Summary Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health - The Lancet www.thelancet.com
66,011 words - html page - View html page
One Line
Ecosystem restoration is necessary to reduce environmental risks, improve human health, and promote food security.
Key Points
- Planetary Health Commission launched to investigate connection between human health and environment
- WHO estimates 13 million deaths annually from environmental causes
- Strategies and technological advancements proposed to reduce climate change effects
- Global food security linked to climate change, including potential for aflatoxin exposure in developing countries
- Health co-benefits and risks associated with public health adaptation strategies to climate change
- UN General Assembly proposed holistic approach that takes happiness into account
- Framework needed to identify "safe and just operating space" for humanity
Summaries
143 word summary
Ecosystem restoration can improve human health and alleviate poverty by reducing emissions from animal products and incentivizing fruit and vegetable production. Global environmental change is linked to health risks, freshwater shortages, species loss, and reduced food nutrition, so urgent action is needed to reduce waste and hazardous materials. The Rockefeller Foundation and The Lancet released a Planetary Health report, identifying three categories of challenges. WHO (1946) and Horton et al. (2014) have proposed frameworks for protecting human health and WHO estimates 13 million deaths annually from environmental causes. Steffen et al. (2015) suggested that human development should be guided by "planetary boundaries". Lal (2004, 2010), Lambin et al. (2011), Montgomery (2007), Koch et al. (2013), Van Lynden and Odeman (1998), Rockström et al. (2009) and multiple other studies have identified soil carbon sequestration and economic globalization as contributing to global food security challenges.
422 word summary
The Lancet has launched the Planetary Health Commission to investigate the connection between human health and the environment. WHO estimates 13 million deaths annually from environmental causes. Google Scholar references cover topics like global environmental governance and sustainable development goals. Crossref, PubMed, and Scopus were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Steffen et al. (2015) suggested that human development should be guided by "planetary boundaries". Lal (2004, 2010), Lambin et al. (2011), Montgomery (2007), Koch et al. (2013), Van Lynden and Odeman (1998), Rockström et al. (2009) and multiple other studies have identified soil carbon sequestration and economic globalization as contributing to global food security challenges.
WHO (1946) seeks to protect human health in its Constitution, while Horton et al. (2014) proposed a manifesto for planetary health and Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Google Scholar has identified numerous studies related to climate change mitigation and its impacts, such as food insecurity, US daily temperatures, crop yields, child undernutrition, coral reefs, ocean ecosystem services, and fish consumption. The Climate and Clean Air Coalition (CCAC) has highlighted kerosene lamps and SLCPS, while Bowler et al. (2010) have explored the effectiveness of 'greening' urban areas.
The Rockefeller Foundation and The Lancet released a report on planetary health which identified three categories of challenges: conceptual and empathy failures, knowledge failures, and implementation failures. Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals, particularly in low-income countries. Policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution and crop productivity. Google Scholar suggests a framework to identify a "safe and just operating space" for humanity. Bioethicists are looking at discounting and justice theorists argue for protecting the future. Ecosystem restoration can alleviate poverty and improve human health. Animal products have higher emissions and are linked to global burden of disease, so incentivising fruit and vegetable production is important. The IPCC and WHO have studied the health co-benefits of reducing fine particulates, which are linked to 3.7 million deaths annually. Other public health issues include household air pollution, toxic chemical exposure, vector-borne diseases, and lead poisoning. Global environmental change is linked to health risks, freshwater shortages, species loss, and reduced food nutrition, so urgent, transformative action is needed to reduce waste and hazardous materials. Since 1970, natural disasters have caused over 1.9 million deaths, and climate change is linked to competition for resources and displacement of people.
612 word summary
Household air pollution, toxic chemical exposure, vector-borne diseases, and lead poisoning are major public health issues. Global environmental change is linked to health risks, freshwater shortages, species loss, and reduced food nutrition, and societies must take urgent, transformative action to reduce waste and hazardous materials. Natural disasters have caused over 1.9 million deaths since 1970 and climate change is linked to competition for resources and displacement of people. Ecosystem restoration has been linked to poverty alleviation, with land use changes having both positive and negative impacts on human health. Animal products have higher emissions and are linked to global burden of disease, so incentivising fruit and vegetable production is important. The health co-benefits of reducing fine particulates have been studied by the IPCC and WHO, with an estimated 3.7 million deaths annually due to air pollution. The Rockefeller Foundation and The Lancet released a report on planetary health which identified three categories of challenges: conceptual and empathy failures, knowledge failures, and implementation failures. Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals, particularly in low-income countries. Policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution and crop productivity. Google Scholar suggests a framework to identify a "safe and just operating space" for humanity. Bioethicists are looking at discounting and justice theorists argue for protecting the future. Three elements for environmental justice have been suggested while high-income countries focus on economic efficiency. The doughnut and resilience approaches have been tested in multiple communities and planetary health should be integrated into training. Steffen et al. (2015) suggested that human development should be guided by "planetary boundaries", including grassroots involvement in protecting planetary health and the implementation of alternative methods for measuring human progress. Lal (2004, 2010), Lambin et al. (2011), Montgomery (2007), Koch et al. (2013), Van Lynden and Odeman (1998), Rockström et al. (2009) and multiple other studies have identified soil carbon sequestration and economic globalization as contributing to global food security challenges. Climate change has serious implications for global food security, including potential for aflatoxin exposure in developing countries and is linked to AIDS in sub-Saharan Africa. WHO (1946) seeks to protect human health in its Constitution, while Horton et al. (2014) proposed a manifesto for planetary health and Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Google Scholar has identified numerous studies related to climate change mitigation and its impacts, such as food insecurity, US daily temperatures, crop yields, child undernutrition, coral reefs, ocean ecosystem services, and fish consumption. The Climate and Clean Air Coalition (CCAC) has highlighted kerosene lamps and SLCPS, while Bowler et al. (2010) have explored the effectiveness of 'greening' urban areas. Successful projects such as the UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania and the World Bank's Loess Plateau Watershed Rehabilitation Project in China have been implemented to reduce deforestation/increase grass coverage and improve surface cover greenness respectively. The Lancet has launched the Planetary Health Commission to investigate the connection between human health and the environment. WHO estimates 13 million deaths annually from environmental causes, such as crop production, landscape fire smoke, and aquaculture. To further study these impacts, Google Scholar references cover topics like global environmental governance, paying for ecosystem services, and navigating the Anthropocene. Organizations have proposed data revolutions and sustainable development goals to address these issues. Crossref, PubMed, and Scopus were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Specific articles published by Google Scholar examine the impact of climate change on human health, such as International Health Regulations, contraceptive services, and a "Urban Water Blueprint".
1020 word summary
The Lancet has launched the Planetary Health Commission to investigate the connection between human health and the environment. WHO estimates 13 million deaths annually from environmental causes. Ecosystem change can affect human health, including crop production, landscape fire smoke, and aquaculture. Google Scholar references cover topics such as global environmental governance, paying for ecosystem services, and navigating the Anthropocene. Several organizations have proposed data revolutions and sustainable development goals. Crossref, PubMed, and Scopus were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Google Scholar has published articles examining the impact of climate change on human health, such as International Health Regulations, contraceptive services, and a "Urban Water Blueprint". The Climate and Clean Air Coalition (CCAC) has highlighted kerosene lamps and SLCPS, while Bowler et al. (2010) have explored the effectiveness of 'greening' urban areas. Elmqvist et al. (2013) discussed urbanization, biodiversity, and ecosystem services, and Jarrett et al. (2012) studied the effect of active travel on NHS costs. Cheng and Berry (2013) reviewed health co-benefits and risks associated with public health adaptation strategies to climate change. Successful projects such as the UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania and the World Bank's Loess Plateau Watershed Rehabilitation Project in China have been implemented to reduce deforestation/increase grass coverage and improve surface cover greenness respectively.
Google Scholar has identified numerous studies related to climate change mitigation and its impacts, such as food insecurity, US daily temperatures, crop yields, child undernutrition, coral reefs, ocean ecosystem services, and fish consumption. A meta-analysis showed positive responses to rising CO2 levels, but these may not be enough to offset negative impacts. Strategies and technological advancements are proposed to reduce the effects.
Climate change is having serious implications for global food security, including potential for aflatoxin exposure in developing countries, and is linked to AIDS in sub-Saharan Africa. Pollinators, soil fertility, hunger in Africa, land degradation, food prices and food insecurity, nutrient requirements for those living with HIV/AIDS are some of the effects studied. WHO (1946) seeks to protect human health in its Constitution, while Horton et al. (2014) proposed a manifesto for planetary health and Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Lal (2004, 2010) and Lambin et al. (2011) found that soil carbon sequestration and economic globalization contribute to global food security challenges. Montgomery (2007) and Koch et al. (2013) discussed soil security, and Van Lynden and Odeman (1998) assessed human-induced soil degradation in South and Southeast Asia. Rockström et al. (2009) proposed a safe operating space for humanity, while UNEP Global Environment Outlooks (2012, 2007), Millennium Ecosystem Assessment (2006), Butler (2014), Lim et al. (2012), Prüss-Üstün and Corvalán (2006), Pimm et al. (2014), Lehner et al. (2011), World Commission on Dams (2000), FAO (2014), Hansen et al. (2013), and Foley et al. (2007) presented findings on global maps, reservoirs, and human health.
Steffen et al. (2015) suggested that human development should be guided by "planetary boundaries". Panel 14 emphasizes the importance of grassroots involvement in protecting planetary health, such as strengthening local governance, reforming taxes and subsidies, and implementing alternative methods for measuring human progress. The UN General Assembly proposed a holistic approach that takes happiness into account, and Monetisation of non-market benefits can help to offset the cost of action. Integrated multifunctional teams should be redirected towards emerging threats in times of emergency, and ecosystem-based adaptation measures such as mangrove planting are cost-effective. Hurricane Katrina raised social justice issues and highlighted weaknesses in disaster preparedness and response, leading to the revision of the National Response Framework. Google Scholar suggests a framework is needed to identify a "safe and just operating space" for humanity. Bioethicists are looking at discounting and justice theorists argue for protecting the future. Three elements for environmental justice have been suggested while high-income countries focus on economic efficiency. The doughnut and resilience approaches have been tested in multiple communities and planetary health should be integrated into training. The Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals, particularly in low-income countries. Policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution and crop productivity, while solar lamps can reduce black carbon emissions, burns, and dependence on kerosene. The health co-benefits of reducing fine particulates have been studied by the IPCC and the Lancet Commission on Climate Change, with WHO estimating 3.7 million deaths annually due to air pollution. Reducing short-lived climate pollutants could yield major health benefits, preventing an estimated 2.4 million premature deaths annually. Ecosystem restoration has been linked to poverty alleviation, with land use changes having both positive and negative impacts on human health. Animal products have higher emissions and are linked to global burden of disease, so incentivising fruit and vegetable production is important. Global environmental change presents three challenges: conceptual, knowledge and implementation failures. Natural disasters have caused over 1.9 million deaths since 1970 and climate change is linked to competition for resources and may increase intergroup conflict. By 2050, between 50 million and 350 million people may be displaced due to climate change, and risk factors for depression in adults after natural disasters include gender, marital status, religious beliefs, education, injury or bereavement during the disaster, or loss of employment or property. Interdisciplinary collaboration is needed to develop and implement appropriate policies to support human health and the planet by reducing poverty, adapting to environmental change and achieving equitable human development. Household air pollution, toxic chemical exposure, vector-borne diseases, and lead poisoning are major public health issues. Research and innovation are needed to reduce environmental impacts and involve local communities. Global environmental change is linked to health risks, freshwater shortages, species loss, and reduced food nutrition. Ocean acidification, climate change, and freshwater resource depletion are all caused by human activity. The Rockefeller Foundation and The Lancet released a report on planetary health to preserve human health in the Anthropocene epoch. Three categories of challenges were identified: conceptual and empathy failures, knowledge failures, and implementation failures. Societies must take urgent, transformative action to reduce waste and hazardous materials.
2266 word summary
The Rockefeller Foundation and The Lancet have released a report on planetary health, compiled by experts from various institutions, which focuses on preserving human health in the Anthropocene epoch. Harvard T.H. Chan School of Public Health and The Rockefeller Foundation's Samuel S Myers collaborated on a research article that identifies three categories of challenges: conceptual and empathy failures, knowledge failures, and implementation failures.
Societies must take urgent, transformative action to reduce waste, incentivize recycling and repair, and substitute hazardous materials with safer alternatives. Global trends in population, consumption, health, and the environment have been drastically altered due to human activity entering a new geological epoch. To achieve rapid scale-up of potential solutions, transdisciplinary research activities and capacity need to expand.
Ocean acidification, climate change, and freshwater resource depletion are all global issues caused by human activity. The Intergovernmental Panel on Climate Change (IPCC) has found clear evidence that climate change is due to human activity. The Millennium Ecosystem Assessment (MEA) in 2005 found that 60% of global ecosystem services were being degraded or used unsustainably. WHO estimates that a quarter of the global disease burden is attributable to modifiable environmental factors. Google Scholar warns that accelerating changes to Earth's natural systems represent a substantial threat to global human health. Research and innovation are needed to reduce the environmental footprint and improve efficiency. Policies must be put in place to cap emissions and involve local communities. By 2050, 150 million people could face water scarcity, and 2–3 billion people may need housing. Reducing population growth and resource consumption is necessary for sustainability, but population growth puts pressure on biodiversity. Biodiversity is decreasing and land degradation is leading to species loss and increased nitrogen and phosphorus levels in the environment. Global environmental change is linked to health risks and reducing food nutrition. Climate change can lead to changes in rainfall patterns, reduced crop yields, nutrient deficiencies, and increased plant toxins, affecting the Food–Water–Energy Nexus and leading to freshwater shortages and increased incidence of diarrhoeal disease. Pollinators are declining due to pests, parasites, environmental stressors, and reduced genetic diversity, leading to soil nutrient depletion and degradation. Fish are threatened by overfishing, marine habitat degradation, and ocean acidification. Wild foods can help households facing mortality and HIV/AIDS buffer against food shortages and increase dietary diversity. Household air pollution and toxic chemical exposure can lead to a range of health issues. Vector-borne diseases, such as malaria, are linked to global environmental changes, while bats have been found to carry Ebola virus, with deforestation potentially linked to its spread. Methylmercury and lead poisoning remain major public health issues, particularly in low-income countries. Natural disasters have caused over 1.9 million deaths since 1970 and the total cost of extreme weather events between 1980 and 2004 has been estimated to be $1.4 trillion. In Pakistan, environmental changes, population growth, and unplanned urbanisation have caused risks from floods and heavy rainfall. Climate change is likely to increase water stress in Pakistan and could become a major destabilising factor in the country. It is also linked to competition for resources and may increase intergroup conflict by 14% for every increase in temperature or rainfall. By 2050, between 50 million and 350 million people may be displaced due to climate change, and risk factors for depression in adults after natural disasters include gender, marital status, religious beliefs, education, injury or bereavement during the disaster, or loss of employment or property. Global environmental change presents three challenges: conceptual, knowledge and implementation failures. Solutions to support both human health and the planet focus on reducing poverty, adapting to environmental change and achieving equitable human development. Interdisciplinary collaboration is needed to develop and implement appropriate policies.
Animal products have higher emissions and are linked to global burden of disease, so incentivising fruit and vegetable production and removing subsidies on unhealthy food is important. WHO dietary recommendations could reduce emissions and increase life expectancy. Small shifts in crop allocation from animal feed and biofuels to direct human consumption could increase global food availability.
Ecosystem restoration has been linked to poverty alleviation, with the Loess Plateau in China and Shinyanga Soil Conservation Programme (HASHI) in Tanzania as examples. Land use changes can have both positive and negative impacts on human health. The REDD+ mechanism has been created to reduce greenhouse gas emissions from deforestation and forest degradation, while providing various co-benefits.
The health co-benefits of reducing fine particulates, attributed to fossil fuel combustion, have been studied by the IPCC and the Lancet Commission on Climate Change. WHO estimates that 3.7 million deaths occur annually due to air pollution. Reducing short-lived climate pollutants could yield major health benefits, preventing an estimated 2.4 million premature deaths annually.
The Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals. Regulatory approaches are often inadequate, particularly in low-income countries. Policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution and crop productivity. Solar lamps can reduce black carbon emissions, burns, and dependence on kerosene. Google Scholar suggests a framework is needed to identify a "safe and just operating space" for humanity. Bioethicists are looking at discounting and justice theorists argue for protecting the future. Three elements for environmental justice have been suggested for low-income countries, while high-income countries focus on economic efficiency. The doughnut and resilience approaches have been tested in multiple communities and planetary health should be integrated into training. Almost a third of the 100 largest cities have green spaces, and exposure to natural environments lowers negative emotions. Google Scholar suggests using technologies with multiple benefits, and the European Commission proposed a circular economy model to reduce costs. The UN General Assembly proposed a holistic approach that takes happiness into account, and national governments must involve local initiatives and international institutions in their strategic plans. Monetisation of non-market benefits can help to offset the cost of action, while low-income countries have more leeway for technological leapfrogging. Integrated multifunctional teams should be redirected towards emerging threats in times of emergency, and ecosystem-based adaptation measures such as mangrove planting are cost-effective. Hurricane Katrina raised social justice issues and highlighted weaknesses in disaster preparedness and response, leading to the revision of the National Response Framework. Google ScholarPanel 14 emphasizes the importance of grassroots involvement in protecting planetary health, such as strengthening local governance, reforming taxes and subsidies, and implementing alternative methods for measuring human progress. Gaps in knowledge need to be addressed with an interdisciplinary research agenda setting process and capacity strengthening. All stakeholders, including citizens, should be involved in promoting planetary health through policies that address environmental health challenges, increase resilience to threats, improve risk communication, and implement creative financing strategies. Google Scholar references various documents from 1971 to 2013, such as the Ramsar Convention on Wetlands of International Importance and the Economics of Ecosystems and Biodiversity (TEEB) (2010). In 2014, the World Wide Fund for Nature released the "Living Planet Report 2014: Species and Spaces, People and Places" which revealed physical water scarcity and the "Great Acceleration" of the Anthropocene. Google Scholar has published numerous studies on the impacts of global climate change and food security. UNEP Global Environment Outlooks (2012, 2007) and Millennium Ecosystem Assessment (2006) focus on human health, ecosystem regulation of infectious diseases, and economic value of biodiversity. Butler (2014), Lim et al. (2012), Prüss-Üstün and Corvalán (2006), Pimm et al. (2014), Lehner et al. (2011), World Commission on Dams (2000), FAO (2014), Hansen et al. (2013), and Foley et al. (2007) present findings on global maps and reservoirs. Steffen et al. (2015) found that human development must be guided by "planetary boundaries".
Lal (2004, 2010) found that soil carbon sequestration can help mitigate anthropogenic carbon emissions and advance global food security, while Lambin et al. (2011) identified economic globalization and land scarcity as further challenges. Montgomery (2007) and Koch et al. (2013) discussed the importance of soil security, and Van Lynden and Odeman (1998) assessed the status of human-induced soil degradation in South and Southeast Asia. Urbanization is closely linked to global environmental change, with developing-country cities particularly vulnerable to climate change. Rockström et al. (2009) proposed a safe operating space for humanity.
Climate change is having serious implications for global food security, including potential for aflatoxin exposure in developing countries, and is linked to AIDS in sub-Saharan Africa. Pollinators, soil fertility, hunger in Africa, land degradation, food prices and food insecurity, nutrient requirements for those living with HIV/AIDS are some of the effects studied. WHO (1946) seeks to protect human health in its Constitution, while Horton et al. (2014) proposed a manifesto for planetary health and Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Google Scholar has identified numerous studies related to climate change mitigation and its impacts, such as food insecurity, US daily temperatures, crop yields, child undernutrition, coral reefs, ocean ecosystem services, and fish consumption. A meta-analysis showed positive responses to rising CO2 levels, but these may not be enough to offset negative impacts. Strategies and technological advancements are proposed to reduce the effects.
Other topics studied include the safety of novel protein sources, labour capacity from heat stress, impacts of ICDPs in the Brazilian Amazon, Dietary Guidelines Advisory Committee's report, FAO's Code of Conduct for Responsible Fisheries, role of aquaculture in global food security, extreme weather events and waterborne disease, health effects of drought, endocrine disruption, biodiversity loss, environmental threats to human health, and government reports.
Studies have also looked at the potential of fish to feed 9 billion people by 2050, transgenic biofortified crops, forest certification in Indonesia, smoke exposure, effects of habitat fragmentation on Lyme disease risk, and global health impacts of floods. Cheng and Berry (2013) reviewed health co-benefits and risks associated with public health adaptation strategies to climate change. The UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania and the World Bank's Loess Plateau Watershed Rehabilitation Project in China have been successful in reducing deforestation/increasing grass coverage and improving surface cover greenness, respectively. Google Scholar has published numerous studies on the externalities of fertilizer use and pesticide ecological and health risks in West African agriculture, as well as the costs of inaction on the sound management of chemicals and public health benefits of strategies to reduce greenhouse-gas emissions.
The Climate and Clean Air Coalition (CCAC) has provided a briefing on kerosene lamps and SLCPS, while Bowler et al. (2010) explored the effectiveness of 'greening' urban areas to reduce air pollution and the 'urban heat island effect'. Elmqvist et al. (2013) discussed urbanization, biodiversity, and ecosystem services, while Jarrett et al. (2012) studied the effect of active travel on NHS costs. UN-Department of Economic and Social Affairs Population Division (2010) and UN Environment Programme (2006) published reports on urbanization and chemicals management, respectively.
Google Scholar has published articles examining the impact of climate change on human health. Kimball and Heymann (2014) discussed the role of International Health Regulations, while O'Neill et al. (2012) analyzed the effects of demographic change and carbon dioxide emissions. Singh and Darroch (2012) estimated the costs and benefits of contraceptive services and the Global Commission on the Economy and Climate (2014) released a report on "Better growth, better climate". McDonald and Shemie (2013) proposed a "Urban Water Blueprint" to address the global water challenge.
Crossref, PubMed, and Scopus (171) were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Loss events worldwide 1980-2013 were evaluated by Munich RE NatCatSERVICE. Various authors discussed topics such as "Safe and just operating spaces" for regional social-ecological systems, regional growth, inequality, and poverty in a carbon-constrained world, equity, environmental justice, and sustainability in climate change politics, threats to health posed by Caribbean heat, human rights obligations and the Earth Summit, weather and mortality in Burkina Faso, global health watch monitoring impacts of environmental change. Yates (2014) proposed recycling fuel subsidies as health subsidies and the Organisation for Economic Co-operation and Development (2011) provided guidance for policy makers on environmental taxation. Bond and Lang (2014) analyzed happiness scales, Costanza et al. (2014) argued for leaving GDP behind, and various organizations proposed data revolutions and sustainable development goals. The New Economics Foundation created the Happy Planet Index, Porter and Stern developed the Social Progress Index, and Talberth et al. created the Genuine Progress Indicator. Dasgupta (2010) investigated nature's role in sustaining economic development, and Sukhdev et al. discussed the Economics of Ecosystems and Biodiversity (TEEB).
Google Scholar references #409-394 cover topics including collapse, environment and society, global environmental governance, and paying for ecosystem services. Ostrom (417) discussed polycentric governance, UNAIDS (416) reported on the global HIV/AIDS epidemic, and Friel et al. (415) discussed potential risks to diet-related health from the Trans Pacific Partnership Agreement. Sunstein (413) presented a tale of two protocols, Biermann et al. (412) discussed navigating the Anthropocene, and Ottersen et al. (411) explored the political origins of health inequity. Conway and Oreskes (410) discussed how a handful of scientists obscured the truth on various issues.
The Lancet has launched initiatives to investigate the connection between human health and the environment, including the Planetary Health Commission. This Commission found that human health gains come with environmental degradation and outlines action points to protect health in the Anthropocene epoch. WHO estimates 13 million deaths annually from environmental causes, and Professor Tony Capon believes planetary health is about protecting current and future generations. Ecosystem change can affect human health, with crop production at the end of the century expected to be affected by water use. Landscape fire smoke is a major mortality risk, and aquaculture is being used to meet fish demand.
4233 word summary
The Lancet has launched initiatives to investigate the connection between human health and the environment, including the Planetary Health Commission. This Commission found that human health gains come with environmental degradation, and outlines action points to protect health in the Anthropocene epoch. WHO estimates 13 million deaths annually from environmental causes, and Professor Tony Capon believes planetary health is about protecting current and future generations. Ecosystem change can affect human health, and crop production at the end of the century is expected to be affected by water use. Landscape fire smoke is a major mortality risk, and aquaculture is being used to meet fish demand. Various organizations have also proposed data revolutions and sustainable development goals. Google Scholar references #409-394 cover topics such as collapse, environment and society, global environmental governance, and paying for ecosystem services. Ostrom (417) discussed polycentric governance, UNAIDS (416) reported on the global HIV/AIDS epidemic, and Friel et al. (415) discussed potential risks to diet-related health from the Trans Pacific Partnership Agreement. Sunstein (413) presented a tale of two protocols and Biermann et al. (412) discussed navigating the Anthropocene, while Ottersen et al. (411) explored the political origins of health inequity and Conway and Oreskes (410) discussed how a handful of scientists obscured the truth on various issues.
Yates (2014) proposed recycling fuel subsidies as health subsidies, the Organisation for Economic Co-operation and Development (2011) provided guidance for policy makers on environmental taxation, Bond and Lang (2014) analyzed the validity of happiness scales, and Costanza et al. (2014) argued for leaving GDP behind. The New Economics Foundation created the Happy Planet Index, Porter and Stern developed the Social Progress Index, Talberth et al. created the Genuine Progress Indicator, Dasgupta (2010) investigated nature's role in sustaining economic development, and Sukhdev et al. discussed the Economics of Ecosystems and Biodiversity (TEEB).
Research has assessed the potential impact of wetland expansion and management on mosquitoes in Britain, mangrove planting in Viet Nam, floods on the Millennium Development Goals in Pakistan, power outages and extreme events on health, environmental change adaptation, heat warning systems, and coastal wetlands for hurricane protection. To prevent disease and slow global warming, behavior change is key and mobile-health technology interventions, handwashing campaigns, and cash-back rebate programs have been used.
Crossref, PubMed, and Scopus (171) were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Loss events worldwide 1980-2013 were evaluated by Munich RE NatCatSERVICE. Various authors discussed topics such as "Safe and just operating spaces" for regional social-ecological systems, regional growth, inequality, and poverty in a carbon-constrained world, equity, environmental justice, and sustainability in climate change politics, threats to health posed by Caribbean heat, human rights obligations and the Earth Summit, weather and mortality in Burkina Faso, global health watch monitoring impacts of environmental change Google Scholar has published several articles examining the impact of climate change on human health. Kimball and Heymann (2014) discussed the role of International Health Regulations, while O'Neill et al. (2012) analyzed the effects of demographic change and carbon dioxide emissions. Singh and Darroch (2012) estimated the costs and benefits of contraceptive services and the Global Commission on the Economy and Climate (2014) released a report on "Better growth, better climate". McDonald and Shemie (2013) proposed a "Urban Water Blueprint" to address the global water challenge.
Bowler et al. (2010) explored the effectiveness of 'greening' urban areas to reduce air pollution and the 'urban heat island effect'. Elmqvist et al. (2013) discussed urbanization, biodiversity, and ecosystem services, while Jarrett et al. (2012) studied the effect of active travel on NHS costs. UN-Department of Economic and Social Affairs Population Division (2010) and UN Environment Programme (2006) published reports on urbanization and chemicals management, respectively.
Cheng and Berry (2013) reviewed health co-benefits and risks associated with public health adaptation strategies to climate change, while The UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania and the World Bank's Loess Plateau Watershed Rehabilitation Project in China have been successful in reducing deforestation/increasing grass coverage and improving surface cover greenness, respectively. Google Scholar has published numerous studies on the externalities of fertilizer use and pesticide ecological and health risks in West African agriculture, as well as the costs of inaction on the sound management of chemicals and public health benefits of strategies to reduce greenhouse-gas emissions in urban land transport and household energy. The Climate and Clean Air Coalition (CCAC) has also provided a briefing on kerosene lamps and SLCPS.
Béné et al. (2015) examined the potential of fish to feed 9 billion people by 2050, and De Steur et al. (2015) analyzed the market potential of transgenic biofortified crops. Miteva D, Loucks C & Pattanayak SK (in review) have studied the impacts of forest certification in Indonesia, while Kim et al. (2015), Allan et al. (2003), Bauch et al. (in press), and Pattanayak et al. (2007) looked at smoke exposure, effects of habitat fragmentation on Lyme disease risk Google Scholar has identified numerous studies related to food security, water-related issues in Pakistan, endocrine disruption, biodiversity loss, environmental threats to human health, and climate change. The studies focus on topics such as the safety of novel protein sources, labour capacity from heat stress, impacts of ICDPs in the Brazilian Amazon, Dietary Guidelines Advisory Committee's report, Global Ocean Commission's report, FAO's Code of Conduct for Responsible Fisheries and State of World Fisheries and Aquaculture, role of aquaculture in global food security, Government Office for Science's Foresight report, Searchinger et al.'s report on creating a sustainable food future, Hyogo Framework for Action 2005-2015, extreme weather events and waterborne disease, global health impacts of floods, health effects of drought, Atlas of Mortality and Economic Losses from Weather Climate and Water Extremes (1970-2012), WHO UN Environment Programme Inter-Organization Programme for the Sound Management of Chemicals State of the Science of Endocrine Disrupting Chemicals 2012, US Environmental Protection Agency High Production Volume (HPV) Challenge, Global Child Labour Developments: Measuring Trends from 2004 to 2008, burden of disease due to chemicals and guidance on Ridding the World of POPs, Ebola outbreak in West Africa, agricultural intensification, urban habituation, ecological connectivity, air pollution, malaria epidemiology, dengue fever and other vector-borne diseases, Nipah virus emergence, HIV and schistosomiasis co-infection, and waterborne diarrhoea. Atehnkeng et al. (2008) have evaluated atoxigenic isolates of Aspergillus flavus as potential biocontrol agents for aflatoxin in maize. Prüss-Ustün et al. (2014) conducted a retrospective analysis of 145 countries to determine the disease burden linked to inadequate water, sanitation, and hygiene. Google Scholar has published numerous studies on climate change mitigation and its impacts. Examples include food insecurity due to heat, US daily temperatures, crop yields and child undernutrition, coral reefs, ocean ecosystem services, and fish consumption. A meta-analysis showed positive responses to rising CO2 levels, but these may not be enough to offset the negative impacts. Public health strategies and technological advancements are proposed to reduce the effects.
Climate change is having serious implications for global food security, including potential for aflatoxin exposure in developing countries. It is also linked to AIDS in sub-Saharan Africa, with urban growth, climate change, and freshwater availability as key components for understanding the impacts. Pollinators, soil fertility and hunger in Africa, land degradation, food prices and food insecurity, nutrient requirements for those living with HIV/AIDS are some of the effects studied.
Urbanization is closely linked to global environmental change, with developing-country cities particularly vulnerable to climate change. The IPCC and other organizations have provided guidance in mitigating these effects. Research has also looked into regime shifts, environmental impacts, biodiversity, chemical pollution, global energy assessment, land use, oil palm production on biodiversity, human health and ecological sustainability in the Arab world, and climate policy. Finally, Rockström et al. (2009) proposed a safe operating space for humanity. Google Scholar has published numerous studies on the impacts of global climate change and food security. Lal (2004, 2010) found that soil carbon sequestration can help mitigate anthropogenic carbon emissions and advance global food security, while Lambin et al. (2011) identified economic globalization and land scarcity as further challenges. Montgomery (2007) and Koch et al. (2013) discussed the importance of soil security, and Van Lynden and Odeman (1998) assessed the status of human-induced soil degradation in South and Southeast Asia.
Steffen et al. (2015) found that human development must be guided by "planetary boundaries", while Shea et al. (2007) developed a tool to assess the quality of systematic reviews. Watts et al. (2015) discussed policy responses to protect public health and McMichael (1987) and Brundtland (1946) discussed planetary overload and our common future. Horton et al. (2014) proposed a manifesto for planetary health and WHO (1946) seeks to protect in its Constitution. Lang and Rayner (2012) argued in favor of ecological public health, while Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Gerland et al. (2014) found world population stabilization unlikely this century, and Bereuter and Glickman (2015) discussed leveraging agriculture and food to improve global nutrition. Raudsepp-Hearne et al. (2010) discussed why human well-being is increasing despite ecosystem degradation, and Myers et al. (2013) discussed human health impacts of ecosystem alteration. IPCC (2014) discussed impacts, adaptation, and vulnerability of climate change.
Google Scholar has published studies linking environmental changes to human health and sustainability. UNEP reports Global Environment Outlook 5 (2012) and Global Environment Outlook 4 (2007) address global priorities, ecosystem regulation of infectious diseases, and economic value of biodiversity. The Millennium Ecosystem Assessment (2006) and Dean (2006) focus on human health and coastal vegetation protection from the Asian tsunami. Butler (2014), Lim et al. (2012), Prüss-Üstün and Corvalán (2006), Pimm et al. (2014), Lehner et al. (2011), World Commission on Dams (2000), FAO (2014), Hansen et al. (2013), and Foley et al. (2007) present findings on global maps, reservoirs, dams, In 2014, the World Wide Fund for Nature released the "Living Planet Report 2014: Species and Spaces, People and Places". It revealed physical water scarcity to be a new phenomenon, while noting the "Great Acceleration" of the Anthropocene. Additionally, it provided an analysis of world poverty and explored the relationships between multiple ecosystem services. The Economics of Ecosystems and Biodiversity (TEEB) (2010) was influential in mainstreaming the economics of nature.
Google Scholar references various documents from 1971 to 2013, such as the Ramsar Convention on Wetlands of International Importance, the Millennium Ecosystem Assessment, UK National Ecosystem Assessment, and the International Commission on Stratigraphy's International Stratigraphic Chart.
Health professionals, research funders, academics, governments, the UN, corporations and citizens can all play a role in promoting planetary health. Policies should be put in place to address environmental health challenges, increase resilience to threats, and improve risk communication. Creative financing strategies should be implemented to support a more sustainable world economy and different approaches should be promoted to encourage environmental stewardship and health protection.
Gaps in knowledge need to be addressed to improve planetary health. A transparent interdisciplinary process of research agenda setting is needed, incorporating decision makers' needs and building on existing knowledge. Capacity strengthening and priority research areas such as understanding environmental change's effects on human health are necessary. Systems modelling and computer modelling can better understand human-ecological system interactions. Research should prioritize reducing environmental damage and emissions, with a focus on health co-benefits and economic consequences. Additionally, research should analyze the knowledge-implementation gap and engage local communities. Google ScholarPanel 14 emphasizes the importance of grassroots involvement in protecting planetary health. HIV/AIDS is a successful movement that has resulted in triple drug treatment and reduced costs, while the UN General Assembly has proposed 17 SDGs and 169 targets to reduce deaths and illnesses from hazardous chemicals and air, water, and soil pollution. Local governance can be strengthened by civil society and indigenous communities, and trade treaties should prioritize health protection. The Montreal Protocol serves as an example for regional trade treaties, and system science approaches such as threshold approaches and scenario planning can be used for decision making. Reform of taxes and subsidies is necessary, and alternative methods for measuring human progress have been proposed, such as the Social Progress Index, Genuine Progress Indicator, and Happy Planet Index. Global fossil fuel subsidies are estimated at 6.5% of global GDP. Google Scholar suggests using technologies with multiple benefits, such as health and environmental, to reduce environmental impact. The European Commission proposed a circular economy model to reduce costs and dependence on natural resources. GDP has been used as an indicator of success since the 1930s and 1940s, but the UN General Assembly proposed a holistic approach that takes happiness into account. National governments must involve local initiatives and international institutions in their strategic plans for resilience. Monetisation of non-market benefits can help to offset the cost of action and human behaviour plays a key role in reducing environmental damage. Coastal ecosystems preserve wetlands and fisheries, but care must be taken. Low-income countries have more leeway for technological leapfrogging. Integrated multifunctional teams should be redirected towards emerging threats in times of emergency and effective surveillance and early warning systems are important for detecting disease outbreaks or changes in food security. Ecosystem-based adaptation measures such as mangrove planting are cost-effective and provide additional benefits. Hurricane Katrina caused catastrophic damage to communities in Mississippi and New Orleans, raising social justice issues and highlighting weaknesses in disaster preparedness and response. The National Response Framework was revised, placing greater responsibility on the Federal Government. Google Scholar suggests a framework is needed to identify a "safe and just operating space" for humanity. Bioethicists are looking at discounting and justice theorists argue for protecting the future. Agricultural intensification has reduced poverty but caused environmental damage. The UN IPCC has identified ethical challenges posed by climate change, and Principle 21 of the Stockholm Declaration of 1972 states countries have the right to exploit their own resources. Three elements for environmental justice have been suggested for low-income countries. High-income countries focus on economic efficiency rather than global ecological health. The doughnut approach has been tested in two Chinese communities and the resilience approach has become policy due to recent events like the Ebola crisis. Planetary health should be integrated into training and population-based surveys, and increased support for rights-based family planning services in high-income countries is necessary. Almost a third of the 100 largest cities have green spaces that provide key services, and São Paulo is experiencing its worst drought in 80 years due to decreased forest cover. A systematic review found that exposure to natural environments lowers negative emotions, and population loss provides opportunities to create green spaces with social and health benefits. The Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals. Strategies to reduce car use in cities and promote active travel can reduce pollutants, address health problems, and reduce risks of certain diseases. Regulatory approaches are often inadequate, particularly in low-income countries. Increased physical activity and active travel can reduce emissions and address physical inactivity, which contributes to more than 3 million deaths a year. Policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution and crop productivity. Solar lamps can reduce black carbon emissions, burns, and dependence on kerosene.
The health co-benefits of reducing fine particulates, attributed to fossil fuel combustion, have been studied by the IPCC and the Lancet Commission on Climate Change. WHO estimates that 3.7 million deaths occur annually due to air pollution. Reducing short-lived climate pollutants could yield major health benefits, preventing an estimated 2.4 million premature deaths annually.
Ecosystem restoration has been linked to poverty alleviation, as seen with the Loess Plateau in China and Shinyanga Soil Conservation Programme (HASHI) in Tanzania. Land use changes have both positive and negative impacts on human health, such as increasing fruit and vegetable consumption and reducing red and processed meat consumption. The REDD+ mechanism has been created to reduce greenhouse gas emissions from deforestation and forest degradation, while providing various co-benefits. Further evidence on the role of the environment in mediating disease risk and how policies can be developed to benefit both health and ecosystems is given in the appendix. Animal products have higher emissions and are linked to global burden of disease, so incentivising fruit and vegetable production and removing subsidies on unhealthy food is important. WHO dietary recommendations could reduce emissions and increase life expectancy, but in France diets with higher nutrition had higher emissions. Small shifts in crop allocation from animal feed and biofuels to direct human consumption could increase global food availability. Indirect and direct strategies for support of large-scale industrial and smallholder subsistence farming exist, as well as aquaponics, novel sources of protein, and insects. The Global Ocean Commission aims to protect coastal zones and reduce overfishing, while strategies such as water conservation and changes in working practices can help sustain farmer productivity. Pre-harvest and post-harvest losses can be reduced to conserve resources and reduce pollution. Sustainable agricultural intensification is a strategy to grow more food on the same land while preserving biodiversity and other environmental assets, with integrated soil-crop system management practices, genetic modification of crops, water harvesting, and improved irrigation methods. Global environmental change presents three main challenges: conceptual and empathy failures, knowledge failures, and implementation failures. Solutions outlined in the Commission report aim to support both human health and the planet, focusing on reducing poverty, adapting to environmental change, and achieving equitable human development within finite limits. Interdisciplinary collaboration is needed to develop and implement appropriate policies. Risk factors for depression in adults after natural disasters include gender, marital status, religious beliefs, education, injury or bereavement during the disaster, or loss of employment or property. Mental health effects of environmental change-related displacement are caused by trauma of leaving familiar surroundings and breaking social ties, increased risk of violence, difficulty of resettlement, and lack of mental health services. A meta-analysis found that for every increase in temperature or rainfall, the median increase in intergroup conflict was 14%. By 2050, between 50 million and 350 million people are predicted to relocate due to climate change. Environmental changes combined with pre-existing susceptibility and social/political issues could become a major destabilising factor in the country. Climate change is increasing the likelihood of conflict due to competition for resources. Deforestation and encroachment onto flood plains can exacerbate the effects of flooding. Natural disasters have caused the loss of 1.94 million lives since 1970 and the total cost of extreme weather events between 1980 and 2004 has been estimated to be $1.4 trillion. In Pakistan, environmental changes, a high population growth rate, and other factors such as unplanned urbanisation and climate change have led to risks from extreme events such as floods and heavy rainfall. Climate change is likely to increase water stress in Pakistan, with water flow into the Indus River predicted to decrease by 30-40% in the next 20 years. Poor water management has led to salination and waterlogging of soils, while the widespread discharge of untreated effluents and use of pesticides and nitrogenous fertilisers has further affected water quality. Methylmercury, lead poisoning, and over 3000 high production volume (HPV) chemicals with unknown toxicity remain major public health issues, particularly in low-income countries. Global progress has been made in reducing mortality risk since the 1980s, but some countries are still at increasing risk due to poor risk management. Endocrine disruptors have been linked to many health issues, and climate change can increase the risk of infectious diseases. Household air pollution caused an estimated 2.6-4.4 million deaths in 2010 and toxic chemical exposure can occur through various pathways. High risk areas for the emergence of infectious zoonotic diseases occur where there is human population growth, ecologically disruptive development, and overlap between humans and wildlife. Vector-borne diseases are linked to environmental change factors such as forest loss and agricultural intensification. Global environmental changes have caused a rise in re-emerging diseases such as malaria, hantavirus pulmonary syndrome, Nipah virus, and Ebola virus disease. Bats have been found to carry Ebola virus, with deforestation in West Africa potentially linked to its spread. Research has linked zoonotic infections in bats to life history traits such as social behavior, migratory patterns, and group size. Climate change can lead to changes in global rainfall patterns, reduced crop yields, nutrient deficiencies, and increased plant toxins. It can also affect the Food–Water–Energy Nexus, leading to freshwater shortages, virtual water trade, and increased incidence of diarrhoeal disease. Pollinators, essential for global food production, are declining due to pests, parasites, environmental stressors, and reduced genetic diversity, leading to soil nutrient depletion and degradation. Fish provide an important source of protein and micronutrients, but are threatened by overfishing, marine habitat degradation, and ocean acidification. Wild foods can help households facing mortality and HIV/AIDS in poverty-stricken areas buffer against food shortages and increase dietary diversity.
Global environmental change is linked to health risks, as well as reducing the nutritional content of foods. High HIV infection rates in sub-Saharan Africa are putting a strain on households and can negatively affect the ability of HIV patients to adhere to antiretroviral therapy. Children are particularly vulnerable to the effects of toxic chemicals, while elderly people are particularly susceptible to thermal stress and are at risk of heatwaves due to an ageing world population. Urbanization provides an opportunity to improve population health and increase resilience to environmental change, but can also lead to an increase in greenhouse gas emissions in developing regions. Climate-related hazards interact with vulnerability and exposure of human and natural systems to create risk of climate related impacts. Most of the world's population now lives in cities, and this trend is set to continue. By 2050, 150 million people will face water scarcity, and another 2–3 billion will need housing. Google Scholar ranked nations based on their environmental impact, with absolute wealth being the main factor. The UN Population Division estimates the world population could reach 9.6 billion by 2050. Reducing population growth and resource consumption is necessary for sustainability, while population growth also puts pressure on biodiversity hotspots. Biodiversity is decreasing globally, with serious potential consequences for human health. Additionally, land degradation due to human activity is leading to species loss and increased nitrogen and phosphorus levels in the environment. Global chemical sales are predicted to increase until 2050, with many of these chemicals entering the environment, causing ecotoxic effects.
To mitigate these issues, research and innovation are needed to reduce the environmental footprint and improve efficiency. Policies must be put in place to cap emissions or the use of a given resource, as well as to involve local communities. The One Health framework has been used to produce knowledge and recommendations for policy makers, while an example of multiple interacting environmental changes contributing to an increase in pregnancy risks in Bangladesh is given in the appendix. Ocean acidification, climate change, and freshwater resource depletion are all global issues caused by human activity. These changes cause significant negative impacts on marine life and humans, including water stress for nearly 4 billion people, habitat conversion, soil erosion, and pollution. The Intergovernmental Panel on Climate Change (IPCC) has found clear evidence that climate change is due to human activity. A framework has been developed to relate nine global or regional pressures to the Earth's biophysical systems. Google Scholar has outlined the concept of planetary health, which integrates human health and environmental sustainability. Despite these changes, human health has improved due to increased food productivity, technological and infrastructural advances, and time lags between the deterioration of ecosystem services and reduction in human wellbeing. The Millennium Ecosystem Assessment (MEA) in 2005 found that 60% of global ecosystem services were being degraded or used unsustainably, resulting in increased global poverty and environmental degradation. WHO estimates that a quarter of the global disease burden is attributable to modifiable environmental factors. Google Scholar warns that accelerating changes to Earth's natural systems represent a substantial threat to global human health. Urban populations are increasing, and policies are needed to improve health and the environment. To achieve rapid scale-up of potential solutions, transdisciplinary research activities and capacity need to expand. Global trends in population, consumption, health, and the environment have been drastically altered due to human activity entering a new geological epoch, the Anthropocene. In order to successfully steward humanity through the 21st century, new knowledge and leadership is needed to address inequities in health and wealth while staying within environmental limits. Natural systems can be managed to protect human health, and improved governance is needed to integrate social, economic, and environmental policies.
Societies must take urgent, transformative action to protect human health and civilization from environmental threats. This includes reducing waste, incentivizing recycling and repair, and substituting hazardous materials with safer alternatives. Planetary health offers an opportunity for global and national economic reforms, such as taxes and subsidies. Resilient food and agricultural systems are needed to address under- and overnutrition and reduce environmental damage. Changes to the Earth's natural systems are a growing threat to human health, yet global health has improved.
Harvard T.H. Chan School of Public Health and The Rockefeller Foundation's Samuel S Myers collaborated on a research article that examines the effects of environmental change on global health. It identifies three categories of challenges: conceptual and empathy failures, knowledge failures, and implementation failures. The Rockefeller Foundation and The Lancet have released a report on planetary health. It focuses on preserving human health in the Anthropocene epoch. Compiled by a commission of experts from various institutions, it is available on The Lancet's website.
8488 word summary
The Rockefeller Foundation and The Lancet have released a report on planetary health, focusing on safeguarding human health in the Anthropocene epoch. The report is compiled by a commission of experts from various institutions and is available through The Lancet's website. Harvard T.H. Chan School of Public Health and The Rockefeller Foundation's Samuel S Myers collaborated on a research article that examines the effects of environmental change on global health. It identifies three categories of challenges: conceptual and empathy failures, knowledge failures, and implementation failures. Changes to the Earth's natural systems are a growing threat to human health, yet global health has improved. This is driven by inequitable, inefficient, and unsustainable patterns of resource consumption and population growth, which threatens future global health gains. Societies must take urgent, transformative action to protect human health and civilization from environmental threats. This includes reducing waste, incentivizing recycling and repair, and substituting hazardous materials with safer alternatives. Planetary health offers an opportunity for global and national economic reforms, such as taxes and subsidies. Resilient food and agricultural systems are needed to address under- and overnutrition and reduce environmental damage. Policies should balance social progress, environmental sustainability, and the economy. Action by six key constituencies is needed, and better evidence is needed to underpin appropriate policies.
Ecosystems provide essential services to humans, such as food and clean water, and biodiversity is important for human wellbeing. Natural systems can be managed to protect human health, and improved governance is needed to integrate social, economic, and environmental policies. Google Scholar's REDD+ seeks to assign financial value to carbon stored in trees, and RCP 8.5 is a pathway with very high emissions in line with present trends. The Ramsar Convention defines wetlands, and biodiversity is the variability among living organisms from all sources. Externalities are benefits or costs that affect an individual or group of people who did not choose to incur them. In order to successfully steward humanity through the 21st century, new knowledge and leadership is needed to address inequities in health and wealth while staying within the Earth's environmental limits. The circular economy model is one example of decoupling economic growth from finite resources and regime shifts can result in large and lasting changes in social-ecological systems. Integrated surveillance systems and improved risk communication can help inform evidence-based decisions, while health professionals should work across sectors to integrate policies that advance health and environmental sustainability.
Urban populations are increasing and policies to improve health and the urban environment are needed. Transdisciplinary research activities and capacity need to expand in order to achieve rapid scale-up of potential solutions. Humanity has made great progress in the past 250 years, but has heavily altered the natural world in order to provide sustenance, shelter, and energy. This has caused the Earth to enter a new geological epoch, the Anthropocene, with global trends in population, consumption, health, and the environment drastically altered. Global water use, agricultural land area, fertilizer consumption, and tropical forest loss have all increased, while ocean acidification and global surface temperature anomaly have increased and vertebrate population abundance has decreased. The Millennium Ecosystem Assessment (MEA) in 2005 found that 60% of global ecosystem services were being degraded or used unsustainably, resulting in increased global poverty and environmental degradation. The natural environment plays an important role in supporting human health and wellbeing, and global environmental change can have direct, secondary, and indirect effects on human health. WHO estimates that a quarter of the global disease burden is attributable to modifiable environmental factors. Google Scholar warns that accelerating changes to Earth's natural systems represent a substantial threat to global human health.
Despite these changes, human health has improved around the world due to increased food productivity, technological and infrastructural advances, and time lags between the deterioration of ecosystem services and reduction in human wellbeing. The Sustainable Development Goals provide an opportunity to address health, social, and environmental challenges in an integrated way, but there is a danger that wealthy nations and populations will meet their demands at the expense of poorer nations and populations. Google Scholar has outlined the concept of planetary health, which integrates human health and environmental sustainability. It stresses how ecosystems underpin human health and makes the case for widening responsibility for health beyond the traditional confines of the health sector. To achieve planetary health, ambitious, integrated policies must be developed.
The Commission assesses threats to health and development posed by environmental changes in the Anthropocene epoch. It identifies gaps in understanding of links between environmental change and health and of interventions and policies to reduce environmental change and protect health. The planetary boundaries framework identifies processes and systems important to the maintenance of the Earth's functions.
Clear evidence now exists that climate change has occurred due to human activity, according to the Intergovernmental Panel on Climate Change (IPCC). Changes to global or regional systems can result in non-linear, potentially irreversible changes in the Earth's environment. A framework has been developed that relates nine global or regional pressures to the Earth's biophysical systems. The current status of the control variables for seven of these planetary boundaries has been normalised and the risk of novel entities is also being considered. Ocean acidification has caused the pH of oceans to decrease by 0.1 pH since the Industrial Revolution, due to increased atmospheric carbon dioxide. Climate change impacts include melting of ice sheets, a rise in sea level, an increase in global mean temperature, and more frequent heatwaves and extreme rainfall events, all due to increased concentrations of greenhouse gases. Freshwater resources can be classified as renewable and non-renewable. Ocean acidification negatively affects marine life, with a 2013 study predicting a collapse of Antarctic krill within 300 years. Groundwater extraction has doubled since 1960 and is projected to reduce renewable resources significantly in most dry subtropical regions by 2050, leading to water stress for 3.9 billion people (over 40% of the world's population). Habitat conversion, soil erosion, and pollution from agricultural run-off are also impacting many water sources globally, with 70% of the world's wetlands lost by the end of the 20th century. Conversion of natural habitats to grow non-food crops is increasing, particularly in tropical and subtropical regions. This has led to reduced biodiversity and desertification. Climate change is expected to worsen soil erosion, leading to increased greenhouse gases and decreased freshwater retention. Human activity is a major cause of land degradation, contributing to species loss and increased nitrogen and phosphorus levels in the environment. Global chemical sales are predicted to increase until 2050, with many of these chemicals entering the environment, causing ecotoxic effects and reduced ecosystem functions. Major sources of chemical waste include agricultural run-off, cement production, electronics recycling, mining and coal combustion, ship breaking, textile production, and electronics manufacturing. Biodiversity is decreasing globally, with only 10-20% of species described. This has serious potential consequences for human health, such as feminisation of fish, developmental delays in amphibians, and increases in pollutants. The 2010 Global Biodiversity Outlook found all major pressures on biodiversity are increasing, such as habitat destruction and climate change. Gaps in knowledge have been identified and a call for cross-sectoral strategies to involve local communities has been made. Evidence suggests biodiversity loss hinders the capacity of ecosystems to provide essential services, and can lead to reduced diversity in human microbiota. Non-linear changes and interactions between environmental threats can result in worse than expected effects. The One Health framework has been used to produce knowledge and recommendations for policy makers. Population growth, consumption, and technology are driving environmental change, which can lead to sudden shifts with significant consequences, especially for ecosystem services. An example is given in the appendix of multiple interacting environmental changes contributing to an increase in pregnancy risks in Bangladesh. Google Scholar ranked nations based on their effects on the environment, finding that absolute wealth was the main factor, with population size and poor governance making additional contributions. Research and innovation are needed to reduce the impact of unsustainable consumption and overuse of resources, as well as biofuel production's effect on food security. The UN Population Division estimates that the world population could reach 9.6 billion by 2050, with a 95% probability of being between 9.0-13.2 billion. Reducing population growth is essential for sustainability, but must be combined with policies to reduce material resource consumption and greenhouse gas emissions in high-income and emerging economies. Additionally, population growth puts pressure on biodiversity hotspots. Most of the world's population now lives in towns and cities, and most population growth will take place in small and medium-sized cities in low-income and middle-income countries. By 2050, 150 million people will live in cities with water scarcity, and by the middle of the 21st century, another 2–3 billion people will need to be housed. Technologies that improve efficiency may not reduce the overall environmental footprint unless accompanied by policies to cap emissions or the use of a given resource.
Urbanization provides an opportunity to improve population health and increase resilience to environmental change, but can also lead to an increase in greenhouse gas emissions in developing regions. According to the 2006 WHO assessment, the total number of healthy life years lost per person from environmental exposures was 15 times higher in developing countries than in developed countries. Climate-related hazards interact with vulnerability and exposure of human and natural systems to create risk of climate related impacts.
High HIV infection rates in sub-Saharan Africa are putting a strain on households and can negatively affect the ability of HIV patients to adhere to antiretroviral therapy. Children are particularly vulnerable to the effects of toxic chemicals, while elderly people are particularly susceptible to thermal stress and are at risk of heatwaves due to an ageing world population. Wild foods can help households facing mortality and HIV/AIDS in poverty-stricken areas buffer against food shortages and increase dietary diversity. Two cross-sectional household surveys conducted in South Africa in 2004 and 2006 showed that wild foods can be an important coping strategy. Global environmental change is linked to health risks, as well as reducing the nutritional content of foods. The IPCC predicts that global risk of adverse health outcomes will increase until the middle of the century, with poor populations increasingly susceptible to negative health effects from degraded natural infrastructure. Climate change could also lead to increased risk of undernutrition in poor regions. Pollinators, essential for global food production, are declining due to pests, parasites, environmental stressors, and reduced genetic diversity. This has implications for agricultural productivity and nutrition, as well as soil nutrient depletion and degradation leading to soil impoverishment and reduced output. Pollinators provide up to 50% of vitamin A cultivation in parts of Southeast Asia and 12-15% of iron and folate in other parts of the world. Fish provide an important source of protein and micronutrients but are threatened by overfishing, marine habitat degradation, and ocean acidification. Climate change is expected to reduce crop yields, leading to malnutrition and stunting, especially in sub-Saharan Africa and South Asia. The IPCC reported that median crop yields would decrease by 0-2% per decade due to climate change alone while demand for crops is projected to increase by 14% per decade. Google Scholar reports that climate change can lead to changes in global rainfall patterns, reduced crop yields, nutrient deficiencies, and increased plant toxins. It can also affect the Food–Water–Energy Nexus, leading to freshwater shortages, virtual water trade, and increased incidence of diarrhoeal disease due to spread of water-borne pathogens. Crop productivity improvements reported in the field are lower than those shown by laboratory results, and rising CO2 concentrations will favour C3 over C4 plants. Additionally, an estimated 150 million people are at risk for zinc deficiency and 16% decrease in crop yields due to aflatoxin production can be expected. Global environmental changes have caused a rise in emerging and re-emerging diseases such as malaria, hantavirus pulmonary syndrome, Nipah virus, and Ebola virus disease. Schistosomiasis is a major burden to poor populations and countries with weak health systems, linked to river fragmentation, biodiversity loss, eutrophication, and overfishing. Bats have been found to carry Ebola virus and a 2007 outbreak was linked to an annual bat migration, with deforestation in West Africa potentially linked to the virus's spread. Little attention has been paid to preventing the spread of Ebola virus from patient zero, but research has linked zoonotic infections in bats to life history traits such as their social behavior, migratory patterns, and group size.
Vector-borne diseases, such as Marburg virus, Chagas disease, yellow fever, and leishmaniasis, are also linked to environmental change factors such as the loss of primary forests, agricultural intensification, and changes in animal community composition. Global trade, climate change, and accidental introduction can lead to the invasion or introduction of disease vectors into new areas. Half of global emerging infectious diseases between 1940 and 2005 are estimated to be caused by changes in land use, agricultural practices, and food production.
High risk areas for the emergence of infectious zoonotic diseases occur where human population growth is high, ecologically disruptive development is under way, and human and wildlife populations overlap substantially. However, detailed mechanisms linking ecosystem alteration to zoonotic disease risk are only understood for a few diseases. Climate change can increase the risk of infectious diseases due to extreme weather events, forest loss, and inadequate infrastructure. The Intergovernmental Panel on Climate Change (IPCC) has studied how climate change can affect the spread of diseases, such as malaria, which is estimated to put 200 million additional people at risk under the A1B scenario. Human factors, such as immune status and treatment, also have a role in malaria transmission. Climate change can also lead to increased incidence of disease due to different mosquito species responding differently to climate warming and land-use changes. Household air pollution caused an estimated 2.6-4.4 million deaths in 2010. Toxic chemical exposure can occur through various pathways, such as ingestion and inhalation, and can travel vast distances. Ground level ozone is estimated to kill about 150 000 people per year worldwide, while smoke from landscape fires is estimated to cause an additional 300 000 premature deaths. Key groups affected by toxins include individuals living in poverty, undernourished, elderly or very young, as well as bioconcentration in food chains. Methylmercury, a toxin which bioaccumulates, and lead poisoning are still major public health issues, particularly in low-income countries. The US Environmental Protection Agency (EPA) has identified 3000 chemicals classified as high production volume (HPV) with insufficient information about their toxicity. Global progress has been made towards reducing lives lost in extreme events since the 1980s, although mortality risk is still increasing in some countries with poor risk management. Endocrine disruptors have been linked to many health issues, with 800 known or suspected to be present in chemicals and many more yet to be tested.
Natural disasters have caused the loss of 1.94 million lives since 1970 and the total cost of extreme weather events between 1980 and 2004 has been estimated to be $1.4 trillion. In Pakistan, environmental changes, a high population growth rate, and other factors such as unplanned urbanisation and climate change have led to risks from extreme events such as floods and heavy rainfall. 96% of water in Pakistan is used for agricultural irrigation, with demand projected to outstrip supply by 2025 if preventive action is not taken. Climate change is likely to increase water stress in Pakistan, with water flow into the Indus River predicted to decrease by 30-40% in the next 20 years. Poor water management has led to salination and waterlogging of soils, while the widespread discharge of untreated effluents and use of pesticides and nitrogenous fertilisers has further affected water quality. The 2011 Sindh floods in Pakistan affected 5.3 million people. Six months later, 54% of destroyed homes still stood wrecked, 50% were living in camps, and 88% reported loss of income. Additionally, 10 million people were forced to drink unsafe water and 37 million infectious disease-related medical consultations were reported. The 2010 Pakistan floods were catastrophic, resulting in 1900 deaths, affecting 18 million people, and submerging a fifth of the country. Environmental changes, combined with pre-existing susceptibility and social/political issues, could become a major destabilising factor in the country. Climate change is increasing the likelihood of conflict due to competition for resources, but attributing extreme events to climate change is difficult due to natural variability. Deforestation and encroachment onto flood plains can exacerbate the effects of flooding. A meta-analysis by Hsiang and colleagues found that for every increase in temperature or rainfall, the median increase in intergroup conflict was 14%. By 2050, between 50 million and 350 million people are predicted to relocate due to climate change. Disruption of place attachment can lead to grief, loss, anxiety, and solastalgia. Migration, war, and conflict disproportionally affect the poor and have a range of health implications. Risk factors for depression in adults after natural disasters include being female, not being married, having religious beliefs, poor education, experiencing injury or bereavement during the disaster, or losing employment or property. Keeping families and communities united is an important protective factor. Mental health effects of environmental change-related displacement are caused by trauma of leaving familiar surroundings, breaking social ties, increased risk of violence, difficulty of resettlement, and lack of mental health services. Global environmental change presents three main challenges: conceptual and empathy failures, knowledge failures, and implementation failures. Solutions outlined in the Commission report aim to support both human health and the planet. To address these issues, policies must focus on reducing poverty, adapting to environmental change, and achieving equitable human development within finite limits. Interdisciplinary collaboration between public health, agriculture, environmental, and nutritional strategies is needed to develop and implement appropriate policies. Sustainable agricultural intensification has been proposed as a strategy to grow more food on the same land, while preserving biodiversity and other environmental assets. Integrated soil-crop system management practices can increase crop yields while reducing adverse environmental effects. Genetic modification of crops may be useful to reduce global hunger, but only if they are accessible to lower-income farmers. Water harvesting and conservation, and improved irrigation methods can also increase water efficiency while reducing losses. Sustainable agricultural intensification consists of three interlinked activities: ecological, genetic, and market intensification. Pre-harvest and post-harvest losses need to be reduced to reduce pollution, increase crop yield and conserve resources. This includes public sector research, soil testing and improved timing of fertilizer application. In some parts of the world, such as sub-Saharan Africa, increased fertilizer use may be necessary. Reducing food waste by 50% is feasible according to the Government Office for Science's 2011 Foresight report, which contributes to biodiversity loss, consumes surface and groundwater, and generates greenhouse gas emissions.
The Global Ocean Commission aims to protect coastal zones, control overfishing, reduce plastic pollution, and tackle harmful subsidies. To meet world fish demand sustainably, a major shift towards aquaculture is needed. Nutritional profiles of fish vary substantially, and health and environmental policies should be harmonised to ensure that dietary recommendations do not lead to overexploitation of fisheries.
Experts debate the balance between support of large-scale industrial and smallholder subsistence farming. Indirect strategies rely on the economic growth of agriculture, while direct strategies promote integrated agricultural development and forest conservation projects. Aquaponics combines aquaculture and hydroponics, while novel sources of protein, such as seaweed and microalgae, could be exploitable if hazards are addressed. Insects can provide high fat, protein, vitamin, fibre, and mineral content, and strategies such as clean water and changes in working practices can help sustain farmer productivity in the face of climate change. Without changing crop mix, enough calories are available to feed an additional 4 billion people. However, 41% of crop production is lost due to animal feed and biofuel production. To combat undernutrition, promotion of nutrient-rich foods for direct human consumption and income generation for women are needed, as well as biofortification of high yielding crops (cross-breeding with nutrient-rich crops). Small shifts in crop allocation from animal feed and biofuels to direct human consumption could increase global food availability.
Animal products have much higher emissions per gram of protein than legumes, and dietary risk factors are a major contributor to the global burden of disease. Therefore, it is important to incentivise fruit and vegetable production and remove subsidies on less healthy foodstuffs. Adhering to WHO dietary recommendations in the UK could reduce greenhouse gas emissions by 17% and increase life expectancy at birth by 8 months, however in France, diets with higher nutritional quality had higher greenhouse gas emissions. Approaches should be taken to optimize diets for low environmental impact, high nutrition quality, and affordability while minimizing departures from current diets. Land use changes have both positive and negative impacts on human health, such as increasing fruit and vegetable consumption, reducing red and processed meat consumption, and improving watershed functions. Research in Brazil and Costa Rica suggests that protected areas, indigenous reserves, roads, and mines can reduce deforestation and protect against diseases such as malaria. Forest conservation has a direct effect on malaria, acute respiratory infections, and diarrhoea. Community zoning policies can protect contiguous forests while promoting the spatial aggregation of deforested areas, such as clustered housing developments. Policies that maintain or enhance biodiversity can reduce the risk of vector-borne and zoonotic diseases. The REDD+ mechanism has been created to reduce greenhouse gas emissions from deforestation and forest degradation, while providing a variety of regional and local co-benefits. Further evidence on the role of the environment in mediating disease risk and how policies can be developed to benefit both health and ecosystems is given in the appendix. Ecosystem restoration has been linked to poverty alleviation, as seen with the Shinyanga Soil Conservation Programme (HASHI) in Tanzania. A 2015 study showed that PM2·5 air pollution levels were lower in communities with forest certification. In Indonesia, protecting peatlands could reduce smoke concentrations in Palembang and Singapore by more than 90%.
The Loess Plateau in China implemented eco-based adaptations in the 1990s, with support from the World Bank and Chinese Government. This project has improved health and environmental outcomes, including increased forest and grass coverage, increased mean annual per person income, increased grain output, reduction of sediment inflow to the Yellow River, improved soil fertility, and increased carbon sequestration.
The health co-benefits of reducing fine particulates, largely attributed to fossil fuel combustion, have been studied by the IPCC and the Lancet Commission on Climate Change. WHO estimates that 3.7 million deaths occur annually due to air pollution. Reducing short-lived climate pollutants could yield major health benefits, preventing an estimated 2.4 million premature deaths annually.
Increased physical activity and active travel in cities can reduce greenhouse gas emissions and address physical inactivity, which contributes to more than 3 million deaths a year. Other policies to reduce methane emissions and ground level ozone can yield co-benefits such as reducing air pollution, crop productivity, and forest growth. Solar lamps can reduce black carbon emissions, burns, and dependence on kerosene. Access to clean household energy can reduce household exposure to air pollution and risk of burns. The Global Chemicals Outlook report calls for investment in capacity for sound management of chemicals, noting that moral arguments have little effect. Strategies to reduce car use in cities and promote active travel can reduce hazardous pollutants, address health problems, and reduce risks of certain diseases. The UN Environment Programme estimated a high rate of return from investments in chemical management. Regulatory approaches are often fragmented and implementation is inadequate, particularly in low-income countries. A systematic review found that exposure to natural environments significantly lowers negative emotions compared to synthetic environments. More than 370 cities worldwide are experiencing population loss, providing opportunities to create green space, enhance biodiversity, and promote urban food production with social and health benefits. Almost a third of the 100 largest cities have nearby green spaces that provide key services such as reducing air pollution, temperature regulation, and groundwater recharge. Urban sprawl costs the US about $400 billion annually, but an alternative growth pattern could cover the infrastructure investment gap. São Paulo is experiencing its worst drought in 80 years due to decreased forest cover, which has necessitated the establishment of the Conservador das Águas water payments scheme. The Better Growth, Better Climate report and the Royal Society's report on People and the Planet both highlight the importance of increased support for rights-based family planning services in high-income countries. This would reduce maternal deaths by almost a third and improve food security. Planetary health concepts should be integrated into the training of health professionals and primary health care should be integrated into areas vulnerable to environmental change. Metrics relevant to planetary health should also be included in facility and population-based health surveys, and integrated systems should be created to collect rigorous health, socioeconomic, and environmental data for long periods of time. The UN IPCC has identified ethical challenges posed by climate change and other global environmental changes. Principle 21 of the Stockholm Declaration of 1972 states that countries have the right to exploit their own resources as long as it does not damage other countries or the global commons. Google Scholar suggests three elements for environmental justice for low-income countries: past emissions should be taken into account, entitlements to emissions should be equal, and mechanisms for agreement should be fair and transparent. High-income countries tend to focus on economic efficiency rather than long-term global ecological health and stability. The doughnut approach has been tested in two Chinese rural communities, using local ecological and palaeoecological data and social survey statistics. The resilience approach is focused on adaptive capacity and has become a dominant theme in policy due to recent events such as the Ebola crisis, Hurricane Katrina, and the Pakistani floods. Katrina had the highest economic cost of any natural disaster, with $108 billion in property damage and fatalities concentrated among elderly and African-American people.
Google Scholar states that a framework is needed to identify a "safe and just operating space" for humanity. The bioethics community is beginning to tackle these issues, such as discounting which reduces the attractiveness of action to prevent environmental change and justice theorists argue the present generation has a moral duty to protect the future. Agricultural intensification has led to poverty reduction and environmental degradation, which the doughnut approach identified in terms of both social needs and environmental constraints around water access and quality. Hurricane Katrina caused catastrophic damage to communities in Mississippi and New Orleans, where levees were breached and 80% of the city was flooded. This disaster raised social justice issues and exposed weaknesses in disaster preparedness and response. In response, the National Response Framework was revised, placing greater responsibility on the Federal Government. Criticism focused on delayed evacuations, inadequate relief efforts, and mismanagement. To protect against extreme weather, resilience strategies should be implemented, such as wave attenuation of coastal protection and greening of river catchments. Integrated multifunctional teams can be redirected towards emerging threats in times of emergency. Effective surveillance and early warning systems are also important for detecting disease outbreaks or changes in food security. Ecosystem-based adaptation measures such as mangrove planting are cost-effective and provide additional benefits. National governments must involve local initiatives and international institutions such as the UN Framework Convention on Climate Change and the Sendai Framework for Natural disaster reduction in their strategic plans for resilience. The 100 Resilient Cities Challenge and other initiatives from the Rockefeller Foundation show how cities can encourage national policy and action. Coastal ecosystems preserve wetlands and fisheries, but care must be taken with ecosystem approaches. Monetisation of non-market benefits can help to offset the cost of action. Human behaviour plays a key role in reducing environmental damage, and policymakers can use an array of regulatory, fiscal, and tax policies; mass media campaigns; and incentive-based interventions to effect behaviour change. Low-income countries have more leeway for technological leapfrogging, although there are still many barriers to adoption. Mobile technologies and information campaigns can lead to behavior change that both improves personal health and reduces community contamination. Google Scholar suggests increasing access to healthy and environmentally friendly food in cafeterias to encourage better decisions. Technologies with multiple benefits, such as health, should be used to reduce environmental impact. The European Commission has proposed a circular economy model to reduce costs and dependence on natural resources. GDP as an indicator of success dates back to the 1930s and 1940s, and transformative change can affect health. Google Scholar proposes two scenarios for the 21st century: Fortress World and Great Transition. Calculations by Arrow and colleagues showed that comprehensive wealth per person decreased in south Asia and sub-Saharan Africa between 1970 and 2000, even though Human Development Index and GDP per person increased. The UN General Assembly adopted Resolution 65/309 to pursue the elaboration of additional measures that better capture the importance of the pursuit of happiness and well-being in development. Economists have long been aware that GDP fails to capture important outcomes for human health and wellbeing, and efforts have been made to capture the true financial worth of ecosystem goods and services. The UN has proposed a holistic approach to development that takes happiness into account. Alternative methods for measuring human progress and success, such as the Social Progress Index, Genuine Progress Indicator, and Happy Planet Index, have been proposed. The 2012 HPI uses global data on life expectancy and experienced wellbeing, weighted by ecological footprint, as a measure of environmental degradation. Subsidies and taxes are important policy tools to redistribute wealth and reduce health inequities. Global fossil fuel subsidies are estimated at $4.9 trillion (6.5% of global GDP) in 2013.
Reform of taxes and subsidies at global, national, and subnational levels is needed to improve planetary health. This requires decision making under uncertainty about critical thresholds of Earth systems. To address the challenges posed by incomplete information, alternative decision rules have been formulated that do not rely on expected values. System science approaches, such as threshold approaches, scenario planning, and creative consideration of complex futures, can be used in decision making for planetary health. Scientists should understand the gap between evidence standards and risk tolerance among the science community, decision makers, and citizens. Scenario planning can help assess policy options, while resilience thinking focuses on managing critical thresholds and transforming to a new mode of operation. To communicate uncertainty to decision makers, scientists need to develop better skills and closer relationships with the public and policy makers.
The Earth Systems Governance project and the University of Oslo Commission have proposed reforms and UN bodies for addressing environmental changes. The Montreal Protocol's restrictions on all countries, strong incentives for participation, and incentives for positive steps can serve as an example. Regional trade treaties should prioritize health protection and Google Scholar has proposed upgrading the UN Environment Programme to a specialized agency similar to the WHO.
At the municipal level, groups like the C40 Cities Climate Leadership Group and the 100 Resilient Cities network can provide test beds for innovative policies. Local governance can also be strengthened by civil society and indigenous communities. Trade treaties may have an effect on planetary health and national governments can support these efforts by integrating cross-sectoral policies. Google ScholarPanel 14 stresses the importance of grassroots involvement in advancing global health to protect planetary health. HIV/AIDS is an example of a successful movement resulting in triple drug treatment and reduced costs. The MDGs were mixed in their success, but the post-2015 Development Agenda has potential to capitalize on this movement. The UN General Assembly proposed 17 SDGs and 169 targets, including reducing deaths and illnesses from hazardous chemicals and air, water, and soil pollution. The SDGs provide an opportunity to integrate health and sustainability through the selection of relevant indicators, however there is criticism that only a third of the targets are well developed. Our overview has uncovered substantial gaps in knowledge that need to be addressed to improve planetary health. A transparent interdisciplinary process of research agenda setting is needed, incorporating decision makers' needs and building on existing knowledge. Capacity strengthening and priority research areas, such as understanding environmental change's effects on human health, are necessary. Google Scholar and Scopus can assess environmental changes' effects and trade-offs, while systems modelling and computer modelling can better understand human-ecological system interactions. A Data Revolution for Sustainable Development is underway to improve access to services. Research should assess strategies to reduce environmental damage and emissions, with a focus on health co-benefits, economic consequences, and policies such as taxes, subsidies, and regulations. Additionally, research should prioritize translational research and implementation science, analyze the knowledge-implementation gap, and engage local communities. Health professionals, research funders, academics, governments, the UN, corporations and citizens can all play a role in promoting planetary health. Policies should be put in place to address the conceptual challenges of advancing planetary health, address environmental health challenges, increase resilience to emerging threats, improve risk communication to policy makers and the public, account for natural capital depreciation, support planetary health, facilitate action before irreversible changes, scale up resilient food and agricultural systems, and develop more resilient health systems. Creative financing strategies should be implemented to support a more sustainable world economy and different approaches should be promoted to encourage environmental stewardship and health protection in the private sector. Civil society and community organizations should be engaged by promoting public discourse and transparency of data. Google Scholar references various documents from 1971 to 2013, such as the Ramsar Convention on Wetlands of International Importance, the Millennium Ecosystem Assessment, UK National Ecosystem Assessment, and the International Commission on Stratigraphy's International Stratigraphic Chart.
In 2014, the World Wide Fund for Nature released the "Living Planet Report 2014: Species and Spaces, People and Places". Kummu et al. (2010) revealed physical water scarcity to be a new phenomenon, while Steffen et al. (2015) noted the "Great Acceleration" of the Anthropocene. Additionally, Roser (2015) provided an analysis of world poverty, Bennett et al. (2009) explored the relationships between multiple ecosystem services, and DeFries and Foley (2004) discussed balancing human needs and ecosystem function. The Economics of Ecosystems and Biodiversity (TEEB) (2010) was influential in mainstreaming the economics of nature.
The World Bank (2013) reported on the state of the poor, Deaton (2013) discussed the origins of inequality, and Population Division of the UN Secretariat (2013) presented a 2012 revision of world population prospects. You et al. (2014) and Rodin (2013) offered perspectives on child mortality and resilience, respectively, while European Commission (2014), UN-REDD Programme (2015), Buchannan and Stubblebine (1962), and Stockholm Resilience Centre (2015) discussed circular economy, REDD+, externalities, and resilience, respectively. Finally, the Intergovernmental Panel on Climate Change (IPCC) offered a 2013 report on climate change. Google Scholar has published numerous studies on the effects of environmental changes on human health and sustainability. Of these, UNEP reports Global Environment Outlook 5 (2012) and Global Environment Outlook 4 (2007) emphasize the importance of connecting global priorities, understanding how ecosystems regulate infectious diseases, and assessing the economic value of biodiversity. The Millennium Ecosystem Assessment (2006) and Dean (2006) focus on human health and the Asian tsunami's protective role for coastal vegetation. Butler (2014), Lim et al. (2012), Prüss-Üstün and Corvalán (2006), Pimm et al. (2014), Lehner et al. (2011), World Commission on Dams (2000), FAO (2014), Hansen et al. (2013), and Foley et al. (2007) present findings on global maps, reservoirs, dams, fisheries, forest cover change, species extinction, distribution, and protection.
Steffen et al. (2015) found that human development must be guided by "planetary boundaries", while Shea et al. (2007) developed a tool to assess the quality of systematic reviews. Watts et al. (2015) discussed policy responses to protect public health and McMichael (1987) and Brundtland (1946) discussed planetary overload and our common future. Horton et al. (2014) proposed a manifesto for planetary health and WHO (1946) seeks to protect in its Constitution. Lang and Rayner (2012) argued in favor of ecological public health, while Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Gerland et al. (2014) found world population stabilization unlikely this century, and Bereuter and Glickman (2015) discussed leveraging agriculture and food to improve global nutrition. Raudsepp-Hearne et al. (2010) discussed why human well-being is increasing despite ecosystem degradation, and Myers et al. (2013) discussed human health impacts of ecosystem alteration. IPCC (2014) discussed impacts, adaptation, and vulnerability of climate change. Google Scholar has published numerous studies on the impacts of global climate change and food security. Lal (2004, 2010) found that soil carbon sequestration can help mitigate anthropogenic carbon emissions and advance global food security, while Lambin et al. (2011) identified economic globalization and land scarcity as further challenges. Montgomery (2007) and Koch et al. (2013) discussed the importance of soil security, and Van Lynden and Odeman (1998) assessed the status of human-induced soil degradation in South and Southeast Asia.
Foley et al. (2005) explored the global consequences of land use, while Savilaakso et al. (2014) studied the effects of oil palm production on biodiversity. Tilman and Clark (2014) linked environmental sustainability and human health, and Davidson (2014) estimated the global wetland area loss. The UN (2014) reported on the Millennium Development Goals, and El-Zein et al. (2014) highlighted the need for health and ecological sustainability in the Arab world. The OECD (2005), FAO (2003), UN Convention on Biological Diversity (2013), IGBP/SCOR (2014), and Sanford et al. (2014) all provided reports on various aspects of climate policy. Finally, Rockström et al. (2009) proposed a safe operating space for humanity.
Google Scholar also examined regime shifts, environmental impacts, global biosphere shifts, biodiversity, life support systems, chemical pollution and personal care products in the environment, global changes in nitrogen and phosphorus cycles, soil erosion under future climate change, Jevons' paradox, population dynamics, consumption trends, biofuels and food security, and the Global Energy Assessment.
Urbanization is closely linked to global environmental change, with developing-country cities particularly vulnerable to climate change and its impacts on health and equity. The IPCC has produced a Summary for Policymakers, while the UN's Department of Economic and Social Affairs Population Division estimates that by 2050, two-thirds of the world's population will be urban. Google Scholar references have demonstrated the importance of considering environmental dimensions in understanding the effects of AIDS in South Africa and other parts of sub-Saharan Africa. Urban growth, climate change, and freshwater availability are key components for understanding the impacts of HIV/AIDS on rural livelihoods. The Intergovernmental Panel on Climate Change (IPCC) and other organizations have provided guidance in mitigating the effects of urban growth and climate change. Studies have revealed the importance of pollinators in changing landscapes for world crops as well as soil fertility and hunger in Africa, the effect of soil degradation on food production, and land degradation. Research has also looked into the effect of rising food prices on food consumption, food insecurity on antiretroviral therapy adherence, and nutrient requirements for people living with HIV/AIDS.
Google Scholar has published numerous studies related to mitigation of climate change and its impacts, such as historical warnings of future food insecurity due to unprecedented seasonal heat, US daily temperatures in the context of non-normality, climate change and crop yields impacting child undernutrition, the impact of climate change on coral reefs, the effects of biodiversity loss on ocean ecosystem services and marine defaunation, and the past and future of fish consumption. A meta-analysis of free-air CO2 enrichment experiments showed positive responses to rising CO2 levels, but these may not be sufficient to offset the negative impacts. Public health strategies and technological advancements have been proposed to reduce these effects, as well as potential negative impacts such as zinc deficiency. Increasing global temperatures and changes in precipitation due to climate change are having serious implications for global food security, including potential for increased aflatoxin exposure in developing countries. Human activity has caused a variety of environmental threats to human health, such as Nipah virus emergence, HIV and schistosomiasis co-infection, and waterborne diarrhoea. In addition, climate change has caused water scarcity and increased the burden of bioenergy production and animal agriculture. The UN and other organizations have published reports on these topics, and Prüss-Ustün et al. (2014) conducted a retrospective analysis of 145 countries to determine the disease burden linked to inadequate water, sanitation, and hygiene.
Biodiversity loss has been linked to global disease ecology, as evidenced by the 2014 Ebola outbreak in West Africa. Agricultural intensification, urban habituation, and ecological connectivity are all factors that influence the emergence of these diseases. Climate change has an indirect effect on the land-carbon sink, resulting in an estimated 7 million premature deaths annually due to air pollution. It also affects biodiversity dynamics, leading to an increase in the global distribution of malaria. Deforestation and agricultural development are linked to an increase in malaria epidemiology, while drought can lead to outbreaks of dengue fever and other vector-borne diseases. Finally, emerging infectious diseases have increased globally.
Google Scholar studies have highlighted the impacts of endocrine disruption, the WHO UN Environment Programme Inter-Organization Programme for the Sound Management of Chemicals State of the Science of Endocrine Disrupting Chemicals 2012, the US Environmental Protection Agency High Production Volume (HPV) Challenge, Global Child Labour Developments: Measuring Trends from 2004 to 2008, and burden of disease due to chemicals and guidance on Ridding the World of POPs. Google Scholar has published numerous studies on water-related issues in Pakistan. These include the Hyogo Framework for Action 2005-2015, extreme weather events and waterborne disease, global health impacts of floods, health effects of drought, and the Atlas of Mortality and Economic Losses from Weather Climate and Water Extremes (1970-2012). Climate change is linked to human conflict and has had a significant impact on the political dynamics of Pakistan. Additionally, food wastage has been studied with regard to natural resources, intensive production practices, and the safety of genetically engineered crops. Mental health is affected by natural disasters, with risk factors for depression in adults and children identified.
Google Scholar has also identified studies related to food security, including the safety of novel protein sources, labour capacity from heat stress, impacts of ICDPs in the Brazilian Amazon, Dietary Guidelines Advisory Committee's report, Global Ocean Commission's report, FAO's Code of Conduct for Responsible Fisheries and State of World Fisheries and Aquaculture, role of aquaculture in global food security, Government Office for Science's Foresight report and Searchinger et al.'s report on creating a sustainable food future. Finally, Atehnkeng et al. (2008) have evaluated atoxigenic isolates of Aspergillus flavus as potential biocontrol agents for aflatoxin in maize. Traoré et al. (2012), Englberger et al. (2003), Kennedy & Burlingame (2003), and Penafiel et al. (2011) have conducted research on the importance of restoring the bridge between agriculture and health for sustainable nutrition security, and the contributions of edible plant and animal biodiversity to human diets. Milner et al. (2015) explored health effects of adopting low greenhouse gas emission diets, while Vieux et al. (2013) studied the association between high nutritional quality and low greenhouse gas emissions. Siegel et al. (2014) and Hallström et al. (2014) asked whether enough fruits and vegetables are produced to meet global health needs and analyzed the environmental impact of dietary change, respectively.
Béné et al. (2015) examined the potential of fish to feed 9 billion people by 2050, and De Steur et al. (2015) analyzed the market potential of transgenic biofortified crops. Miteva D, Loucks C & Pattanayak SK (in review) have studied the impacts of forest certification in Indonesia, while Kim et al. (2015), Allan et al. (2003), Bauch et al. (in press), and Pattanayak et al. (2007) looked at smoke exposure, effects of habitat fragmentation on Lyme disease risk, public health impacts of ecosystem change, and diarrhea, watershed protection, and biodiversity conservation, respectively. Snider et al. (2003) and Jagger et al. (2009) discussed policy innovations for private forest management and conservation in Costa Rica and evaluated impacts of REDD projects, respectively.
The UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania and the World Bank's Loess Plateau Watershed Rehabilitation Project in China have been successful in reducing deforestation/increasing grass coverage and improving surface cover greenness, respectively. Google Scholar has published numerous studies on the externalities of fertilizer use and pesticide ecological and health risks in West African agriculture, as well as the costs of inaction on the sound management of chemicals and public health benefits of strategies to reduce greenhouse-gas emissions in urban land transport and household energy. The Climate and Clean Air Coalition (CCAC) has also provided a briefing on kerosene lamps and SLCPS.
Cheng and Berry (2013) reviewed health co-benefits and risks associated with public health adaptation strategies to climate change, while Bowler et al. (2010) explored the effectiveness of 'greening' urban areas to reduce air pollution and the 'urban heat island effect'. Elmqvist et al. (2013) discussed urbanization, biodiversity, and ecosystem services, while Jarrett et al. (2012) studied the effect of active travel on NHS costs. UN-Department of Economic and Social Affairs Population Division (2010) and UN Environment Programme (2006) published reports on urbanization and chemicals management, respectively.
Google Scholar has published several articles examining the impact of climate change on human health. Kimball and Heymann (2014) discussed the role of International Health Regulations, while O'Neill et al. (2012) analyzed the effects of demographic change and carbon dioxide emissions. Singh and Darroch (2012) estimated the costs and benefits of contraceptive services and the Global Commission on the Economy and Climate (2014) released a report on "Better growth, better climate". McDonald and Shemie (2013) proposed a "Urban Water Blueprint" to address the global water challenge.
Crossref, PubMed, and Scopus (171) were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Loss events worldwide 1980-2013 were evaluated by Munich RE NatCatSERVICE. Dearing et al. (2014) proposed "Safe and just operating spaces" for regional social-ecological systems, while Raworth (2012) proposed a "safe and just space for humanity." Woodward (2015) discussed regional growth, inequality, and poverty in a carbon-constrained world. Ikeme (2003) explored equity, environmental justice, and sustainability in climate change politics. Macpherson et al. (2015) highlighted the threats to health, well-being, and humanity posed by Caribbean heat. Knox (1992) and UN Conference on Environment and Development (1992) discussed human rights obligations and the Earth Summit, respectively. Diboulo et al. (2012) studied weather and mortality in Burkina Faso. Haines et al. (1993) examined global health watch monitoring impacts of environmental change, while Redwood-Campbell & Abrahams (2011) discussed primary health care and disasters. Finally, Jamison et al. (2013) proposed "Global Health 2035" and UNICEF (2013) highlighted a far-reaching health worker programme in Ethiopia that has helped reduce child mortality. Research has assessed the potential impact of wetland expansion and management on mosquitoes in Britain, mangrove planting in Viet Nam, floods on the Millennium Development Goals in Pakistan, power outages and extreme events on health, environmental change adaptation, heat warning systems, and coastal wetlands for hurricane protection. To prevent disease and slow global warming, behavior change is key and mobile-health technology interventions, handwashing campaigns, and cash-back rebate programs have been used. The UNFCCC developed guidelines to help countries address climate change, while the UN General Assembly advocated for a holistic approach to development. The New Economics Foundation created the Happy Planet Index, Porter and Stern developed the Social Progress Index, Talberth et al. created the Genuine Progress Indicator, Dasgupta (2010) investigated nature's role in sustaining economic development, and Sukhdev et al. discussed the Economics of Ecosystems and Biodiversity (TEEB). Google Scholar has published studies on economic and social progress, such as Yates (2014) proposing recycling fuel subsidies as health subsidies, the Organisation for Economic Co-operation and Development (2011) providing guidance for policy makers on environmental taxation, Bond and Lang (2014) analyzing the validity of happiness scales, and Costanza et al. (2014) arguing for leaving GDP behind. Google Scholar references #409-394 provide literature on topics such as collapse, environment and society, global environmental governance, visualizing uncertainty about the future, and paying for ecosystem services. Ostrom (417) discussed polycentric governance, UNAIDS (416) reported on the global HIV/AIDS epidemic, and Friel et al. (415) discussed potential risks to diet-related health from the Trans Pacific Partnership Agreement. Sunstein (413) presented a tale of two protocols and Biermann et al. (412) discussed navigating the Anthropocene, while Ottersen et al. (411) explored the political origins of health inequity and Conway and Oreskes (410) discussed how a handful of scientists obscured the truth on various issues.
Google Scholar references 426-423 report on data revolution and sustainable development. The Secretary-General's Independent Expert Advisory Group on a Data Revolution for Sustainable Development (426) proposed A world that counts: mobilising the data revolution for sustainable development (426). Passmore and Schmidt (425) reported the January 2015 status report to DIFID and Cities Alliance, while Koppelaar et al. (424) reviewed current advanced integrated models for city-regions. Future Earth (423) discussed their mission, Mace et al. (422) reviewed the risk register for natural capital, Waage et al. (421) presented their paper on governing the UN Sustainable Development Goals, and Rah et al. (420) studied the associations between household sanitation and personal hygiene practices and child stunting in rural India. ISSC (419) reviewed the Sustainable Development Goals from a science perspective, and the UNOpen Working Group (418) proposed goals for sustainable development.
Natural systems provide essential services to humans, and the Anthropocene epoch brings global trends in population, consumption, health, and the environment. Ecosystem change can affect human health through various mechanisms, and seven of nine planetary boundaries are currently being monitored. Countries vary in their proportional and absolute impact on the environment, and crop production at the end of the century is expected to be affected by the maximal use of available water. Landscape fire smoke is a major global mortality risk, and grain production requirements must increase to feed the world. Aquaculture production is expanding to meet fish demand, and protein conversion efficiency and emissions of various livestock are being compared. Climate change risks and environmental change risks are being examined, as well as psychological and emotional outcomes from exposure to natural The global community must prioritize human and planetary health for climate mitigation. The Rockefeller Foundation-Lancet Commission on Planetary Health has highlighted the relationship between human health and environmental change, and this year's World Health Day has the theme of “our planet, our health”. WHO estimates that more than 13 million deaths annually are due to avoidable environmental causes. Tony Capon, the world's first Professor of Planetary Health, believes that planetary health is about safeguarding the health and wellbeing of current and future generations.
The Lancet has launched a series of initiatives, including the Planetary Health Commission, to investigate the connection between human health and the environment. This commission found that human health gains have been achieved at a high cost, with environmental degradation threatening to reverse these gains. To protect our health in the Anthropocene epoch, the Commission outlines several action points. These include audio and infographic resources, as well as a full-text report and executive summary. We also offer additional services such as Lancet Alerts, Connect, Research4Life, and more.
19931 word summary
We use cookies to provide and enhance our service, tailor content, and analyze our content and digital experience. For more information on cookies, please see our Cookie Policy. You may choose to not allow some types of cookies, though this may impact your experience. We also offer additional services such as Lancet Alerts, Connect, Research4Life, and more. To update your cookie settings, please visit the Cookie settings | Your Privacy Choices for this site. For more information on our services and offerings, please visit our website. The Lancet has launched a series of global health initiatives, including the Planetary Health Commission, to investigate the connection between human health and the environment. This commission found that human health gains have been achieved at a high cost, with environmental degradation threatening to reverse these gains. To protect our health in the Anthropocene epoch, the Commission outlines several action points. These include audio and infographic resources, as well as a full-text report and executive summary. This year's World Health Day has the theme of “our planet, our health”, and draws attention to the link between human health and environmental change. WHO estimates that more than 13 million deaths annually are due to avoidable environmental causes. Global health trainees are not adequately equipped to confront the climate crisis, so a workshop was hosted at the 2020 Canadian Conference on Global Health. In the Rockefeller Foundation–Lancet Commission on Planetary Health, there was an error regarding soil degradation estimates. Tony Capon is the world's first Professor of Planetary Health, and he believes that planetary health is about safeguarding the health and wellbeing of current and future generations. Judith Rodin, President of the Rockefeller Foundation, believes that planetary health is the big idea for this century. The Rockefeller Foundation–Lancet Commission on Planetary Health has highlighted the relationship between human health and environmental change. The UNDP recognizes this link and has included it in their Strategic Plan for 2014–17. Aldo Leopold's essay "The Land Ethic" from the 1940s discussed how humanity must redefine itself as part of nature, rather than its external conqueror, to solve conservation challenges.
The global community must recognize that human and planetary health are interconnected and prioritize them together for climate mitigation. The Sustainable Development Goals, World EXPO, and defining juncture for climate action in 2015 presents a unique opportunity for this. Finally, Aldo Leopold's quote reminds us that we must make an effort to understand the world and learn what is good for it. Natural systems provide essential services to humans, and the Anthropocene epoch brings global trends in population, consumption, health, and the environment. Ecosystem change can affect human health through various mechanisms, and seven of nine planetary boundaries are currently being monitored. Countries vary in their proportional and absolute impact on the environment, and crop production at the end of the century is expected to be affected by the maximal use of available water. Landscape fire smoke is a major global mortality risk, and grain production requirements must increase to feed the world. Aquaculture production is expanding to meet fish demand, and protein conversion efficiency and emissions of various livestock are being compared. Climate change risks and environmental change risks are being examined, as well as psychological and emotional outcomes from exposure to natural versus synthetic environments. A circular economy model and framework for examining interactions between sustainable development goals are also being implemented. Google Scholar 426-411 report on various aspects of data revolution and sustainable development. The Secretary-General's Independent Expert Advisory Group on a Data Revolution for Sustainable Development (426) proposed A world that counts: mobilising the data revolution for sustainable development (426). Passmore and Schmidt (425) reported the January 2015 status report to DIFID and Cities Alliance, while Koppelaar et al. (424) reviewed current advanced integrated models for city-regions.
Future Earth (423) discussed their mission, while Mace et al. (422) reviewed the risk register for natural capital. Waage et al. (421) presented their paper on governing the UN Sustainable Development Goals, and Rah et al. (420) studied the associations between household sanitation and personal hygiene practices and child stunting in rural India. ISSC (419) reviewed the Sustainable Development Goals from a science perspective, and the UNOpen Working Group (418) proposed goals for sustainable development.
Ostrom (417) discussed polycentric governance of complex economic systems, UNAIDS (416) reported on the global HIV/AIDS epidemic, Friel et al. (415) discussed potential risks to diet-related health from the Trans Pacific Partnership Agreement, and the EPA North American 2014 HFC Submission to the Montreal Protocol (414) was summarized. Sunstein (413) presented a tale of two protocols, while Biermann et al. (412) discussed navigating the Anthropocene and improving Earth system governance. Finally, Ottersen et al. (411) explored the political origins of health inequity, while Conway and Oreskes (410) discussed how a handful of scientists obscured the truth on issues from tobacco smoke to global warming. Google Scholar references #409-394 provide a range of literature on the topics of collapse, environment and society, global environmental governance, visualizing uncertainty about the future, paying for ecosystem services, benefits and costs of improved cookstoves, decision-making under great uncertainty, choice under uncertainty with catastrophic risks, non-expected utility theory, phasing out environmentally harmful subsidies, household electricity access and CO2 emissions growth in India, global energy subsidies, World Energy Outlook, Energy Subsidy Reform, Resource Revolution, and forest figures and ecosystem services valuation and policy evaluation in developing countries. Google Scholar has published a number of important studies that explore the concept of economic and social progress. For example, Yates (2014) proposed recycling fuel subsidies as health subsidies, while the Organisation for Economic Co-operation and Development (2011) provided guidance for policy makers on environmental taxation. Bond and Lang (2014) analyzed the validity of happiness scales, and Costanza et al. (2014) argued for leaving GDP behind.
The New Economics Foundation (2012) created the Happy Planet Index to measure sustainable well-being, and Porter and Stern (2014) developed the Social Progress Index. Talberth et al. (2006) created the Genuine Progress Indicator, Dasgupta (2010) investigated nature's role in sustaining economic development, and Sukhdev et al. (2014) discussed the Economics of Ecosystems and Biodiversity (TEEB).
Finally, the UN General Assembly (2013) advocated for a holistic approach to development, Arrow et al. (2004) questioned whether we are consuming too much, Dasgupta (2001) discussed human well-being and the natural environment, Stiglitz et al. (2009) revisited the measurement of economic performance and social progress, and Coyle (2014) examined GDP. Raskin et al. (2010) concluded with a study on searching for sustainability. To prevent disease and slow global warming, behavior change is key. Mobile-health technology interventions, handwashing campaigns, and cash-back rebate programs have been used to encourage such changes. Additionally, evaluating and valuing the co-benefits of global greenhouse gas mitigation, such as improved air quality and human health, are important for setting national policy. The UNFCCC developed guidelines in 2001 for preparing National Adaptation Programmes of Action to help countries address the effects of climate change. Research has assessed the potential impact of wetland expansion and management on mosquitoes in Britain (Medlock et al., 2011). In Viet Nam, mangrove planting has been found to save lives and money (IFRC, 2002). An analysis of the impact of floods on the Millennium Development Goals in Pakistan found that a resilient health system is essential (Kruk et al., 2015). A systematic review of the literature from 2011-2012 examined the effects of power outages and extreme events on health (Klinger et al., 2014). A resilience framework was used to analyze environmental change adaptation (Nelson et al., 2007). Studies examining the effectiveness of heat warning systems (Toloo et al., 2013) and the value of coastal wetlands for hurricane protection (Costanza et al., 2008) have been conducted. The US Government released "The Federal Response to Hurricane Katrina: Lessons Learned" (US Government, 2006) and the American Society of Civil Engineers' "The New Orleans Hurricane Protection System: What Went Wrong and Why" (ASCE, 2007) report. Finally, a review and vulnerability assessment of the health effects of coastal storms and flooding in urban areas was conducted (Lane et al., 2013). Crossref, PubMed, and Scopus (171) were used to review literature on Hurricane Katrina deaths and health impacts of environmental change. Loss events worldwide 1980-2013 were evaluated by Munich RE NatCatSERVICE. Dearing et al. (2014) proposed "Safe and just operating spaces" for regional social-ecological systems, while Raworth (2012) proposed a "safe and just space for humanity." Woodward (2015) discussed regional growth, inequality, and poverty in a carbon-constrained world. Ikeme (2003) explored equity, environmental justice, and sustainability in climate change politics. Macpherson et al. (2015) highlighted the threats to health, well-being, and humanity posed by Caribbean heat. Knox (1992) and UN Conference on Environment and Development (1992) discussed human rights obligations and the Earth Summit, respectively. Diboulo et al. (2012) studied weather and mortality in Burkina Faso. Haines et al. (1993) examined global health watch monitoring impacts of environmental change, while Redwood-Campbell & Abrahams (2011) discussed primary health care and disasters. Finally, Jamison et al. (2013) proposed "Global Health 2035" and UNICEF (2013) highlighted a far-reaching health worker programme in Ethiopia that has helped reduce child mortality. Google Scholar has published several articles examining the impact of climate change on human health. Kimball and Heymann (2014) discuss the role of the International Health Regulations in global safety, while O'Neill et al. (2012) analyze the effects of demographic change and carbon dioxide emissions. Singh and Darroch (2012) estimate the costs and benefits of contraceptive services in 2012. The Global Commission on the Economy and Climate (2014) released a report on "Better growth, better climate". McDonald and Shemie (2013) proposed a "Urban Water Blueprint" to address the global water challenge. Colding (2013) revisited the Stockholm Urban Assessment, and Haase (2013) discussed shrinking cities, biodiversity, and ecosystem services.
Bowler et al. (2010) explored the effectiveness of 'greening' urban areas in reducing human exposure to air pollution and the 'urban heat island effect'. Elmqvist et al. (2013) discussed urbanization, biodiversity, and ecosystem services. Jarrett et al. (2012) studied the effect of increasing active travel in urban England and Wales on costs to the National Health Service. UN-Department of Economic and Social Affairs Population Division (2010) released World Urbanization Prospects, and UN Environment Programme (2006) published a Strategic Approach to International Chemicals Management.
Cheng and Berry (2013) reviewed health co-benefits and risks associated with public health adaptation strategies to climate change, while De Silva et al. (2005) conducted a systematic review on social capital and mental illness. Berry (2009) proposed climate change as a mental health opportunity. Google Scholar has published numerous studies on the externalities of fertilizer use and pesticide ecological and health risks in West African agriculture, as well as the costs of inaction on the sound management of chemicals. Additionally, the public health benefits of strategies to reduce greenhouse-gas emissions in urban land transport and household energy have been studied. The Climate and Clean Air Coalition (CCAC) has also provided a briefing on kerosene lamps and SLCPS.
In terms of solutions, the UNDP's Shinyanga Soil Conservation Programme (HASHI) in Tanzania has been successful in reducing deforestation and increasing grass coverage. China has also seen significant improvements in surface cover greenness since 2000, due to the World Bank's Loess Plateau Watershed Rehabilitation Project. Studies have been conducted on the area's change and off-poverty mechanisms, as well as the soil and water conservation effects of the project. Miteva D, Loucks C & Pattanayak SK (in review) have studied the impacts of forest certification in Indonesia. Kim et al. (2015) looked at population smoke exposure in Equatorial Asia, and Allan et al. (2003) investigated the effects of habitat fragmentation on Lyme disease risk. Bauch et al. (in press) have studied public health impacts of ecosystem change in the Brazilian Amazon, while Pattanayak et al. (2007) observed diarrhea, watershed protection, and biodiversity conservation in Flores, Indonesia. Snider et al. (2003) discussed policy innovations for private forest management and conservation in Costa Rica, and Jagger et al. (2009) evaluated impacts of REDD projects.
Milner et al. (2015) explored health effects of adopting low greenhouse gas emission diets in the UK, while Vieux et al. (2013) studied the association between high nutritional quality and low greenhouse gas emissions in French adults. Siegel et al. (2014) asked whether enough fruits and vegetables are produced to meet global health needs, and Hallström et al. (2014) conducted a systematic review of the environmental impact of dietary change. Béné et al. (2015) examined the potential of fish to feed 9 billion people by 2050, and De Steur et al. (2015) analyzed the market potential of transgenic biofortified crops.
Traoré et al. (2012) highlighted the importance of restoring the bridge between agriculture and health for sustainable nutrition security, and Englberger et al. (2003) identified Micronesian banana, taro, and other foods as newly recognized sources of provitamin A and other carotenoids. Kennedy & Burlingame (2003) analyzed food composition data on rice from a plant genetic resources perspective, and Penafiel et al. (2011) conducted a systematic review on the contributions of edible plant and animal biodiversity to human diets. Google Scholar has identified a number of studies related to food security, including the 2013 study by van der Spiegel et al. on the safety of novel protein sources, Dunne et al.'s 2013 study on the reduction of labour capacity from heat stress, Weber et al.'s 2011 study on the impacts of Integrated Conservation and Development Projects (ICDPs) in the Brazilian Amazon, and the 2015 Dietary Guidelines Advisory Committee's report. The Global Ocean Commission has also released a report in 2014 on the recovery of the global ocean, and the FAO has published its Code of Conduct for Responsible Fisheries and its 2012 State of World Fisheries and Aquaculture. Troell et al. (2014) have studied the role of aquaculture in global food security, and Waite et al. (2014) have proposed ways to improve its productivity and environmental performance. The Government Office for Science's 2011 Foresight report and Searchinger et al.'s 2013 report on creating a sustainable food future provide additional information. Finally, Atehnkeng et al. (2008) have evaluated atoxigenic isolates of Aspergillus flavus as potential biocontrol agents for aflatoxin in maize. Google Scholar has researched the impacts of food wastage on natural resources. A planetary boundary for phosphorus was reconsidered in 2011. The National Geographic article, "Feast or Famine" (2013), examined intensive production practices and their effect on agricultural sustainability. Research has found that grain production can be increased with lower environmental costs. Genetically engineered crop safety was reviewed in 2014. The book "One Billion Hungry" (2010) discussed food security and sustainable intensification. Mental health is affected by natural disasters, with risk factors for depression in adults and children identified. Climate change increases distress related to displacement and environmental change, with health effects in northwest Alaska. Google Scholar has published numerous studies on climate refugees in the 21st century. The UN Refugee Agency (UNHCR) has identified displacement as a new 21st century challenge. Studies have revealed that environmental refugees in sub-Saharan Africa face a variety of challenges. Additionally, climate change has been linked to human conflict and is expected to have a significant impact on the political dynamics of Pakistan. The 2010 floods in Pakistan are believed to be a result of both climate change and natural variability. Heat stress is also increasing human migration in rural Pakistan while thermal extremes are changing in the country. Lastly, upstream water storage and diversion are having an impact on the lower Indus river basin. Google Scholar235 discusses the water economy in Pakistan and how it is running dry. Google Scholar234 examines the Indus River Basin in Pakistan. Google Scholar233 looks at population, labor force, and employment in Pakistan. Google Scholar232 is the Hyogo Framework for Action 2005-2015 to build resilience of nations and communities to disasters. Google Scholar231 evaluates extreme water-related weather events and waterborne disease. Google Scholar230 examines global health impacts of floods. Google Scholar229 is the World Disaster Report 1997. Google Scholar228 reviews the health effects of drought. Google Scholar227 is the Atlas of Mortality and Economic Losses from Weather Climate and Water Extremes (1970-2012). Google Scholar226 is the Impact of Endocrine Disruption: A Consensus Statement on the State of the Science. Google Scholar225 is the WHO UN Environment Programme Inter-Organization Programme for the Sound Management of Chemicals State of the Science of Endocrine Disrupting Chemicals 2012. Google Scholar224 is the US Environmental Protection Agency High Production Volume (HPV) Challenge. Google Scholar223 is Global Child Labour Developments: Measuring Trends from 2004 to 2008. Finally, Google Scholar222 and 221 review burden of disease due to chemicals and provide guidance on Ridding the World of POPs respectively. Google Scholar studies have found that climate change has an indirect effect on the land-carbon sink, resulting in an estimated 7 million premature deaths annually due to air pollution. Other studies have shown that climate change can affect biodiversity dynamics, leading to an increase in the global distribution of malaria. Deforestation and agricultural development are linked to an increase in malaria epidemiology. Additionally, drought can lead to outbreaks of dengue fever and other vector-borne diseases. Finally, emerging infectious diseases have increased globally. The impacts of biodiversity on the emergence and transmission of infectious diseases have been documented in numerous studies. The President's Council of Advisors on Science and Technology published a report in 2011 on sustaining environmental capital and its implications for protecting society and the economy. Biodiversity loss has been linked to global disease ecology, as evidenced by the 2014 Ebola outbreak in West Africa. Other zoonotic diseases, such as Hendra virus, Nipah virus, and bat-borne viruses, have also been studied in relation to biodiversity. Research has indicated that agricultural intensification, urban habituation, and ecological connectivity are all factors that influence the emergence of these diseases. In 2007, a human Ebola outbreak in Luebo, Democratic Republic of Congo was linked to direct exposure to fruit bats. The 2014 Ebola outbreak in Guinea was traced to a Zaire strain of the virus. Human activity has caused a variety of environmental threats to human health, such as Nipah virus emergence, HIV and schistosomiasis co-infection, and waterborne diarrhoea. In addition, water scarcity due to climate change is a growing concern, with bioenergy production and animal agriculture posing additional burdens. The Food and Agricultural Organization of the United Nations published the State of the World's Forests 2012, which highlights the importance of tropical forests in providing new agricultural land during the 1980s and 1990s. The UN-Habitat also published The State of African Cities in 2014, which aims to promote sustainable urban transitions. Prüss-Ustün et al. (2014) conducted a retrospective analysis of data from 145 countries, finding that inadequate water, sanitation, and hygiene are a major source of disease burden. Solutions to address these issues must involve both adaptation strategies and improved water management. Increasing global temperatures and changes in precipitation due to climate change are impacting crop production and water availability. This has serious implications for global food security, as well as the potential for increased aflatoxin exposure in developing countries.
Public health strategies and technological advancements have been proposed to reduce these effects. Additionally, the potential negative impacts of rising CO2 levels, such as zinc deficiency, have been identified.
A meta-analysis of free-air CO2 enrichment experiments showed that photosynthesis, canopy properties, and plant production all respond positively to rising CO2 levels. However, these responses may not be sufficient to offset the negative impacts of climate change. Google Scholar has published numerous studies related to mitigation of climate change and its impacts. Historical warnings of future food insecurity have been identified due to unprecedented seasonal heat (Battisti et al., 2009). US daily temperatures are being studied in the context of non-normality (Huybers et al., 2014). Climate change and crop yields have been studied to quantify the impact on child undernutrition (Lloyd et al., 2011). Additionally, the impact of climate change on coral reefs has been studied (Cinner et al., 2012), as have the effects of biodiversity loss on ocean ecosystem services (Worm et al., 2006) and marine defaunation (McCauley et al., 2015). Finally, the past and future of fish consumption has been studied in order to meet healthy eating recommendations (Thurstan & Roberts, 2014). Nutritional aspects of fish compared to other protein sources have been studied, and research has shown that decreases in animal pollinators can have a negative effect on human nutrition and global health. Studies have revealed that pollinators contribute to nutritional health, and economic valuation of the vulnerability of world agriculture due to pollinator decline has been explored. Additionally, research has shown the importance of pollinators in changing landscapes for world crops. Furthermore, soil fertility and hunger in Africa, the impact of soil degradation on food production, and land degradation have been examined. Studies have also looked into the effect of rising food prices on food consumption, how food insecurity can affect adherence to antiretroviral therapy, and the nutrient requirements for people living with HIV/AIDS. Lastly, research has explored adult mortality and household food security in rural South Africa and the effect of AIDS on mortality shock. Google Scholar references (109-124) demonstrate the importance of considering environmental dimensions in understanding the effects of AIDS in South Africa and other parts of sub-Saharan Africa. Additionally, urban growth, climate change, and freshwater availability are key components of understanding the impacts of HIV/AIDS on rural livelihoods. The Intergovernmental Panel on Climate Change (IPCC) has provided a summary for policy makers to address the vulnerability associated with climate change. The Rockefeller Foundation's 100 Resilient Cities program and The Royal Society's report on weather resilience also provide guidance in mitigating the effects of urban growth and climate change. Urbanization and global environmental change are closely linked. Developing-country cities are particularly vulnerable to climate change and its impacts on health and equity. The Intergovernmental Panel on Climate Change (IPCC) has produced a Summary for Policymakers. Jevons' paradox suggests that increased efficiency can lead to increased consumption. Population dynamics and consumption trends have implications for future carbon emissions. Human population reduction is not a viable solution to environmental problems, but an understanding of global demographic trends is necessary. The UN's Department of Economic and Social Affairs Population Division estimates that by 2050, two-thirds of the world's population will be urban. The High Level Panel of Experts on Food Security and Nutrition has produced a report on biofuels and food security. The Global Energy Assessment, published by the Institution of Mechanical Engineers, provides an energy primer and looks at global food waste. Google Scholar92 and 91 demonstrated that regime shifts and environmental impacts of countries can be evaluated using PLoS One and Philos Trans R Soc Lond B Biol Sci., respectively. Google Scholar90-86 focused on global biosphere shifts, biodiversity, and life support systems, as well as the One World, One Health Conference. Google Scholar85-81 discussed chemical pollution and personal care products in the environment, and Google Scholar80-77 explored global changes in nitrogen and phosphorus cycles, as well as soil erosion under future climate change. Google Scholar has published numerous studies on the impacts of global climate change and food security. Lal (2004, 2010) found that soil carbon sequestration can help mitigate anthropogenic carbon emissions and advance global food security. Lambin et al. (2011) identified economic globalization and land scarcity as further challenges. Montgomery (2007) and Koch et al. (2013) discussed the importance of soil security. Van Lynden and Odeman (1998) assessed the status of human-induced soil degradation in South and Southeast Asia. Foley et al. (2005) explored the global consequences of land use, while Savilaakso et al. (2014) studied the effects of oil palm production on biodiversity. Tilman and Clark (2014) linked environmental sustainability and human health, and Davidson (2014) estimated the global wetland area loss. The UN (2014) reported on the Millennium Development Goals, and El-Zein et al. (2014) highlighted the need for health and ecological sustainability in the Arab world. The OECD (2005), FAO (2003), UN Convention on Biological Diversity (2013), IGBP/SCOR (2014), and Sanford et al. (2014) all provided reports on various aspects of climate policy. Finally, Rockström et al. (2009) proposed a safe operating space for humanity. Google Scholar has published numerous studies on the effects of environmental changes on human health and sustainability. Of these, Steffen et al. (2015) found that human development must be guided by "planetary boundaries". Shea et al. (2007) developed a tool to assess the quality of systematic reviews. Watts et al. (2015) discussed policy responses to protect public health. McMichael (1987) and Brundtland (1946) discussed planetary overload and our common future. Horton et al. (2014) proposed a manifesto for planetary health, which WHO (1946) seeks to protect in its Constitution. Lang and Rayner (2012) argued in favor of ecological public health. Dora et al. (2015) proposed indicators to link health and sustainability for the post-2015 development agenda. Gerland et al. (2014) found world population stabilization unlikely this century. Bereuter and Glickman (2015) discussed leveraging agriculture and food to improve global nutrition. Raudsepp-Hearne et al. (2010) discussed why human well-being is increasing despite ecosystem degradation, while Myers et al. (2013) discussed human health impacts of ecosystem alteration. IPCC (2014) discussed impacts, adaptation, and vulnerability of climate change. Google Scholar41 and 40 refer to two UNEP reports: Global Environment Outlook 5 (2012) and Global Environment Outlook 4 (2007). Google Scholar39 is a review from the CBD-WHO entitled Connecting Global Priorities: Biodiversity and Human Health (2015). Google Scholar38 is from the Millennium Ecosystem Assessment (2006) which focuses on human health and ecosystem regulation of infectious diseases. Google Scholar37 is from Dean (2006) on New Orleans and the Wetlands of Southern Louisiana. Google Scholar36 is from Danielsen et al. (2005) on the Asian tsunami and its protective role for coastal vegetation. Google Scholar35 is from IEEP/Ramsar Secretariat (2013) on the economics of ecosystems and biodiversity for water and wetlands. Google Scholar34 is a mini-review by Butler (2014) on climate change and global health. Google Scholar33 is from Lim et al. (2012) on a comparative risk assessment of burden of disease in 21 regions. Google Scholar32 is from Prüss-Üstün and Corvalán (2006) on preventing disease through healthy environments. Google Scholar31 is from the Millennium Ecosystem Assessment Board (2005) on living beyond our means. Google Scholar30 is from Pimm et al. (2014) on biodiversity of species and their rates of extinction, distribution, and protection. Google Scholar29 is from Lehner et al. (2011) on high-resolution mapping of the world's reservoirs and dams for sustainable river-flow management. Google Scholar28 is from the World Commission on Dams (2000) on dams and development. Google Scholar27 is from FAO (2014) on the state of world fisheries and aquaculture. Finally, Google Scholar26, 25 are from Hansen et al. (2013) and Foley et al. (2007) respectively, both focusing on global maps of 21st-century forest cover change and our share of the planetary pie. Gland, Switzerland (2014) saw the release of the "Living Planet Report 2014: Species and Spaces, People and Places" by the World Wide Fund for Nature (WWF). Research by Kummu et al. (2010) revealed physical water scarcity to be a new phenomenon, while Steffen et al. (2015) noted the "Great Acceleration" of the Anthropocene. Roser (2015) provided an analysis of world poverty, Bennett et al. (2009) explored the relationships between multiple ecosystem services, and DeFries and Foley (2004) discussed balancing human needs and ecosystem function. The Economics of Ecosystems and Biodiversity (TEEB) (2010) was influential in mainstreaming the economics of nature. The World Bank (2013) reported on the state of the poor, Deaton (2013) discussed the origins of inequality, and Population Division of the UN Secretariat (2013) presented a 2012 revision of world population prospects. You et al. (2014) and Rodin (2013) offered perspectives on child mortality and resilience, respectively, while European Commission (2014), UN-REDD Programme (2015), Buchannan and Stubblebine (1962), and Stockholm Resilience Centre (2015) discussed circular economy, REDD+, externalities, and resilience, respectively. Finally, the Intergovernmental Panel on Climate Change (IPCC) offered a 2013 report on climate change. Google Scholar 6 references the Ramsar Convention on Wetlands of International Importance, enacted in 1971 and amended in 1982 and 1987. Google Scholar 5 references the Millennium Ecosystem Assessment (MEA), published in 2011. Google Scholar 4 references the UK National Ecosystem Assessment from 2005. Google Scholar 3 references the MEA's Health Synthesis from 2005, and Google Scholar 2 references a 2002 Nature article by Crutzen on the Geology of Mankind. Finally, Google Scholar 1 references the International Commission on Stratigraphy's International Stratigraphic Chart from 2013. Achieve improved global, national, and subnational governance for planetary health through cross-sectoral action. Implement creative financing strategies to support a more sustainable world economy. Promote transformative change through different approaches such as regulatory, fiscal, and tax policies, media campaigns, and individual behavior change interventions. Incentivize and provide evidence-based methods to encourage more robust environmental stewardship and health protection in the private sector. Engage civil society and community organizations by promoting public discourse and transparency of data.
Contributors: RH proposed the concept of planetary health. SW and AH wrote the first draft of the Commission report. All authors contributed to the overall report structure and concepts, writing of drafts, and approved the final draft. Additional text was written by contributing authors, including Alex Martinez, Faraz Usmani, Lukasz Aleksandrowicz, Marina Maiero, Diarmid Campbell-Lendrum, David Cooper, Sarah H Olson, Wayne Twine, Lori M Hunter, Stephen Tollman, Shannon Doocy, Tim Shorten, Christopher Golden, Simon J Lloyd, Christi Electris, Gillian Christie, Kevin Patrick, Vera Oziransky, and Qu Cheng.
Declaration of Interests: All authors declared no conflicts of interest. Policies are needed to advance planetary health by addressing the unfinished agenda of environmental health challenges and increasing resilience to emerging threats. Research should not delay action and integrated surveillance systems should be built to collect rigorous health, socioeconomic, and environmental data for defined populations. Risk communication to policy makers and the public should be improved and decision-making frameworks that operate under uncertainty should be embraced. Policies should account for depreciation of natural capital, support planetary health, facilitate action before irreversible changes in key natural systems occur, scale up resilient food and agricultural systems, and develop more resilient health systems. Policies should be put in place to address the conceptual challenges of advancing planetary health. This includes sustaining a reporting framework as well as reviewing and updating metrics on corporate effects of determinants of planetary health. Citizens can also be empowered to act through successful civil society movements. These policy propositions will help advance planetary health. Health professionals, academics and research funders, governments, the UN, and corporations and citizens can all play pivotal roles in promoting planetary health. Health professionals can use their voice to help mobilize a wide community of actors and should become informed about the dangers posed by global environmental change. Research funders and the academic community should invest and develop a culture of interdisciplinary research. The UN and Bretton Woods bodies should define metrics and build early warning and response systems. Governments should put planetary health at the centre of national policy discourse. Investors and corporate reporting bodies should require companies to report on non-financial aspects of their performance. Google Scholar and Scopus emphasize the need for research on indicators of human welfare and natural systems that are more robust than those currently available. Additionally, research should prioritize translational research and implementation science to address the on-the-ground realities of what is feasible and relevant in the settings facing the greatest threats to planetary health. Research should also analyze the causes of the gap between knowledge and implementation of that knowledge, especially in poor countries, and point towards solutions on the global and local levels. Community engagement can empower disadvantaged and marginalized groups. Research is needed to assess strategies and technologies that reduce environmental damage and emissions, with a focus on health co-benefits and potential co-harms, including the economic consequences of these. Policies such as taxes, subsidies, and regulations should be studied to identify effective approaches to promote planetary health.
Additionally, research should assess strategies that use ecosystem approaches to reduce vulnerability to environmental change and engage local communities, particularly in low-income countries. Methods such as resilience thinking, decision theory, threshold approaches, and scenario planning can be used to guide management under uncertain conditions. Models that are based on an understanding of the underlying processes are needed to make projections of future trends. A Data Revolution for Sustainable Development is underway to improve access to services, identify inequalities and improve the quality of household survey data. Advances in climate and earth system modelling, geospatial data and human demographic health datasets are being used to create resource flow models to better inform decision-making. These models also consider economic values, societal health, welfare and productivity, and environmental impacts. 17 resource models currently exist but none incorporate ecological systems and human wellbeing. Google Scholar can be used to assess the effects of environmental changes on human health and equity. This assessment, as well as assessments of trade-offs between short-term gains and longer-term benefits, can inform decision making. Systems modelling and computer modelling techniques have been evolving rapidly in recent years to better understand human-ecological systems interactions. Addressing gaps in knowledge, our overview has uncovered substantial gaps in knowledge that need to be addressed to improve planetary health. To do this, a transparent interdisciplinary process of research agenda setting is needed, taking into account the needs of decision makers and building on existing knowledge. Capacity strengthening is needed, such as developing a global collaborative effort analogous to the Cochrane Collaboration, and universities and research institutes need to find ways to encourage transdisciplinary research teams. Priority areas for research include understanding how environmental change affects human health, advancing research on decision making under uncertainty, and developing an integrated research agenda for the Sustainable Development Goals (SDGs). The UN Sustainable Development Goals (SDGs) provide an opportunity to integrate health and sustainability through the selection of relevant indicators. Figure 20 shows the proposed SDGs representing human wellbeing (inner circle) are dependent on those that provide the enabling infrastructure for development (the first ring) and the supporting natural systems (the outer ring). Criticism exists that only a third of the targets are well developed, with the remainder either being too unspecific or requiring refinement.
For example, target 3·9 suggests a substantial reduction in deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination. Indicators relevant to planetary health fall into several categories indicating reductions in poverty or improvement in human development, such as universal health coverage and increased access to education. Additionally, policies to increase resilience to environmental change and policies to reduce or reverse environmental change, particularly where health co-benefits exist, are needed for successful implementation. The Millennium Development Goals (MDGs) failed to address unsustainable environmental trends and inequities, so the post-2015 agenda must include social, economic, and environmental dimensions of sustainable development. The UN General Assembly has proposed 17 SDGs and 169 targets. According to the Millennium Ecosystem Assessment, any progress made with the MDGs cannot be sustained if ecosystem services continue to be degraded.
Progress towards the MDGs has been mixed. In 2000, 40 million people in Africa, Asia, and Latin America faced early deaths due to lack of access to HIV/AIDS treatment. Thanks to a global movement, today half of the 37 million living with HIV have access to treatment and drug costs have been reduced to $50/person/year.
Planetary health requires new coalitions to bring meaningful and lasting change. Communities in need must work with scientists and health leaders to create social change, and scientists and health communities must work with civil society to influence decision makers. Better evidence is needed for planetary health, but it will take a broad-based movement for social change to have an impact. The post-2015 Development Agenda offers potential to capitalize on this movement. Google ScholarPanel 14 highlights the need for grassroots involvement in the advancement of global health thinking to protect planetary health. Grassroots movements to protect food, water, environments, and livelihoods are underway; however, to have real effect, these local movements must be organized and work in solidarity with the scientific and health communities. An example of this is seen with the HIV/AIDS pandemic, which saw an effective triple drug treatment emerge but with uneven access to those treatments.
Trade treaties may also have an effect on planetary health and national governments can support these efforts by integrating cross-sectoral policies at the cabinet level. At the municipal level, groups like the C40 Cities Climate Leadership Group and the 100 Resilient Cities network can provide test beds for innovative policies. Local governance can further be strengthened by civil society and indigenous communities. An example of this is seen with the HIV community galvanizing progress. Such movements help to support polycentric governance, wherein individuals and local communities solve common-pool resource issues. Google Scholar has proposed upgrading the UN Environment Programme to a specialized agency similar to the World Health Organization (WHO), and creating a high level UN Sustainable Development Council. However, their proposals do not include a role for health as an indicator of long-term success. To address this, UN agencies responsible for health, environment, and development should collaborate more closely to tackle the threats to planetary health.
The Montreal Protocol, which has successfully phased out substances that deplete stratospheric ozone, can serve as an example. It proposed restrictions on all countries, had strong incentives for participation and compliance, and created incentives for positive steps. Regional trade treaties should also prioritize health protection in both the near and long term.
The Earth Systems Governance project has proposed seven building blocks for reform, which include UN reforms. The University of Oslo Commission on governance for global health recommended the creation of a multi-stakeholder platform and an independent scientific monitoring panel on social and political determinants of health, but did not propose mechanisms for addressing environmental changes. A new body focused solely on social and political determinants of health should be combined with environmental sustainability efforts. Decision makers often wish to avoid high political and social costs, and so may act before all evidence is in. To effectively communicate uncertainty to them, scientists need to develop better skills and closer relationships with the public and policy makers. Innovative methods, such as infographics and other visual representations, can be used to represent uncertainty.
Scenario planning can help to assess the robustness of policy options by depicting a range of potential futures. Resilience thinking is another approach, which focuses on identifying and managing critical thresholds for system performance, conserving key processes, and transforming to a new mode of operation if necessary.
The science of decision making for planetary health should be done in two phases: scoping the issue broadly and combining what is known with what is possible and unknown to guide policy making. Scientists should also understand the gap in standards of evidence and risk tolerance between the science community, decision makers, and informed citizens.
Other approaches based on system science include a threshold approach, scenario planning, and creative consideration of complex possible futures. Uncertainty is a common factor when considering planetary health. To address the challenges posed by incomplete information, alternative decision rules have been formulated that do not rely on expected values.
History is full of examples of decision makers failing to act in time, often due to a complex interplay between environmental change, sociopolitical forces, and civil war. To improve governance for planetary health, action must be taken at global, national, and subnational levels before irreversible changes occur. This requires decision making under uncertainty about the critical thresholds or rates of deterioration of key Earth systems. However, decision makers tend to overestimate the resilience of their system due to incomplete knowledge. Google ScholarPlanetary health requires comprehensive global and national measures to reform taxes and subsidies for sectors such as energy, agriculture, and health. The Institute for European Environmental Policy (IEEP) recommends phasing out harmful subsidies in the European Union, with safety nets to protect the poor, new pricing structures, financial transfers, and multilateral agreements on environmental objectives. This type of reform is underway in countries such as Iran, Nigeria, and Tunisia, but can be difficult to achieve due to powerful and vocal constituencies.
An update from the International Monetary Fund suggests global fossil fuel subsidies are greater than previously estimated, at $4.9 trillion (6.5% of global GDP) in 2013. Eliminating post-tax subsidies in 2015 could boost global economic welfare by $1.8 trillion (2.2% of global GDP), despite increased energy costs to consumers. Governments face trade-offs between goals when removing subsidies, as 1.5 billion people still live without electricity and 3 billion people still rely on solid fuels. Subsidizing a transition to modern energy is likely to reduce black carbon emissions while only increasing carbon dioxide emissions trivially. Subsidies are often poorly targeted and captured by the wealthiest, totaling around $1.9 trillion in 2010, and are primarily in the energy, water, agriculture, and fisheries sectors. Taxes and subsidies are key mechanisms to redistribute wealth and reduce health inequities. Taxes can be used to make polluters pay for environmental damage, while subsidies can reward those who provide environmental services. Well-designed and implemented taxes and subsidies are an important policy tool to mobilize resources and align incentives for planetary health goals. The 2012 Happy Planet Index (HPI) uses global data on life expectancy and experienced wellbeing, weighted by ecological footprint, as a measure of environmental degradation. Subjective self-reported measures such as happiness are difficult to compare accurately across nations.
Alternative methods have been proposed for measuring human progress and success, such as the Social Progress Index and Genuine Progress Indicator. The Social Progress Index measures three dimensions of society: basic survival needs, access to the building blocks for the improvement of life, and the chance to pursue goals and dreams. The Genuine Progress Indicator adjusts income inequality adjusted GDP with monetised economic, social, and environmental factors. The Happy Planet Index measures the extent to which countries deliver long, happy, sustainable lives for their citizens.
Efforts have been made to capture the true financial worth of ecosystem goods and services, such as the Natural Capital Initiative and the Economics of Ecosystems and Biodiversity. The UN has also proposed a holistic approach to development that takes happiness into account. In 2011, the UN General Assembly adopted Resolution 65/309 to pursue the elaboration of additional measures that better capture the importance of the pursuit of happiness and well-being in development. Economists have long been aware that GDP was never intended as a broad measure for the state of national progress, and it fails to capture the cost of environmental degradation, ecosystem services, and other outcomes of relevance to human health and wellbeing.
Calculations by Arrow and colleagues showed that comprehensive wealth per person decreased in south Asia and sub-Saharan Africa between 1970 and 2000, even though Human Development Index and GDP per person increased. This was because gains in manufactured and human capital might not offset the diminution of natural capital. Google Scholar presents two scenarios for the 21st century: Fortress World, which is authoritarian and fragmented, and Great Transition, which is a positive transformation with reduced material consumption but greater equity. The Policy Reform and Great Transition scenarios result in better health outcomes and lower greenhouse gas emissions.
The current focus on GDP as an indicator of societal success dates back to the 1930s and 1940s. An example of how transformative economic change can affect health is given in the appendix case study. In the Market Forces and Policy Reform scenarios, government-led redirection of growth toward sustainability goals could bring health benefits, such as reduced air and water pollution, increased employment opportunities, and changes in diet and physical activity.
The European Commission has proposed a circular economy model to reduce costs and dependence on natural resources, boost growth and jobs, and limit waste and emissions. The aim is to keep resources within the circle so that the system functions optimally. Google Scholar suggests that cafeterias should increase the accessibility of healthy and environmentally friendly food choices to encourage people to make better decisions. To transition to a circular economy, steps need to be taken to reduce waste, incentivize recycling, and substitute hazardous materials with safer alternatives. An alternative approach to changing behaviors is to change environments or target the automatic processes that underpin decisions. Technologies need to be assessed for their capacity to yield multiple benefits, such as for health, while avoiding unintended consequences. Examples of technologies that could reduce environmental impact are given in the appendix. Behavior change interventions should focus on encouraging individuals to reflect on their conscious decisions. Google Scholar has shown that mobile technologies (m-health) and information campaigns can lead to behavior change that both improves personal health and reduces community contamination. In rural India, a village-level intervention based on emotional drivers of behavior improved handwashing substantially. In South Africa, a cash-back rebate program for healthy food purchases (Vitality by Discovery) led to estimated decreases of 8–13% in land requirements, 7–12% in water footprint, and 8–10% in greenhouse gas emissions.
Low-income countries are now thought to have more leeway for technological leapfrogging; however, there are still many barriers to adoption, including financial constraints, cultural behaviors, and weak institutions and infrastructure. Human behaviour plays a key role in reducing environmental damage and attempting to reduce the magnitude of these issues. Policy makers can use an array of regulatory, fiscal, and tax policies; mass media campaigns; and incentive-based interventions to effect behaviour change. The values of human lives can be estimated and used in cost-benefit analysis for federal policies. The US and Europe traditionally estimate economic benefits and costs related to environmental change and ecosystem services.
A recent paper shows that the monetization of the health co-benefits of climate mitigation should encourage the top 20 emitting nations to cut carbon dioxide emissions. Locations such as East Asia have air quality-related health benefits 10-70 times the abatement costs in 2030. 100 Resilient Cities (100RC) is an initiative that promotes the strengthening of cities' resilience to a range of threats by addressing social, health, environmental, and governance concerns. Monetisation of non-market benefits is a way to help policymakers offset the cost of action. A 2014 full lifecycle analysis based in the USA showed that monetised human health benefits stemming from air quality improvements can offset the cost of US carbon policies by 26–1050%.
The 100 Resilient Cities Challenge and other initiatives from the Rockefeller Foundation are demonstrating how cities can catalyse effective policy and action at the national level. Additionally, coastal ecosystems preserve wetlands and marine food chains that support local fisheries. However, care must be taken with ecosystem approaches to consider potential adverse health effects.
National governments have an important role in strategic planning for resilience, and plans should involve local initiatives and international institutions/initiatives such as the UN Framework Convention on Climate Change, the UN International Strategy for Disaster Reduction, the Sendai Framework for Natural disaster reduction, and the new SDG process. National Adaptation Programmes of Action provide a process for countries to identify priority activities that respond to their urgent and immediate needs to adapt to climate change. Ecosystem-based adaptation measures are cost-effective and provide additional benefits beyond resilience. For example, mangrove planting in Vietnam is 7 times cheaper than building seawalls or dykes for storm surge protection.
Integrated resilience strategies should be implemented to protect human health, such as the wave attenuation of coastal protection and greening of river catchments to reduce river flooding. Multifunctional teams can be redirected towards emerging threats in times of emergency. Effective surveillance and early warning systems are also important for detecting disease outbreaks or changes in food security, particularly for vulnerable subgroups such as elderly people. Resilience to extreme weather is crucial to protect the health and wellbeing of populations, particularly those in low-income and middle-income countries and in Asia. Even wealthy, highly developed areas can suffer economic losses due to extreme weather. Evidence suggests that societally based support and resilience networks can buffer people from the worst extremes. A systematic review found that power outages due to extreme events can make it harder to access health care and maintain front-line services, suggesting the need for resilient power systems. Building resilience requires planning and preparation, capacity to restore functions quickly, and capacity to adapt and change after a shock. Resilient health systems need five elements: awareness, diversity, self-regulation, integration, and adaptability. Ecosystem and ecosystem–engineering hybrid approaches to adaptation, such as restoring and protecting forest covered wetlands, can reduce the wind stress available to generate surface waves and provide wave attenuation. Coastal wetlands can act as natural horizontal levees. The National Response Framework (NRF) was revised in response to the 2005 hurricane season. Prior to Hurricane Katrina, the US National Response Plan outlined disaster response as mainly a local government responsibility. The Federal Government declared a state of emergency before landfall, however many New Orleans residents were unable to evacuate due to ineffective communication and insufficient access to vehicles. The Superdome sustained substantial damage and looting and violence ensued. Criticism of the Katrina response was widespread and focused on delayed evacuations, inadequate preparation for relief efforts and mismanagement. Many difficulties arose due to inadequate planning and back-up communication systems at various levels. Hurricane Katrina caused the most devastation in coastal communities of Mississippi and the city of New Orleans, where levees were overtopped or breached, leaving 80% of the city flooded up to 6m for weeks. New Orleans, which has a history of floods, was particularly vulnerable due to its location below sea level and surrounded by water. The flooding was largely attributed to engineering and policy failures, raising important social justice issues. Climate change is expected to increase the frequency and intensity of storms like Katrina, making preparedness efforts even more crucial.
Katrina had the highest economic cost of any natural disaster, with $108 billion in property damage. Fatalities were concentrated among elderly and African-American people, with mortality rates 1.7-4.0 times higher than white people in some areas. Google Scholar states that the resilience approach is focused on adaptive capacity and converges with other approaches in identifying necessary components of adaptation. Hurricane Katrina in 2005 caused severe destruction and 1833 deaths, making it one of the deadliest and costliest natural disasters in US history. It highlighted the need for essential systems such as health care and emergency responses to reduce vulnerabilities to environmental change. The imperative to strengthen resilience has become a dominant theme in policy due to recent events such as the Ebola crisis, Hurricane Katrina, and the Pakistani floods. Agricultural intensification has led to poverty reduction and environmental degradation, which the doughnut approach identified in terms of both social needs and environmental constraints around water access and quality. High-income countries focus on economic efficiency rather than long-term global ecological health and stability, leading to a projected 200-year timeline for poverty eradication at a poverty line of $5/day. To improve and maintain human health, a framework is needed to identify a "safe and just operating space" for humanity. This doughnut approach adds social boundaries based on global development goals and has been tested in two Chinese rural communities, using local ecological and palaeoecological data and social survey statistics. Google Scholar's perspective on environmental justice for low-income countries includes three elements: past emissions should be taken into account, entitlements to emissions should be equal, and mechanisms for agreement should be fair and transparent. Compensatory justice implies those who cause harm should compensate those affected. Economic approaches to environmental policies have ethical dimensions, such as discounting which reduces the attractiveness of action to prevent environmental change. The bioethics community is beginning to tackle these issues, although national policies and consumption patterns can have adverse effects outside their own boundaries. Finally, justice theorists argue the present generation has a moral duty to protect the health and wellbeing of future generations. The UN IPCC has identified ethical challenges posed by climate change and other global environmental changes. Principle 21 of the Stockholm Declaration of 1972 states that countries have the right to exploit their own resources, as long as it does not damage the environment of other countries or the global commons. Training programmes allow for the development of locally credible strategies to harness biological resources safely, such as avoiding consumption of species that can carry hazardous viruses such as Ebola.
Integrating primary health care into areas vulnerable to environmental change, and training local community members as primary health-care workers, can help protect health and biodiversity. Primary care and public health provision should foster multisectoral collaboration and take advantage of new technologies and local knowledge. Metrics relevant to planetary health should be included in facility and population-based health surveys, and integrated systems should be created to collect rigorous health, socioeconomic, and environmental data for long periods of time. These systems would give early warning of breakdown in adaptation mechanisms that could reduce a population's health status. Google Scholar Planetary health concepts should be integrated into the training of health professionals. In Ethiopia, over 35,000 health extension workers have been trained to address hygiene, sanitation, and nutrition issues. Opportunities exist for the integration of health care and environmental care at the primary level. Health systems need to be created to address the investment trade-off between subsectors, and between technology, prevention, and care. WHO has proposed a Health Systems Framework consisting of six building blocks to analyse health systems. Planetary health should be included in budgeting and purchasing processes and countries need to ensure a minimum threshold of health-worker density and capacity to prevent and respond to the health consequences of environmental change. The Royal Society's report on People and the Planet highlights the importance of increased support for rights-based family planning services, including family planning, reproductive health, and HIV service integration, as a complementary measure to address population growth in high-income countries. This would help reduce pressure on infrastructure, as well as greenhouse gas emissions. Fulfilment of unmet need for family planning could reduce maternal deaths by almost a third and improve food security, at an additional cost of only $5.3 billion per year.
The Better Growth, Better Climate report also stresses the importance of integrating health and environmental goals into the planning of low-income cities to reduce costs and environmental impacts, and improve health. Urban sprawl costs the US about $400 billion per year, amounting to 2.6% of GDP. An alternative growth pattern could cover the funding gap for infrastructure investment. Similarly, São Paulo is experiencing its worst drought in 80 years due to a decrease in the Cantareira watershed's forest cover, necessitating the establishment of the Conservador das Águas water payments scheme. Allotment gardens can provide a range of ecosystem services, such as habitats for pollinators, physical activity and locally produced foods. Almost a third of the 100 largest cities have nearby natural areas that provide catchment for the supply of stable and affordable drinking water. Green spaces in or near cities also deliver services such as reducing air pollution, temperature regulation, groundwater recharge, and cultural services, contributing to the physical and mental health of the urban population. Urban parks are around 1°C cooler than built-up areas during the day and help reduce the effects of urban heat islands.
More than 370 cities worldwide, mainly but not exclusively in industrialised countries, are experiencing population loss. This provides opportunities to create additional green space, enhance biodiversity, and promote urban food production with a range of social and health benefits. The rich biodiversity that urban areas can contain is being increasingly recognised and policies to preserve ecosystems and their services could provide many benefits.
A systematic review found that exposure to natural environments significantly lowers negative emotions such as anger and sadness compared to exposure to synthetic environments. Pooled effect sizes (Hedges g) and 95% CI for each outcome were based on aggregated data from studies measuring these outcomes. Exposure to natural environments may improve mood, but had no effect on physiological variables. Physical activity is associated with reduced risk of depression, and sustainable practices have mental health benefits. Active travel (walking, cycling) can reduce risks of certain diseases, mortality and costs to health systems. To address chemical safety, the Strategic Approach to International Chemicals Management (SAICM) has identified five themes for risk reduction, knowledge and information, governance, capacity building and technical cooperation, and illegal international traffic in chemicals. Healthy city design also promotes active and healthy living. The sound management of chemicals is often seen as an environmental issue, rather than a health issue. Regulatory approaches are often fragmented and implementation is inadequate, particularly in low-income countries. The financial and insurance sectors have limited capacity to address chemical liabilities, and banks have often failed to consider these risks when providing financing. International mechanisms to implement the "polluters pay" principle are inadequate. A range of approaches are needed to achieve the Strategic Approach to International Chemicals Management (SAICM) goals by 2020, including promoting safer alternatives and guidance. In Africa, the estimated health costs of pesticides in 2009 were greater than the total overseas development assistance to health care. Sound chemical management in the agricultural sector would also result in improved crop yields (by about 20%). The UN Environment Programme estimated a high rate of return from investments to improve the management of chemicals. Unregulated pesticide use poses substantial risk to human health and ecosystems, and evidence that permits quantification of externalities and costs is still fragmentary.
The Global Chemicals Outlook report calls for an investment in capacity for sound management of chemicals, noting that moral arguments have little effect on how chemicals are managed. Strategies to reduce private car use in cities, such as improved public transport and encouraging active travel, can reduce hazardous pollutants and address health problems related to physical inactivity and obesity. Furthermore, physical activity related to transport and changes in dietary patterns are associated with obesity, which is a risk factor for major non-communicable diseases. Increased physical activity and active travel (walking and cycling) in cities can reduce greenhouse gas emissions and address physical inactivity, which contributes to more than 3 million deaths a year. Policies to reduce methane emissions yield co-benefits through increased crop productivity due to reduced tropospheric ozone levels, while policies to reduce ground level ozone can also yield co-benefits, such as reducing air pollution, crop productivity, and forest growth. Solar lamps can reduce black carbon emissions, burns, and dependence on costly kerosene. Access to clean household energy can reduce household exposure to air pollution, the risk of burns, and the emissions of black carbon and a range of other pollutants.
Measures to reduce short-lived climate pollutants could yield major health benefits, with an estimated 2.4 million premature deaths worldwide prevented annually, mainly due to reduced black carbon exposure. Some measures to reduce short-lived climate pollutants also reduce carbon dioxide emissions and thus contribute to efforts to combat climate change. The health co-benefits of reduced fine particulate air pollution, resulting from reduced fossil fuel combustion, have been studied by the IPCC and the Lancet Commission on Climate Change. WHO estimates that 3.7 million deaths occur annually due to air pollution. A key mechanism for reducing air pollution is by reducing fine particulates, which are largely attributed to fossil fuel combustion.
The Loess Plateau Watershed Rehabilitation Project in China has improved health and environmental outcomes, including an increase in forest and grass coverage from 11.4% to 27.3%, mean annual per person income from ¥360 to ¥1624, grain output from 427 000 tonnes to 1 265 000 tonnes, reduction of annual sediment inflow to the Yellow River by 57 million tonnes, increased biodiversity, improved soil fertility, and increased carbon sequestration. Additionally, high grain yields in good years, together with livestock and fruit trees, provide enough food to sustain local people during drought years, while increased income helps buffer against food poverty. In the 1990s, the Loess Plateau in China was one of the poorest regions in the country. To combat poverty and soil and water loss, two consecutive projects were implemented with support from the World Bank and Chinese Government. Eco-based adaptations such as afforestation, dune stabilisation, banning of grazing, and construction of sediment retention dams and terraces were used. Additionally, farmers were given the right to acquire use of the land after the project was completed.
Ecosystem restoration has been linked to poverty alleviation. For example, the Shinyanga Soil Conservation Programme (HASHI) in Tanzania combined forest restoration and traditional land management techniques to restore ecosystems and increase household income. A 2015 study showed that PM2·5 air pollution levels were lower in communities with forest certification compared to those without. In Indonesia, protecting peatlands from degradation and burning would reduce smoke concentrations in Palembang and Singapore by more than 90%, and by 80% for equatorial Asia. Modelling the health effects of land use can help create targeted policy solutions that reduce biodiversity loss and optimise population health. Google Scholar Community zoning policies can protect contiguous forests while promoting the spatial aggregation of deforested areas, such as clustered housing developments. Policies that maintain or enhance biodiversity can reduce the risk of vector-borne and zoonotic diseases. Landscape fires in Southeast Asia are both a major public health threat and a driver of biodiversity loss. To reduce the risk of Lyme disease transmission, forested areas should be maintained near or abutting residential zones to keep the composition of ecological communities intact and mouse population sizes low. Habitat destruction and fragmentation have been associated with reduced vertebrate diversity, which increases the risk of transmission of Lyme disease and West Nile virus. Further evidence on the role of the environment in mediating disease risk and how policies can be developed to benefit both health and ecosystems is given in the appendix. Google ScholarForest conservation has a direct effect on malaria, acute respiratory infections, and diarrhoea. Intact forests contain fewer breeding sites for vectors, larger predator populations, and microclimates that inhibit anopheline mosquitoes. They can also filter air particulates, reduce fires, and stabilize the hydrological cycle. Protected areas have various effects, depending on their type. Strict protected areas reduce human exposure to forest habitat of anopheline mosquitoes and reduce forest disturbance. Sustainable use protected areas allow more forest disturbance and are more likely to promote the mixing of infected and susceptible populations. Indigenous reserves can reduce mixing of infected and susceptible populations if regulations and borders are enforced.
Roads create a favourable habitat for anopheles, thus creating so-called frontier malaria. They also worsen air and water quality, ease access to medical care, and attract susceptible labourers. Mining creates vector breeding sites, worsens air and water quality, and draws in migrants who can be both susceptible and disease carriers. Each change in land use might either decrease or increase the likelihood of the spread of the given disease or diseases in the area. Google Scholar research and evidence from Brazil and Costa Rica suggests that protected areas, indigenous reserves, roads, and mines can reduce deforestation and protect against diseases such as malaria. These land use changes have distinct effects on the environment and people's interaction with the environment, affecting both disease and exposure to disease. Additionally, forest protection can improve watershed functions, reducing cases of diarrhoea. The REDD+ mechanism has been created to reduce greenhouse gas emissions from deforestation and forest degradation, and also provides a variety of regional and local co-benefits.
Overall, these land use changes can improve health through increased fruit and vegetable consumption, reduced consumption of red and processed meat, and improved watershed functions. Google Scholar research shows that adhering to WHO dietary recommendations in the UK could reduce greenhouse gas emissions by 17% and increase life expectancy at birth by 8 months. However, in France, diets with higher nutritional quality had higher greenhouse gas emissions. Therefore, approaches should be taken to optimize diets for low environmental impact, high nutrition quality, and affordability while minimizing departures from current diets.
Dietary risk factors are a major contributor to the global burden of disease, with inadequate consumption of vegetables, fruit, and nuts being a particularly large cause of premature deaths. Diets with reduced animal product consumption, particularly from ruminants, are associated with reduced greenhouse gas emissions and tend to be healthier. However, relative changes may counteract some of the variability in methods across studies. The scientific literature on environmental impacts and emissions from lifecycle analysis has several limitations, including the use of a single absolute number and a focus on European populations. Additionally, varying assumptions exist regarding system boundaries and greenhouse gas emissions. A study on the environmental impact of dietary change found that relative differences in greenhouse gas emissions and land use could be reduced by switching to healthy, sustainable diets. This highlights the need for policies to incentivise fruit and vegetable production, and remove subsidies on less healthy foodstuffs. A report from the Chicago Council on Global Affairs calls for actions to make food systems more productive, nutritious, and sustainable. Small shifts in crop allocation from animal feed and biofuels to direct human consumption could increase global food availability. However, the different bioavailability and aminoacid content of vegetable and animal proteins needs to be taken into account. Additionally, affordability of food traded internationally is an issue for many poor people, as livestock products provide essential protein and micronutrients. In high consuming countries, animal product consumption could be reduced and fruit and vegetable consumption increased, benefiting health and reducing environmental impact. Global production of fruits and vegetables is insufficient to meet nutritional requirements, but if present dietary trends continue, demand for animal products will be a major contributor to 80% increase in agricultural greenhouse gas emissions by 2050. Animal products have much higher emissions per gram of protein than legumes, with beef and lamb having emissions 250 times higher. The ratio of animal product calories to feed calories is still only 10%. Without changing crop mix, enough extra calories could be available to feed an additional 4 billion people. However, 41% of available crop production is lost due to feeding animals or biofuel production. To combat undernutrition, promotion of nutrient-rich foods for direct human consumption and income generation for women are needed. Biofortification (cross-breeding high yielding varieties with nutrient-rich crops) can also help improve micronutrient profiles in deficient populations, but regulatory hurdles must be addressed. Additionally, research has found varying levels of provitamin A in different species of bananas. Nutrient content can vary significantly within a single food type, such as rice which can range from 5-15% protein. Dietary diversity is linked to improved dietary quality and micronutrients, and diversification of diets and crops can improve prospects for adaptation and nutrition. Novel sources of protein, such as seaweed and microalgae, could be exploitable if hazards are addressed. Insects are a nutritious food source with high fat, protein, vitamin, fibre, and mineral content, and they also have high feed conversion efficiencies and lower greenhouse gas emissions than conventional livestock. Strategies such as clean water and changes in working practices can help sustain farmer productivity in the face of increased thermal stress from climate change. Insects form part of the traditional diets of at least 2 billion people, and other potential strategies for adaptation include enhanced social protection, education, improved access to markets and credit, and information systems. Experts debate the balance between support of large-scale industrial and smallholder subsistence farming, which is linked to undernutrition and is often done by women. An indirect strategy is to rely on the economic growth of agriculture, while a direct strategy is to promote integrated agricultural development and forest conservation projects. Aquaponics, which combines aquaculture and hydroponics, is a potential way to support both sustainable aquaculture and the reduction of fertiliser use in agriculture.
Nutritional profiles of fish vary substantially and may depend on the type of fish farmed. Increases in aquaculture could provide enough fish globally to satisfy nutritional guidelines, but health and environmental policies should be harmonised to ensure that dietary recommendations do not lead to overexploitation of fisheries. The Global Ocean Commission aims to protect coastal zones, control overfishing, reduce plastic pollution, and tackle harmful subsidies. To meet world fish demand sustainably, a major shift towards aquaculture is needed. Aquaculture makes use of 600 freshwater and marine species, and has major benefits to the environment and world economy. Reduce spoilage due to fungal contamination with a natural, non-toxic technology using atoxigenic strains of Aspergillus flavus. This has been adapted for use in Africa. Reducing food waste along the food supply chain by about 50% is feasible according to the Government Office for Science's 2011 Foresight report. Food waste contributes to biodiversity loss, consumes surface and groundwater, and generates greenhouse gas emissions. In low-income countries, wastage occurs at the farmer-producer end, while in developed countries it occurs further up the supply chain. About 1.4 billion hectares of agricultural land is used to produce food that is never eaten.
Pre-harvest and post-harvest losses are split fairly evenly, and greater efficiency of use is needed to help reduce pollution and increase crop yield. This includes public sector research, extension education, soil testing and improved timing of fertilizer application. In parts of the world, such as sub-Saharan Africa, increased fertilizer use may be necessary, and phosphorus recycling from regions of excess to regions of deficiency is recommended. Google Scholar suggests that integrated soil-crop system management practices can increase yields for crops like rice, wheat, and maize while reducing adverse environmental effects. It is also noted that genetic modification of crops may be useful to reduce global hunger, but only if they are accessible to lower-income farmers. Strategies such as water harvesting and conservation, and improved irrigation methods can also increase water efficiency while reducing losses. Sustainable agricultural intensification consists of three interlinked activities: ecological, genetic, and market intensification. Global crop yields have increased 115% between 1967 and 2007, despite agricultural land increasing by only 8%. Sustainable agricultural intensification has been proposed as a strategy to grow more food on the same land, while preserving biodiversity and other environmental assets. This approach has been published in the Philosophical Transactions of the Royal Society and is supported by The American Association for the Advancement of Science. Present trends threaten to reverse health gains and destabilise human civilisation unless collaborative and coordinated policies are implemented to reduce risks. To address these issues, policies must focus on reducing poverty, adapting to environmental change, and achieving equitable human development within finite limits. To improve health and protect environmental sustainability, specific strategies and interventions must be put in place, as well as enabling policies and improvements in governance. For example, food and agricultural policies must reduce environmental impact, develop resilience, ensure stability of food prices, and tackle malnutrition. Interdisciplinary collaboration between public health, agriculture, environmental, and nutritional strategies is needed to develop and implement appropriate policies. Global environmental change presents three main challenges to humanity: conceptual and empathy failures, knowledge failures, and implementation failures. Conceptual and empathy failures include an over-reliance on GDP as a measure of progress and the disproportionate effect of environmental harms on the poor and people in developing nations. Knowledge failures are due to a lack of transdisciplinary research, molecular approach to medicine, and inability to deal with uncertainty. Implementation failures arise from governments' recognition and response to threats, especially with pooled resources and time lags between action and effect. Solutions outlined in the second half of the Commission report aim to support both human health and the planet. These propositions provide a starting point for a conceptual planetary health framework.
Risk factors for depression in adults after natural disasters include being female, not being married, having religious beliefs, poor education, experiencing injury or bereavement during the disaster, or losing employment or property. An important protective factor is keeping families and communities united. Mental health effects of environmental change-related displacement are caused by trauma of leaving familiar surroundings, breaking social ties, increased risk of violence, difficulty of resettlement, and lack of mental health services. Google Scholar has been proposed to support quantitative study of place attachment and its effects on mental health. Disruption of these bonds can lead to grief, loss, anxiety, and solastalgia. Studies have documented an increase in anxiety, depression, and possibly suicidality in rural populations due to the decade-long drought in Australia. Migration, war, and conflict disproportionally affect the poor and have a range of health implications, especially on mental health and the health of women and children. Climate change is already increasing the likelihood of conflict. A meta-analysis by Hsiang and colleagues found that for every increase in temperature or rainfall, the median increase in intergroup conflict was 14%. Sub-Saharan Africa has been most affected by environmental refugees, but other areas are increasingly at risk with multiple environmental stressors. Gradual changes in the environment tend to have a greater effect on population movements than extreme events. In 2008, 20 million people were displaced by extreme weather, compared to 4.6 million displaced by conflict and violence. By 2050, between 50 million and 350 million people are predicted to relocate due to climate change. Environmental changes, together with pre-existing susceptibility and social/political issues, could become a major destabilising factor in the country. By 2013, a record number of 51 million people had been forcibly displaced worldwide due to conflict, making them vulnerable to environmental threats. In Pakistan, water stress is creating rivalries between ruling agriculturalists and the manufacturing sector, and between feudal families over water access. Climate change increases the chances of conflict due to competition for resources, but a single extreme event like the 2010 floods is hard to attribute to climate change due to natural variability. Deforestation and encroachment onto flood plains by human settlements also contribute to exacerbating the effects of floods. The 2010 Pakistan floods were catastrophic, resulting in 1900 deaths and affecting 18 million people through displacement, disease, loss of income and damage to infrastructure. Monsoon rains caused the floods, submerging a fifth of Pakistan's land. Water-related issues are a serious threat to economic growth and food security as 45% of the workforce is employed in the agricultural sector. Six months after the floods, 54% of homes destroyed still stood wrecked, 50% of people affected were living in camps for the internally displaced, and 88% reported loss of income. Additionally, 10 million people were forced to drink unsafe water and 37 million infectious disease-related medical consultations were reported. The 2011 Sindh floods affected 5.3 million people. Climate change is predicted to increase the frequency of extreme precipitation events, which will have potential impacts on agricultural productivity. Heatwaves are also becoming more frequent in Pakistan and can cause long-term human migration. Climate change is likely to increase water stress in Pakistan, as the amount of water flowing into the Indus River is predicted to decrease by 30-40% in the next 20 years. Poor water management has led to salination and waterlogging of soils, while the widespread discharge of untreated effluents and use of pesticides and nitrogenous fertilisers has further affected water quality.
To meet demand, large volumes of water have been diverted from the Indus River, causing a decrease in water flow downstream and threatening the livelihoods of fishermen and destroying coastal ecosystems. 96% of water in Pakistan is used for agricultural irrigation, but by 2005 the amount of water available per person had reduced to 1400 m3. If preventive action is not taken, demand is projected to outstrip supply by 2025, resulting in many populations facing conditions of water stress. Pakistan is facing threats to the health and development of millions of people due to a combination of environmental changes, a high population growth rate, and other factors such as unplanned urbanisation and climate change. This has resulted in risks from extreme events such as floods and heavy rainfall, leading to contamination of drinking water and an increased risk of water-borne diseases.
At a global scale, natural disasters have caused the loss of 1.94 million lives since 1970 and the total cost of extreme weather events between 1980 and 2004 has been estimated to be $1.4 trillion. For every person killed by natural disasters, another 1000 people are estimated to be affected physically, mentally, or through loss of property or livelihood. Progress has been made globally towards reducing the number of lives lost in extreme events since the 1980s, although mortality risk is still increasing in some countries with poor risk management. Societies are good at learning from disasters and taking steps to build resilience. Evidence suggests that chemical pollution has pervasive effects on human health, both directly and indirectly. Extreme events result from the effect of unusual and severe natural hazards, with the severity determined by the hazard and people's exposure to it. Endocrine disruptors are known or suspected to be present in 800 chemicals, with many more yet to be tested. These disruptors have been linked to genital malformations, poor quality semen, rising rates of cancer, and neurobehavioral disorders. The US Environmental Protection Agency (EPA) has identified 3000 chemicals classified as high production volume (HPV) with insufficient information about their toxicity, and no information on their capacity to harm children or cause developmental toxicity. Of these, more than half are used in agriculture, where exposure to pesticides is common. Additionally, the International Labour Organization estimates that 215 million children aged 5-17 are in child labour, with 115 million in hazardous conditions. Methylmercury, a known toxin which bioaccumulates, is a particular concern, with lead poisoning still an issue in many low-income countries. Data on the release of pollutants relevant to human health are sparse, with the International Agency for Research on Cancer assessing 941 chemicals and reporting more than 400 as carcinogenic. Key groups affected by toxins include individuals living in poverty, undernourished, elderly or very young, as well as bioconcentration in food chains. Toxic chemical exposure can occur through various pathways including ingestion, inhalation, dermal contact, and transfer through breastmilk. These chemicals can travel vast distances, creating exposure far from the sources. Ground level ozone is created from chemical reactions between oxides of nitrogen, methane, and volatile organic compounds, and is estimated to kill about 150 000 people per year worldwide, as well as reducing crop productivity and forest growth. Smoke from landscape fires is estimated to cause an additional 300 000 premature deaths per year due to PM2·5 and ozone emissions. Combustion of biomass emits a variety of pollutants, including black and brown carbon which have both warming and cooling effects on the climate. Black carbon has been linked to disruption of the monsoon in Asia and warming of the Himalayan-Tibetan region, as well as deforestation. Charcoal is easier to transport than wood, but requires cutting down trees. Household air pollution from burning solid fuels affects 2.8 billion people and is linked to acute respiratory infections in children and chronic diseases in adults, causing up to 4.3 million deaths per year according to WHO estimates. The fifth assessment report of the Intergovernmental Panel on Climate Change (IPCC) 2014 outlines the contribution of Working Group II to the impacts, adaptation, and vulnerability of climate change. Household air pollution caused an estimated 2.6-4.4 million deaths in 2010, mainly in women and children. The combustion of fossil fuels, particularly coal and diesel, produces large amounts of fine particulates with significant health implications.
Climate change can lead to increased incidence of disease. Different mosquito species respond differently to climate warming and precipitation changes, while land-use and biodiversity changes can lead to new emerging infectious diseases. The effectiveness of control measures will play a role in determining disease incidence, and the effects of climate change on malaria incidence are generally hard to predict. The IPCC has studied how climate change can affect the spread of diseases such as malaria. Despite socioeconomic development helping to reduce malaria risk, 200 million additional people are estimated to be at risk under the A1B scenario. Prevention and control programmes must take into account human behaviour that contributes to ecological changes as well as behavioural responses to malaria risk. Human factors such as immune status, migration patterns and treatment also have a role in malaria transmission. Deforestation and resulting settlement create breeding sites for malaria-transmitting mosquitoes, microclimatic differences can also speed up mosquito reproduction rates and pathogen development. Climate change can contribute to the emergence of infectious diseases, with extreme weather events such as drought and rewetting affecting mosquito populations. Forest loss, habitat fragmentation, and reduced plant diversity are associated with increased risk of malaria transmission. Inadequate infrastructure, such as water restrictions during drought, can also lead to increased risk of vector-borne diseases, as seen in São Paulo in 2015.
Detailed mechanisms linking ecosystem alteration to zoonotic disease risk are only understood for a few diseases. However, high risk areas for the emergence of infectious zoonotic diseases occur where human population growth is high, ecologically disruptive development is under way, and human and wildlife populations overlap substantially. Half of global emerging infectious diseases between 1940 and 2005 are estimated to be caused by changes in land use, agricultural practices, and food production. The 2014 Ebola outbreak threatened the “very survival of societies and governments in already very poor countries” according to the WHO.
Environmental change can lead to increased transmission of vector-borne diseases, such as Marburg virus, Chagas disease, yellow fever, and leishmaniasis. Factors include the loss of primary forests, agricultural intensification, and changes in animal community composition. Additionally, global trade, climate change, and accidental introduction can lead to the invasion or introduction of disease vectors into new areas. Finally, genetic changes in disease vectors or pathogens caused by human actions can result in mosquito resistance to pesticides or the emergence of antibiotic-resistant bacteria.
The overall cost of the 2014 Ebola outbreak is high and has extended beyond treatment and containment. Little attention has been paid to preventing the spread of Ebola virus from patient zero. However, research has linked zoonotic infections in bats to life history traits such as their social behavior, migratory patterns, and group size. Outbreaks of the virus have been related to habitat changes, particularly in the dry season, due to development and resource availability. In West Africa, deforestation has been linked to the virus's spread. The definitive host of Ebola is not yet known, but great apes, duikers, and pigs have all been found to be susceptible. Some outbreaks have been traced back to hunters consuming infected animal carcasses. Bats have been found to carry antibodies or viral RNA from Ebola virus, and a 2007 outbreak was linked to an annual bat migration and a stopover site at an abandoned palm oil plantation. Further evidence connecting environmental change to Ebola virus disease outbreaks is circumstantial, but there is reason to conclude that land cover and population changes have increased the likelihood of contact between people and wildlife. Bats are the putative natural host of Ebola virus, and 10% of Africa's forest has been lost between 1990 and 2010, mostly due to agricultural cultivation. To better understand the ecological mechanisms of human disease, more predictive power is needed. Global environmental changes have led to a rise in emerging and re-emerging diseases such as malaria, hantavirus pulmonary syndrome, Nipah virus, and Ebola virus disease. Of the emerging infectious diseases, more than three-quarters are transmitted directly. Schistosomiasis is a major burden to poor populations and countries with weak health systems, and it is a cofactor for the spread and progression of HIV/AIDS. River fragmentation, biodiversity loss, eutrophication, and overfishing have all contributed to an increase in the number of snails that act as vectors of schistosomiasis.
Climate change can exacerbate the spread of water-borne pathogens, leading to increased incidence of diarrhoeal disease. Rising temperatures and humidity, as well as increased variability of rainfall, can all contribute to this. The Ganges river basin provides freshwater for 400 million residents of northern India, but is also a dumping ground for raw sewage. Despite prevention and treatment campaigns, by the 2040s the incidence of diarrhoeal disease is expected to increase due to changing environmental conditions. Water-rich and water-poor nations are increasingly dependent on finite water resources, leading to virtual water trade. Biofuels and certain meats require large amounts of water, and growing populations and changing diets will put further strain on available water resources. The Food–Water–Energy Nexus is increasingly challenged as demands for food rise faster than at any time in human history. Conventional flushing systems may fail during droughts, and water tables in major grain-producing nations are decreasing due to unsustainable withdrawals for agriculture. Climate change is predicted to result in freshwater limitations in some irrigated regions, causing a potential loss of 600-2900 × 1012 kcal of food production. In addition, yield losses of 400-1400 × 1012 kcal from direct climate impacts are projected, amounting to 8% of the present-day total. Google Scholar reports that development of sewage treatment lags behind extension of sewerage connection, increasing risk of exposure to untreated sewage after floods and storms. Despite advances in sanitation coverage, about 1 billion people are still defecating in the open, and 748 million people still relied on unsafe drinking water sources in 2012. Climate change can increase aflatoxin production by Aspergillus sp infecting crops, potentially decreasing crop yields by an estimated 16%. Heat-stressed plants are generally less able to defend against pathogen attacks, and aflatoxin exposure increases the risk of liver cancer. Google Scholar Climate change will lead to changes in global rainfall patterns and an increased likelihood of extreme events, with potential to reduce crop yields. Research suggests that rising CO2 concentrations will reduce the zinc, iron, and protein content in grain crops such as rice and wheat, and similar reductions in zinc and iron in legumes such as soybeans and field peas. This could put an additional 150 million people, mostly in Africa and South Asia, at risk for zinc deficiency. Additionally, methane emissions could lead to increased ground-level ozone, which is a potent plant toxin. Field trials show that rising CO2 concentrations will favour C3 plants like wheat, sugar, barley, potatoes, or rice over C4 plants such as maize, sorghum, and millet. However, research suggests that crop productivity improvements reported in the field are lower than those shown by laboratory results. Climate change has the potential to reduce crop yields, leading to an increase in malnutrition and stunting, especially in sub-Saharan Africa and South Asia. Studies have shown that crops are highly sensitive to increased temperatures. The Intergovernmental Panel on Climate Change (IPCC) reported that median crop yields would decrease by 0-2% per decade due to climate change alone. This is while demand for crops is projected to increase by 14% per decade up to 2050. Positive trends in crop production have been recorded in some high latitude regions, but overall negative trends have been more common. Climate change is expected to have a range of impacts on the quality and quantity of food produced globally. Poorly regulated aquaculture may lead to antibiotic resistance, while overfishing reduces fish stocks and terrestrial biodiversity. In 2012, 70% of total aquaculture production was dependent on supplemental feed inputs. In the UK, fish supply was 19% of the recommended intake in 2012. Omega-3 fatty acids present in oily fish provide potential health benefits, such as reduced risk of ischaemic heart disease. The Intergovernmental Panel on Climate Change (IPCC) concluded with medium confidence that large negative impacts on agricultural productivity and substantial risks to global food production and security would arise from local warming of 3-4°C, particularly in tropical countries. Ocean acidification has already cost the Pacific Northwest oyster industry $110 million and 3200 jobs. Climate change threatens fisheries, with projections of catch potential redistributing globally and locally-important species suffering from extinctions and shifts in distributions. In addition to overharvesting, environmentally-damaging activities such as bottom trawling are contributing to further depletion of fish stocks. The true health of global fisheries is largely unknown, but continuing reductions in fish catch suggest populations are still being depleted. Fish provide an important source of protein and micronutrients and are a vital part of the global diet. However, overfishing and marine habitat degradation threaten fish supplies, leading to food insecurity and poverty. According to the latest Food and Agriculture Organization assessment, nearly 90% of assessed stocks are overfished or fished at maximum yield.
Animal pollinators also play a critical role in human nutrition, contributing up to 50% of vitamin A cultivation in some parts of Southeast Asia and 12-15% of iron and folate in other parts of the world. If pollinators were to suffer a 50% loss, it is estimated that it would result in around 0.7 million deaths annually. Pollinators are essential for global food production, but their population and abundance are decreasing due to multiple factors, such as increased exposure to pests and parasites, environmental stressors, and reduced genetic diversity. This has significant implications for agricultural productivity and nutrition. Additionally, soil nutrient depletion and degradation over the past 30 years has led to soil impoverishment and reduced agricultural output in many parts of the world. This is estimated to lead to a potential loss of up to 20 million tonnes of grain per year, as 90% of food is grown in soil. Climate change has the potential to affect four dimensions of global food security: availability, accessibility, utilisation and stability. Evidence suggests environmental changes can also reduce the nutritional content of foods. Land degradation, soil erosion and desertification have led to significant reductions in agricultural productivity. Despite some decreases in rates of undernutrition, one in four children under 5 years old worldwide are still stunted. The IPCC concluded with high confidence that if temperatures increase as predicted, normal human activities - including growing food - will be compromised. This could lead to an increased risk of even greater undernutrition in poor regions. The Intergovernmental Panel on Climate Change (IPCC) predicts (with very high confidence) that until the middle of the century, global risk of adverse health outcomes will increase due to intense heatwaves and fires, as well as food and water-borne diseases. Two reports published in 2014 and 2015 have provided insights into the links between global environmental change and health. The IPCC concluded that it is likely that climate change has contributed to global levels of ill health in recent decades, though the present burden of ill health from climate change is relatively small compared to other stressors. An "ecological transition" from direct dependence on local ecosystems to one with the ability to purchase services is associated with health benefits for those able to make the transition. Poor populations, however, are increasingly susceptible to negative health effects if their natural infrastructure is degraded. People living in poverty are more likely to be exposed to hazardous locations and lack access to essential services. This increases their risk from environmental change and their susceptibility to undernutrition due to increases in food prices. Local natural resources provide opportunities for supplementary income, cost savings and materials for households in times of crisis. Wild foods are often used for up to 3 years after the death of an income provider as a longer-term adaptation. Sustainable resource use and improved environmental governance are needed to help protect those living in poverty. Wild foods can buffer households from severe food shortages and increase dietary diversity. Local ecosystems provide a source of readily available wild foods, such as fruit, herbs, and insects, which substitute for previously purchased food. This case study focused on households affected by a prime-age death (18-49 years of age) and HIV/AIDS in particular, with a specific focus on food security. Two cross-sectional household surveys were conducted in 2004 and 2006 at the Agincourt Health and Socio-Demographic Surveillance System in rural South Africa. HIV/AIDS rates in the area are high, and rural households rely greatly on the local natural environment for resources to meet daily needs. Wild foods can be an important coping strategy for households facing mortality and HIV/AIDS. High HIV infection rates in sub-Saharan Africa are putting a strain on households. Food insecurity, environmental change, and other infections can negatively affect the ability of HIV patients to adhere to antiretroviral therapy and cause inadequate nutrition. Interactions between existing health burdens and environmental change could further impede progress against HIV. Children are particularly vulnerable to the effects of toxic chemicals. Factors such as undernutrition, age, and pre-existing disease can increase sensitivity to environmental change. Elderly people are particularly susceptible to thermal stress and are at risk of heatwaves due to an ageing world population. Risk of climate-related impacts results from the interaction of climate-related hazards (including hazardous events and trends) with the vulnerability and exposure of human and natural systems. Vulnerability is related to sensitivity, one or more factors that increase the likelihood that individuals will have negative health effects due to environmental change. The level of exposure of individuals or populations is related to the likelihood that they will experience hazards resulting from environmental change from living in a particular place.
The public health impacts of environmental exposures are important in their own right and populations exposed to some of these risks might have increased susceptibility to the effects of global environmental change on health. According to 2006 WHO assessment, the total number of healthy life years lost per person from environmental exposures was 15 times higher in developing countries than in developed countries. Changes in both the climate system and socioeconomic processes, including adaptation and mitigation, are drivers of hazards, exposure, and vulnerability. Urbanization provides an opportunity to improve population health and increase resilience to environmental change. Exposure to dangerously high temperatures in urban centers is increasing due to global climate change and the urban heat island effect. Low elevation coastal zones occupy a small land area but contain a large portion of the urban population, making them more prone to flooding and extreme events. In India, urban living can accelerate the transition away from highly polluting biomass and coal combustion, leading to major population health benefits. Urbanization can lead to an increase in greenhouse gas emissions in developing regions, but after controlling for income, urban living can be more energy efficient than living in rural areas. Most of the world's population now lives in towns and cities, and most population growth will take place in small and medium-sized cities in low-income and middle-income countries. By 2050, 150 million people will live in cities with water scarcity, and by the middle of the 21st century, another 2–3 billion people will need to be housed. Technologies that improve efficiency may not reduce the overall environmental footprint if they are not accompanied by policies to cap emissions or the use of a given resource. Rebound effects can be between 20–45%, and are likely higher in low-income countries. Technological development has enabled human progress across all key sectors of the economy, but it has also enabled the exploitation of the environment. Reducing population growth is essential to move humanity towards a more sustainable trajectory of development. However, it is not enough to avoid severe environmental damage unless it is combined with policies to reduce material resource consumption and greenhouse gas emissions in high-income and emerging economies. Population growth also puts pressure on biodiversity hotspots, particularly in Africa and South Asia. Tropical deforestation is driven by population growth in combination with political, economic, and other factors, such as migration and the transition from subsistence farming to market-oriented crops.
Population ageing can reduce emissions substantially over time, especially in industrialised nations, due to its effect on labour supply and economic activity. Comparing UN low (7.4 billion) and high (10.6 billion) population growth scenarios for 2050 suggests a 32% difference in global carbon dioxide emissions.
However, merely considering change in population size does not take into account other factors. Empirical analysis of historical trends suggest that carbon dioxide emissions from energy use respond almost proportionally to changes in population size. If worldwide mean fertility could be reduced to two children per woman by 2020, the world's population would have 777 million fewer people by 2050 than if present fertility rates continued. The UN Population Division estimates that world population could reach 9.6 billion by 2050. A study published in 2014 used a probabilistic model and concluded that there is a 95% probability that world population in 2100 will be between 9.0-13.2 billion. Contraceptive use varies between urban and rural residents, rich and poor households, and the educated and uneducated. A study published in 2013 used crop use statistics to determine the number of calories delivered to the food system, which include food calories and feed calories after conversion to meat, egg, and dairy calories. Biofuel production can have impacts on food security due to competition for land with food crops and potential increases in food prices. A 2013 review of this topic concluded that rigid biofuel demand can affect food commodity prices. Inefficiencies in production and consumption, such as 30-50% of food produced being wasted, are also a concern. To address these issues, research and innovation are needed to achieve accelerated progress in human development using lower amounts of resources and energy. In 2011, world biofuel production was 5 times that of 2001. Google Scholar ranked nations based on their effects on the environment and found that overall, increasing absolute wealth was the main factor for increased absolute environmental impact. Population size made an additional contribution and poor governance made a smaller but significant contribution. There was no evidence for an environmental Kuznets curve, but a small reduction in environmental impact for countries with increasing per-person wealth may be due to some degree of environmental recovery. The three key factors mediating human induced environmental changes are unsustainable consumption or overuse of resources, population numbers, and available technologies. These factors interact, usually to multiply each other's impact, but appropriate technology can reduce these effects. Population growth, consumption, and technology are drivers of environmental change, which can lead to sudden shifts in social-ecological systems. These shifts can have significant consequences, particularly for ecosystem services. An example of multiple interacting environmental changes contributing to an increase in the risk of adverse pregnancy outcomes in coastal populations in Bangladesh is given in the appendix.
Non-linear changes and interactions between multiple environmental threats can result in a total effect that is worse than the sum of its parts. At a planetary scale, biodiversity plays a key role in limiting the impacts of changes to other Earth systems, such as regulating the climate and removing harmful pollutants. The One Health framework has been used to produce knowledge and recommendations that can be used by policy makers and practitioners. Loss of biodiversity can affect the ways that ecosystems are structured and function, with local consequences for ecosystem services. The evidence gathered in a 2015 State of Knowledge review on the links between human health and biodiversity, ecosystems, and the life-supporting services they provide reveals how anthropogenic drivers of biodiversity loss are hindering the capacity of ecosystems to provide essential services. This loss of agrobiodiversity and complex effects on the regulation of infectious diseases, combined with emerging evidence that biodiversity loss in wider environments might lead to reduced diversity in human microbiota, have been identified as key risks to human health.
Gaps in the state of knowledge have been identified and a call for the creation of coherent cross-sectoral strategies to ensure that biodiversity and health linkages are recognised, valued, and implemented with the involvement of local communities has been made.
The 2010 Global Biodiversity Outlook reported that all major types of pressure on biodiversity were increasing, such as the loss, degradation, and fragmentation of natural habitats; overexploitation of biological resources; pollution; introduction of invasive alien species; and climate change and acidification of the oceans. At the species level, biodiversity is being lost at a rate unprecedented in human history. Biodiversity is decreasing globally and is largely uncatalogued, with only 10-20% of species currently described. This loss of biodiversity has serious potential consequences for human health and well-being. Climate change can increase the airborne transport of persistent organic pollutants and lead to increases in some pollutants, such as brominated fire retardants and perfluorinated compounds. These pollutants can cause issues such as feminisation of fish and developmental delays and malformations in amphibians. Many man-made pollutants accumulate in the environment, including in the atmosphere and deep oceans, where they are consumed by small marine organisms and enter the food chain. These chemicals can cause ecotoxic effects and reduced ecosystem functions, leading to species loss and land-use changes. In North America, releases of chemicals into the environment increased by 15% between 2012 and 2013. Globally, the total quantity of chemicals released into the environment as waste is unknown, but major sources include agricultural run-off, cement production, electronics recycling, mining and coal combustion, ship breaking, textile production, and electronics manufacturing. Global chemical sales are predicted to increase at 3% annually until 2050, with most of the production shifting from high-income economies to low and middle-income countries. There are an estimated 140,000 chemicals on the EU market. Chemicals are essential in modern life, with production and consumption of most types increasing since 1950.
Excess nitrogen in terrestrial ecosystems leads to decreased plant diversity, and excess nitrogen and phosphorus in water bodies leads to algal blooms and eutrophication. Present flow of phosphorus into the oceans is three times the preindustrial level, resulting from synthetic production of nitrogen fertiliser. Human beings now produce more biologically available nitrogen than all natural pathways combined.
Increases in amounts of nitrogen and phosphorus entering the environment from agricultural fertiliser run-off and soil erosion have become key drivers of ecosystem change in the past 60 years. Levels of biologically available nitrogen and phosphorus are projected to increase substantially in the future. Climate change is expected to affect soil erosion due to changes in rainfall and temperature. Soil erosion contributes to increased greenhouse gases in the atmosphere, and is a threat to food security. It can lead to desertification and decreased freshwater retention, as well as decreased microbial biodiversity and carbon sinks. About 55% of land desertification is caused by soil degradation due to human activity. This is exacerbated by urban development, unsustainable land use by industry, and land clearance. Intensive farming techniques also contribute to natural soil degradation, as well as increased nitrogen and phosphorus deposition and air pollution. Land use changes, particularly tropical deforestation, are leading to substantial losses of native species. The conversion of natural habitats to grow non-food crops for biofuel and cosmetics is increasing, particularly in tropical and subtropical regions. Oil palm plantations consistently hold half as many vertebrate species as primary forests and show reduced species richness compared with secondary forests. In southeast Asia, almost 50% of the natural habitat has been converted, while in temperate northern realms of North America and Europe, the expansion of agricultural lands has stabilised with small increases in the past 40 years.
Habitat conversion continues at a rapid pace and is driven by a growing demand for animal products as populations increase in wealth. Soil erosion and pollution (especially from agricultural run-off) are also affecting many water sources globally. Wetlands have been particularly impacted - about 70% of the world's wetlands existing in 1900 were lost by the end of that century, with even higher losses in Asia. Cambridge, UK and New York, USA 2014: Google Scholar published a study concluding that climate change is projected to reduce renewable surface water and groundwater resources significantly in most dry subtropical regions. This could lead to water stress due to unsustainable extraction of groundwater and speed up glacial melt. By 2050, 3.9 billion people (over 40% of the world's population) are projected to be living in river basins under severe water stress. Water demand is projected to increase globally by 55%, mainly from manufacturing, electricity, and domestic use. The Arab world is particularly susceptible to freshwater shortages, with a reduction in freshwater availability from 3035 m3 per person in 1962 to 743 m3 per person in 2011.
Groundwater supplies about 50% of the freshwater globally withdrawn for domestic use, 40% of the non-piped water for industry, and 20% of the water used for irrigation. In many parts of the world, groundwater is being extracted faster than it can be recharged; the rate of extraction doubled between 1960 and 2000. The highest rates of groundwater depletion are in regions of high agricultural production such as northwest India, northeast China, northeast Pakistan, California's central valley, and the Midwest of the USA. Freshwater resources can be classified as renewable (e.g. rivers, surface water, and groundwater) and non-renewable (e.g. deep aquifers). Ocean acidification, caused by increased carbon dioxide emissions, has drastic effects on marine life. It reduces survival rates and abundance, impairs growth, and decreases the ability to form and maintain shells. This, in turn, can lead to the collapse of species such as Antarctic krill, which are a primary source of food for top predators. A study published in 2013 predicted that the entire population of Antarctic krill could collapse within 300 years if emissions continue to increase. Furthermore, cascading disturbances from affected species can affect other parts of the food chain. Ocean acidity is predicted to increase by up to 170% by 2100. Ocean acidification, caused by increased absorption of atmospheric carbon dioxide, has caused the pH of the oceans to decrease by 0.1 pH (equivalent to an increase in ocean acidity of 26%) since the Industrial Revolution. Climate change impacts include melting of ice sheets in Greenland and the Antarctic, a rise in mean sea level of 0.19m since 1900, an increase in global mean surface temperature of 0.85°C since 1880, and an increase in the frequency and duration of heatwaves and extreme rainfall events. These effects are due to increased concentrations of greenhouse gases, particularly carbon dioxide, methane, and nitrous oxide, from the burning of fossil fuels and conversion of natural habitats. The world's emissions trajectory is greater than the highest Representative Concentration Pathway (RCP 8.5) used by the Intergovernmental Panel on Climate Change. Clear evidence now exists that climate change has occurred due to human activity, according to the Intergovernmental Panel on Climate Change (IPCC). Boundaries associated with climate change have been estimated to be outside of the identified safe operating space, while the boundary associated with ocean acidification is estimated to be nearing its threshold value. Changes to global or regional systems can result in non-linear, potentially irreversible changes in the Earth's environment. A framework has been developed that relates nine global or regional pressures to the Earth's biophysical systems. The current status of the control variables for seven of these planetary boundaries has been normalised and the risk of novel entities is also being considered. The planetary boundaries framework identifies processes and systems important to the maintenance of the Earth's functions. To assess the relation between environmental change and human health, a systematic review was undertaken including studies detailing policy options to improve health and environmental outcomes. This Commission is complementary to the Lancet Commission on climate change, which focuses on the opportunities for health and development that arise from policies to address climate change. The Commission builds on previous work, such as the Brundtland Commission, the IPCC, the MEA, the Convention on Biological Diversity, and Tony McMichael whose book addressed many of the issues present today. The Commission assesses threats to health and development posed by environmental changes in the Anthropocene epoch. It identifies gaps in understanding of links between environmental change and health and of interventions and policies to reduce environmental change and protect health. To address these threats, the Commission outlines research needs and implementation efforts. A call for accompanying papers and case studies was issued by The Lancet in August, 2014.
The scope of the Commission is to develop an improved understanding of the connections between natural systems and health, including potential for destabilising changes. It also requires recognition of benefits to health from conservation and rehabilitation of natural systems, and mitigation of damaging emissions. To achieve planetary health, ambitious, integrated policies must be developed, implemented, and assessed to address social, economic, and environmental determinants of health.
The concept of planetary health builds on this approach to address challenges of protecting and promoting human health. According to the WHO definition, "health is a state of complete physical, mental and social wellbeing." The model stresses not only how ecosystems underpin human health but also makes the case for widening responsibility for health beyond the traditional confines of the health sector. Google Scholar has outlined the concept of planetary health, which integrates human health and environmental sustainability. An ecological public health model has been proposed that takes into account the complexity and non-linearity of the dynamics of natural systems. Unparalleled opportunities exist to improve governance, harness new knowledge and exploit a range of technologies to improve health and reduce environmental damage.
The Sustainable Development Goals (SDGs) provide an opportunity to address health, social, and environmental challenges in an integrated way. However, there is a danger that wealthy nations and populations will meet their demands at the expense of poorer nations and populations, thus widening health inequities. Humanity has benefited from the harnessing of the environment to human needs, but this cannot continue at the same rate as the world population grows. Life expectancy at birth and other widely used measures are not predictions of the future, but rather a reflection of the current experience of those who have reached old age. Improvements in health could be one of the first outcomes of ecosystem conversion due to reduced threats. Wealthier populations can access ecosystem services from other locations, but eventually resources will be depleted and it will become increasingly difficult to source food and other services.
The apparent contradiction between environmental trends and human wellbeing has been partially explained by increased food productivity, technological and infrastructural advances, and time lags between the deterioration of ecosystem services and reduction in human wellbeing. An assessment conducted by Raudsepp-Hearne et al. (2010) found partial support for these explanations. Google Scholar have warned that accelerating changes to Earth's natural systems represent a substantial threat to global human health. Despite these changes, human health has improved around the world. To explain this paradox, recent studies emphasize the role of biodiversity in mediating exposure to infectious diseases. Global assessments such as the Millennium Ecosystem Assessment and the Intergovernmental Panel on Climate Change (IPCC) reports have gained increased prominence since devastating events such as the 2004 Indian Ocean earthquake and hurricane Katrina in 2005. The natural environment plays an important role in supporting human health and wellbeing. Examples include wetlands providing wave attenuation and reducing damage from tsunamis and storm surges. Global environmental change can have direct, secondary, and indirect/tertiary effects on human health, such as heat stress from climate change or social disruption. The 2012 Global Burden of Disease study showed that exposure to air pollution, contaminated water, and unintentional injury have adverse effects on health. In 2006, a WHO report estimated that a quarter of the global disease burden and more than a third of the burden in children was attributable to modifiable environmental factors. These factors can disrupt the progress of humanity due to their far-reaching effects on vital ecosystem services and potential for compounding pre-existing threats. The Millennium Ecosystem Assessment (MEA) in 2005 found that 60% of ecosystem services, like air quality and water purification, were being degraded or used unsustainably. In 2014, the Living Planet Report estimated that species and spaces were being impacted by this degradation. In 2015, Roser's data showed global poverty was increasing due to this degradation, and Steffen and colleagues reported on the 'Great Acceleration' of environmental degradation in the Anthropocene. Human activity has caused the Earth to enter a new geological epoch, the Anthropocene. Global trends in population, consumption, health, and the environment have been drastically altered. For example, poverty levels have dropped significantly and life expectancy has increased. However, global water use, agricultural land area, fertilizer consumption, and tropical forest loss have all increased. Additionally, ocean acidification and global surface temperature anomaly have increased, and vertebrate population abundance has decreased. Humanity is driving species to extinction at a rate 100 times faster than the fossil record. Humans have heavily altered the natural world in order to provide sustenance, shelter, and energy to reach a population of over 7 billion people. This has included damming 60% of the world's rivers, harvesting 90% of monitored fisheries beyond their maximum sustainable yield limits, and cutting down 2.3 million km2 of primary forest per year. Roughly half of all accessible freshwater is also appropriated for human use. As a result of these changes, many of the Earth's supportive and regulating processes have been exchanged for human population growth and development, often at the cost of other vital services. Humanity has made great progress in the past 250 years, with life expectancy increasing and death rates in children under 5 decreasing substantially. This progress has been supported by the Earth's ecological and biophysical systems, which provide clean air, regulate the climate, and cycle nutrients. Natural systems also provide direct goods such as food, fuel, timber, and medicinal compounds. In the past 30 years, the total number of people living in extreme poverty has fallen by 0.7 billion despite an increase in the total population of poor countries. Human flourishing is due to the environment being the foundation for our success. Resilience is defined as "the capacity of any entity—an individual, a community, an organization, or a natural system—to prepare for disruptions, recover from shocks and stresses, and adapt and grow from a disruptive experience." Urban populations are increasing and policies to improve health and the urban environment are needed, such as reducing air pollution, increasing physical activity, and providing green spaces. Transdisciplinary research activities and capacity need to expand in order to achieve rapid scale-up of potential solutions.
Integrated surveillance systems that collect health, socioeconomic, and environmental data can provide early detection of emerging disease outbreaks or changes in nutrition and non-communicable disease burden. Risk communication to policy makers and the public needs to be improved and systematic reviews and policy briefs can help inform evidence-based decisions. Health professionals have an important role to play in achieving planetary health by working across sectors to integrate policies that advance health and environmental sustainability.
In order to successfully steward humanity through the 21st century, new knowledge, wise policies, decisive action, and leadership are needed to address inequities in health and wealth within the environmental limits of the Earth. The circular economy model is one example of decoupling economic growth from finite resources, while regime shifts can result in large and lasting changes in social-ecological systems. Google Scholar's REDD+ (Reducing Emissions from Deforestation and Forest Degradation) seeks to assign financial value to carbon stored in trees to help developing countries invest in sustainable development. It includes an added focus on conservation, sustainable management of forests, and enhancement of forest carbon stocks. Social-ecological systems are interconnected and coevolve across spatial and temporal scales. Representative Concentration Pathways (RCPs) are trajectories of greenhouse gas concentrations in the atmosphere, with RCP 8.5 being a pathway with very high emissions in line with present trends. The Ramsar Convention defines wetlands as "areas of marsh, fen, peatland or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt." Biodiversity is the variability among living organisms from all sources, including terrestrial, marine, and other aquatic ecosystems. Externalities are benefits or costs that affect an individual or group of people who did not choose to incur them. Ecosystems provide essential services to humans, such as food and clean water, regulation of floods and soil erosion, and recreational and spiritual benefits. Biodiversity is a key component of ecosystems and is important for human wellbeing. The Anthropocene is an epoch marked by human activities having a substantial global effect on the Earth's systems. Natural systems can be managed to protect human health and the Sustainable Development Goals provide a great opportunity to integrate health and sustainability. Improved governance is needed to aid the integration of social, economic, and environmental policies and to strengthen planetary health. Societies face urgent, transformative action to protect present and future generations from environmental threats to human health and civilization. The concept of planetary health is based on the understanding that human health depends on flourishing natural systems and their wise stewardship. To transform the economy, several essential steps need to be taken, including reducing waste, incentivizing recycling and repair, and substituting hazardous materials with safer alternatives. Regional trade treaties should incorporate the protection of health. Planetary health also offers an opportunity for global and national reforms of taxes and subsidies for many sectors, including energy, agriculture, water, fisheries, and health. To support a large population, resilient food and agricultural systems are needed to address under- and overnutrition and reduce environmental damage. Policies should balance social progress, environmental sustainability, and the economy, while accounting for natural capital depreciation and nature's subsidy. This Commission identifies opportunities for action by six key constituencies: health professionals, research funders, UN bodies, governments, investors/corporate bodies, and civil society organisations. Better evidence is needed to underpin appropriate policies, but this should not be used as an excuse for inaction. Changes to the Earth's natural systems are a growing threat to human health. Yet global health has improved. We are concerned this is due to mortgaging future generations' health for economic and development gains today. Health effects from changes such as climate change, ocean acidification, and biodiversity loss threaten global health gains and will become increasingly dominant in the future. This is driven by inequitable, inefficient, and unsustainable patterns of resource consumption and population growth.
We identify three categories of challenges that must be addressed to maintain and enhance human health: conceptual and empathy failures, knowledge failures, and implementation failures. Conceptual failures include an over-reliance on GDP as a measure of progress and a failure to account for future harms. Knowledge failures involve a lack of transdisciplinary research and an unwillingness to address uncertainty. Implementation failures involve governments and institutions delaying recognition and responses to threats. Harvard T.H. Chan School of Public Health's Sania Nishtar, Steven A Osofsky, Subhrendu K Pattanayak, Montira J Pongsiri, Cristina Romanelli, Agnes Soucat, Jeanette Vega, and Derek Yach collaborated on a research article that was published July 15, 2015. The paper titled Effects of decreases of animal pollinators on human nutrition and global health: a modelling analysis examines the effects of environmental change on global health. It also includes principles for transformative change, governance to secure planetary health, and opportunities for action by key constituencies. The Rockefeller Foundation's Samuel S Myers is also an author of the paper. The Rockefeller Foundation–Lancet Commission on planetary health brings together experts from various institutions to research and report on how to safeguard human health in the Anthropocene epoch. Prof Andy Haines (University College London, UK), Prof Chris Beyrer (London School of Hygiene & Tropical Medicine, UK), Frederick Boltz (The Rockefeller Foundation, NY, USA), Prof Anthony G Capon (International Institute for Global Health, Malaysia), Braulio Ferreira de Souza Dias (Convention on Biological Diversity, Canada), Alex Ezeh (African Population and Health Research Center, Kenya), Howard Frumkin (School of Public Health, University of Washington, USA), Prof Peng Gong (Center for Earth System Science, China), Peter Head (The Ecological Sequestration Trust, UK), Richard Horton (The Lancet, UK), Prof Georgina M Mace (University College London, UK) and Robert Marten (London School of Hygiene & Tropical Medicine, UK) are the authors of this report. Correspondence should be addressed to Dr Sarah Whitmee at Centre for Biodiversity and Environment Research, Department of Genetics, Evolution and Environment, University College London, London WC1E 6BT, UK. The Rockefeller Foundation and The Lancet have released a report on planetary health. The report focuses on safeguarding human health in the Anthropocene epoch. It is available through The Lancet's website, which also provides access to their various journals and other information. To access the report, users must create a free account or log in to their existing account.