The Planetary Health Framework: The Way to Achieve a Sustainable Future

Planetary Health: Protecting Nature to Protect Ourselves / Island Press

Humanity has become totally out of synch with the planet’s biophysical systems — for proof, just look to climate change, COVID-19, environmental degradation, ocean acidification, and the accelerated extinction of species. As we now begin to understand, the planet is a single organism, a complex, inter-connected system that can either be healthy and in balance — or not. Furthermore, our health and well-being are intrinsically connected to the health and well-being of natural systems.

In Planetary Health: Protecting Nature to Protect Ourselves, a new book edited by Drs. Howard Frumkin and Samuel Myers, we are given a roadmap for how to undo the damage to the Earth and live in a way that is more respectful of the planet’s limited capacity. The authors convince us to take this path not just for nature’s sake but also for our own future health and well-being.

Dr. Howard Frumkin is former Dean of Public Health at the University of Washington and former director of the National Center for Environmental Health at the Centers for Disease Control and Prevention. Dr. Samuel Myers is principal research scientist at the Harvard T.H. Chan School of Public Health. Together, they have put together a thought-provoking and rich 500-page overview of the emerging field of planetary health, which is increasingly used by UN organizations, governments, non-profits, and universities as a framework for understanding the relationship between human and environmental health.

Frumkin and Myers and their contributors build their case so methodically, with loads of persuasive data, that by the end of the book, it seems difficult to imagine a better framework for understanding Earth’s contemporary human-environmental dynamics. This book is a must-read for anyone passionate about creating better outcomes for more people, far into the future.

In their introduction, the editors explain how today is “the best of times and the worst of times.” On one hand, it has “never been a better time to be a human being.” In the past 65 years, the percentage of the world’s population living in extreme poverty fell from 63 percent to 10 percent, despite the population tripling in size. Child mortality rates are the lowest in recorded history.

But on the other hand, human activity is “driving biophysical change at rates that are much steeper than have existed in the history of our species.” 40 percent of the planet is now dedicated to agriculture, at the expense of natural systems. Habitat destruction and the anticipated extinction of up to a million species threatens the underlying biodiversity that maintains the resilience of natural systems.

Some may see promise in the Anthropocene, the new geological epoch created by humans, and imagine a future planet optimized by direct human control. But in reality, the poor human management of the planet’s biophysical systems to date means that more of the status quo will lead to civilizational collapse.

According to Frumkin and Myers, we have disrupted the climate system; polluted air, water, and soils; caused rapid biodiversity loss; reconfigured biogeochemical cycles; made pervasive changes in land use; and depleted fresh water and arable land. These changes all have significant health implications for billions of people. A new approach rooted in planetary health is needed.

The book first provides a background on the intellectual history of the concept of planetary health, which only began as a systems-scale field of research in the 1990s. As Dr. Warwick Anderson explains in his essay, the field made a big leap in 2010, when The Lancet, a major research journal, and the Rockefeller Foundation partnered with other public health groups to promote a “new health discipline — public health 2.0.” In 2015, with the release of the seminal Lancet – Rockefeller Foundation commission report Safeguarding Human Health in the Anthropocene Epoch, Richard Horton, editor of The Lancet, deemed the new field of inquiry “planetary health,” which Anderson states, “rapidly gained currency.”

The book then lays out the scale and complexity of the problems and offer some positive models to addressing them:

A chapter by a team of esteemed researchers from organizations such as the Population Council, Population Reference Bureau, and Population Institute explore how the growth in human population and consumption are driving environmental change. They argue that “given the tight interconnectedness of the two drivers, it may be best to see them as coequal challenges.”

These contributors call for disincentivizing the excessive consumer consumption of the U.S. and western Europe, which would doom the planet if expanded to a global scale. They also point to the connected drivers that can further reduce population growth, including greater investment in the education of girls and women around the world, which helps to empower them to make their own decisions, and the expansion of access to contraceptives.

Their conclusion: a “multi-pronged strategy that integrates education, sound policies, and high-quality health services — all while guaranteeing the rights and respecting the dignity of all people — could dramatically accelerate the transition to truly sustainable levels of human population and consumption.”

A companion essay outlines the environmental impacts of the twinned growth in population and consumption. The authors argue: “We live on a different planet than the one our great-grandparents called home a century ago. It is a warmer planet, a more crowded planet, a planet with fewer species, a planet marked by widespread contamination and altered biogeochemical cycles.”

In this chapter, we learn about humans’ many impacts on the environment — ranging from the climate to the nitrogen cycle in agriculture, from land use and cover to water scarcity, biodiversity loss, and pollution.

Through a series of essays, Planetary Health delves into how those specific environmental changes — all driven by human behavior — are in turn jeopardizing human health and well-being by increasing risks in the area of nutrition, infectious diseases, non-communicable diseases, population displacement and conflict, and mental health.

In the section on nutrition, Myers explains how rising temperatures and carbon dioxide levels increase risks in the agricultural sector, impacting everything from the amount of time farm workers can stay in the heat to the nutritional yield of important mainstay plants. He also flags the lack of genetic diversity of the few plant species we rely on and the need to greater protect plant diversity.

A chapter on infectious diseases by Richard Ostfeld, with the Cary Institute of Ecological Studies, and Felicia Keesing, a biologist at Bard College, explains the growing risks of various infectious diseases. They write: “key environmental drivers, such as climate change, biodiversity loss, land use change, pollution, and alteration of biogeochemical cycles cause changes in the abundance, distribution, physiology, and behavior of important species involved in the transmission of both zoonotic and nonzoonotic pathogens to humans.” They analyze the relationships between land use, biodiversity, and diseases like malaria, lyme disease, and schistosomiasis, among others.

Non-communicable diseases, which include cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and other conditions, account for 70 percent of global deaths each year. In this chapter, Frumkin and Andy Haines, a professor at the London School of Hygiene and Tropical Diseases, lay out the data on how climate change, urbanization, and air pollution increase non-communicable disease risk. Of particular interest for landscape architects and planners is a section on the dangers of automobile-dependent communities.

A team of researchers then connect the dots between environmental change, migration, conflict, and heath impacts, explaining how the conflict in Darfur, Sudan, is now understood as the first “modern climate change conflict,” and how we can expect more to come.

One of their arguments for investing in climate solutions is worth re-stating: “Adaptation to global environmental change is part of preventing migration. Adaptation can reduce vulnerability to both sudden shocks and long-term trends. Examples include switching farming practices to drought-tolerant crops and soil-conserving techniques, not building in floodplains, constructing levees and sea walls, restoring coastal barrier systems (mangroves, vegetated dunes, coral reefs, wetlands), and altering building codes to put key utilities on roof instead of in basements.”

Susan Clayton, a professor of psychology at the College of Wooster, provides a much-needed overview of the expected mental health impacts of climate and environmental change. She collects many useful studies in one place, providing a valuable reference.

One worrying conclusion: “Higher temperatures can provoke increased aggression. This manifests in many ways: from pitchers beaning batters during baseball games and drivers aggressively honking their horns, all the way to violent crime, particularly when combined with frustration over limited access to resources, such as fresh water or arable land.” One of her key solutions is expanding access to nature, particularly in cities. “Reconnecting with nature…offers a range of direct and indirect mental health benefits.”

Planetary Health then turns to building the case for systemic changes in our societies and economies, including a shift away from using gross domestic product (GDP) as a measure of growth and instead using gross national happiness and other metrics that better account for human health, well-being, and environmental health. Central arguments include: “happiness and human health are intertwined; natural environments make people happy; and happiness production is not resource-intensive.” In other words, more experiences in nature create happiness, not the latest purchases.

After wading through the problems, we then get to the solutions — healthier models for various sectors: energy, chemicals, cities, economic development, and private sector growth. The chapter on urban places and planetary health is particularly worth reading as it makes the health argument for “integrated green urbanism,” transit-oriented development, bicycle infrastructure, and urban food systems. Iryna Dronova, a professor of landscape architecture at UC Berkeley, contributes to this discussion. The chapter on chemicals outlines how to reduce the risk of endocrine disruptors and create new green chemicals.

This significant new book also proposes how to create a set of planetary health ethics that can guide current and future action — a mutual promise to do no further harm in our era of climate and environmental change. Here, the contributors call for a “social movement, a scientific framework, an attitude towards life, and a philosophy of living that fosters resilience and adaptation.”

The core message: If we truly commit to maximizing human and environmental health in all communities, and undertaking all that entails, we will get on a pathway to saving the planet.

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