Planetary Health – Economist Intelligence Unit
December 25, 2014
In 2013, Martin Rees, former president of the UK’s Royal Society, a prestigious fellowship of scientists from every field across science, engineering and medicine, wrote in Science magazine, “The main threats to sustained human existence now come from people, not from nature. We have a limited time base for exposure to [these threats] and can’t be so sanguine that we would survive them for long, or that governments could cope if disaster strikes.”
The first part of Rees’s statement is uncontroversial. It is widely agreed that we live in an anthropocene era, one in which human activities are perceived to impact our planet’s ecosystems unfavorably. But the second part is more alarming. Here, he suggests that our ability to escape these threats may be limited. Dangers humans face may not be resolved by adapting to or lessening the harm wrought by our activities. Rees is describing the ultimate threat to human health—our species’ extinction by our own hand.
Yet there is a paradox in this predicament. In the past decade, driven mostly by the United Nations’ Millennium Development Goals (MDGs)—eight goals for 2015, agreed to by all the world’s countries, including halving poverty and improving maternal and child health—a powerful new discipline deeply concerned with human health and well-being known as ”global health” has emerged. This intense concern with our well-being is reflected in an astonishing increase in Development Assistance for Health (DAH), or development-focused funds for health from public and private institutions for low- and middle-income countries.
Before the MDG era (pre-2000), annual growth in DAH was 5.9%. In 2001, total DAH stood at $10.8bn. But from 2001 onwards, annual DAH growth accelerated as high as 11.2% for DAH that totaled US$28.2bn by 2010.
Shifts in research or policies often reflect the concerns of particular times and places. Such is the case with global health. Global health has emerged at a moment when the risks and drivers shaping the health of populations cross national borders in entirely new ways, evident in global epidemics and the increasingly common causes of non-communicable diseases, such as smoking and obesity. The complex and intertwined nature of global health thus suggests an interest in trans-border health issues and solutions, interdisciplinary study and the integration of public health with the multiple dimensions of health care.
Global health is an improvement over the concept that preceded it: international health. The word ‘global’ implies a commitment not only to improving health, but also to achieving equity among peoples. Because the concept suggests that individuals and populations are interdependent, global health also demands revisiting the political, economic and social contexts of health and disease.
Indeed, understanding our current challenges and finding solutions to them will require far deeper levels of collaboration between peoples. The values that underpin global health have created a new generation of activism for a healthier and more equitable world.
But is global health—in both its definition and scope—truly meeting the demands that our societies currently face? One could argue that global health may still be too narrow to explain and illuminate some pressing challenges today. Global health does not fully take into account the natural foundation on which humans live—the planet itself. Nor does it factor in the force and fragility of human civilisations.
Our planet is under increasing pressure, not just from the 2bn more people who will inhabit it between now and 2050. That is why the post-MDG era is focused on sustainability, or the idea that not only are human and natural systems interdependent, but also that the deviation of environmental trajectories from their natural course could be catastrophic. In this way, the goals of sustainability differ greatly from those that have dominated the MDG era. Sustainability means valuing tomorrow as much as today because the planet’s potential to sustain the human species is slowly declining. It means being concerned about all of us, not just some of us. Clearly, the post-2015 era’s most important idea is that global sustainability is the bedrock of human health, survival and prosperity.
To more precisely define what it is we must sustain, Johan Rockström, a professor of Environmental Science at Stockholm University, introduced the concept of planetary boundaries, or the idea that our species must live within a safe operating space. That space is defined by dangers such as ocean acidification, ozone depletion, declining freshwater resources, biodiversity loss, chemical pollution and climate change. If one or more of these boundaries is breached, environmental trajectories that veer from their natural path could impact planetary systems so severely that the very survival of the human species would be in jeopardy. Already, Rockström argues, three planetary boundaries have been crossed—those of climate change, biodiversity and the global nitrogen cycle.
Since its 2009 introduction, this planetaryboundary approach has captured the imagination of many scientists and policymakers. But another dimension should also be considered. Planetary boundaries focus on our planet’s natural systems and how human activity is changing them. But what about human systems—the political, economic, social, technical and environmental policies and institutions we create, which together shape the decisions and actions that affect our planet’s natural systems? In other words, what about human civilisations, and how they impact our future? And how will that future, in turn, affect human civilisations? One could argue that the way we organise society’s decisions and actions to face planetary threats is more important than the threats themselves.
Consider these questions: What risks do our civilisations face, and how will we identify them? Are we living through a key transition for our species and civilisations, and how would we know if we were? What forces have shaped past civilisations and our civilisations today, and what will protect future civilisations? What will determine human sustainability and resilience in the face of these planetary dangers? Is human and planetary sustainability compatible with our current expectations for economic growth and material prosperity?
To answer these and other questions, The Lancet and The Rockefeller Foundation are launching a commission and convening a major global gathering at the Foundation’s Center in Bellagio, Italy. This special edition of The Economist magazine will, together with other inputs, help shape that ongoing conversation.
This commission and the July 2014 Bellagio Center meeting will investigate the threats to human civilisations from planetary-system disturbances and explore a wide range of possible responses to those threats. It will argue that we need to go beyond even the broad manifesto of global health, by instead adopting a whole-planet (planetary) view of human health and well-being. It will describe the nature of the systems affecting planetary health, define the goals of securing planetary health, suggest a roadmap for achieving these ambitious objectives and propose concrete actions to do so. Finally, the commission will seek to identify the concepts, methods and tools necessary to prevent civilisational collapse, and to foster the flourishing of human societies.