civilizations and environments. It’s a commonsense idea. If water or air is polluted, people experience damaging health effects and shortened lifespans. If the societal systems that provide safe housing, economic security, or healthcare don’t function, more people live unhoused, in poverty, or without access to care – all of which lead to worse health for individuals and the planet as a whole.
Planetary health explores the connection between the health of people, civilizations, and the natural systems on which they depend. A 2025 UN Environment Program report found that investing in planetary health could add trillions to the global GDP, save millions of lives, and reduce hunger and poverty around the world. The field was first defined at a 2014 convening at the Bellagio Center held by The Rockefeller Foundation and The Lancet – one of the world’s most respected medical journals. The subsequent report laid out the core principles of planetary health and offered key recommendations, such as engaging the scientific community in economic and governance issues and redefining prosperity to incorporate quality of life, health, and protection of natural systems.
Dr. Richard Horton has served as The Lancet’s editor-in-chief for nearly 40 years, and he has been a leading voice on planetary health from the very beginning. We spoke to Horton about what planetary health means, how the 2014 Bellagio Center convening drove the development of the field, and what makes him hopeful about the future health of our planet.
The survival of any species under threat comes through extraordinary acts of cooperation. I really believe that, and it gives me hope.
Dr. Richard HortonEditor-in-Chief, the Lancet
What is a real-world example of something that affects planetary health?
Planetary health is the health of human civilizations and the natural systems they depend on to survive and function. It looks through a planetary lens, asking questions about the health of our economies and political systems, alongside our biological health. By doing so, it helps people understand that their health – and the health of their communities, nations, and planet – depend upon issues they may not have thought were relevant.
I’m trying to encourage people to take a much wider view of what affects health. Health is economics, government, and politics, not just medicine or biology. The U.K.’s decision to build a National Health Service, for example, was a political choice that has heavily impacted the health of its population. The economic effects of Brexit resulted in less money to invest in healthcare or factors like housing that affect health, creating a measurable effect on British health. So our government and political systems do directly connect to the health of people, nations, and our overall planetary health.
When I talk about the health of human civilizations, I don’t just mean what people usually think of as public health. It encompasses everything, in particular, the political, economic, and social factors that underpin our society.
How did The Rockefeller Foundation-Lancet Planetary Health Commission come into being?
In the run-up to their centennial, The Rockefeller Foundation invited me to give a talk, where I spoke about this emerging concept of planetary health. They thought it was interesting and asked me to put together a commission where we could define this idea.
So we brought on Andy Haynes, then director of the London School of Hygiene and Tropical Medicine, to serve as chair. One of our first major meetings was a convening at the Bellagio Center to develop the concept of planetary health.
When you hold a convening at the Bellagio Center, you have about 25 people who arrive on Monday, each with a different perspective. You fight it out for three days, and by the time you leave on Friday, you’ve created something that everyone is pretty much aligned on. That’s one of the things that makes the place unique.
We brought together people from many different disciplines and backgrounds to think about the connection between human health, natural systems, and civilizational health – the health of government, economic and other societal systems that keep civilizations going. What is a civilization and what does it depend on? How does it connect to other issues like climate or the biosphere?
At the time, these ideas hadn’t really been put together in a meaningful way. Over the course of three days, we refined the concept of what planetary health could be, and that work formed the core of the commission’s 2015 report.
Today, planetary health has definitely taken off as a discipline. There are professors of planetary health and departments of planetary health. There’s a Planetary Health Alliance that meets every year.
How has the way you talk about planetary health changed over the last ten years?
At the beginning, I talked a lot about civilizational collapse, which is a bit of a downer. A decade on, we realize that creating fear isn’t a very effective way of making change happen. If I tell you you’re going to die from climate change, you’re likely not going to feel mobilized to do anything about it, because, again, it’s a downer. But if I tell you that climate change is the biggest opportunity for global health in the 21st century, your whole psychology changes, because “opportunity” means you can do something. You have agency. You can use this moment to achieve good things. It’s a win-win situation.
We made that switch with planetary health. You can put it in positive terms, talking about how planetary health is about the factors that can lead to a thriving, sustainable, flourishing society. Making people enthusiastic because there’s something positive and optimistic that they can achieve is the best way to convince people to act. We have to talk about the positive things that we can do to improve our democracies, our economies, and our environments.
How would the world be different if people embraced this approach?
In A Theory of Justice, John Rawls talks about the concept of a “realistic utopia.” There’s no perfect society where everybody lives forever in perfect harmony and total happiness, of course. But Rawls says that we should modify the idea and think of a realistic utopia, while still being ambitious about what we want to achieve. The idea isn’t that every single person gets everything, but that society should have the minimum possible level of inequality.
As doctors, we should see ourselves as part of the struggle to create a realistic utopia. That means not just looking after the health of our patients, but being part of a wider movement. We should be just as concerned about the state of governance in the world as we are about the health system, because they’re all connected.
We also need to redefine the boundaries of our disciplines. Planetary health works at the intersection of ecology, public health, economics, and governance. But our disciplines of study remain in silos. Political scientists work in departments of political science, not departments of medicine. Medical journals don’t publish on economics or anthropology. Without places to interact, our disciplines stay isolated. That’s the beauty of The Rockefeller Foundation and the Bellagio Center – bringing people from different disciplines together to work on a common problem.
What makes you hopeful about our ability to positively influence planetary health?
Cooperation between scientists in different countries can be unbelievably powerful. When the COVID-19 pandemic started in Wuhan, Chinese scientists who were defining the first cases and sequencing the virus sent their work to the Lancet. We published five papers from Chinese authors in February 2020 describing the entire outbreak, how it worked, and the exact clinical impact that it would have. They reached out at this moment of extraordinary political pressure because they were part of a community that goes beyond national borders.
All over the world, you saw medical scientists all doing similar things. Everybody worked together to contribute to solving the problem, whether it was understanding which variant of the virus was being transmitted or producing an effective vaccine. Whatever the challenge, people worked in an unprecedented, collaborative way. That makes me hopeful.
It’s also why I worry about anything that closes the door to cooperation. My role in life is to bring people together. It may only be in my little corner of global health and medicine, but I want to bring as many people from as many different cultures and countries together to work together on our common problems.
Our future is as strong as our connections to each other. Though humanity may face many difficult challenges, Horton believes that the key to solving them lies in our ability to collaborate. “The survival of any species under threat comes through extraordinary acts of cooperation,” Horton said. “I really believe that, and it gives me hope.”
Learn More:
- Read the report from the The Rockefeller Foundation–Lancet Commission on planetary health.
- Explore the factors that impact planetary health and what we can do to address them in this infographic from The Lancet.
- Watch this brief overview of planetary health from the Planetary Health Alliance.
The opinions expressed in this article are those of the author. The Rockefeller Foundation is not responsible for and does not endorse its content.