As planetary health establishes itself as both a concept and an academic field, a key challenge will be how to integrate the disparate and sometimes conflicting disciplines it comprises. A convergence around the limits to growth, planetary boundaries and the great acceleration highlights the need for a “synthesis of syntheses” that must not be afraid of its diversity.
The Rockefeller Foundation-Lancet Commission on Planetary Health identified three key areas of challenge associated with health in the Anthropocene epoch, the period when human activities began to impact global climate and ecosystems. They are: imagination failures, knowledge failures and implementation failures.
During the recent workshop on “Improving health in an era of social-ecological instability and economic contraction” at the University of Waterloo in Canada, the organisers asked participants to address the imagination failure by thinking of ourselves as only a small part of the Earth’s biosphere, a fragile link in the chain between the deep past and far future – custodians of a shared planet rather than its masters. This in turn should enable us to reconceptualise health, to think about it as something we nurture, not just something we fix when it goes wrong.
Addressing conceptual challenges
In contemplating questions around how health systems of the future might be arranged and financed, workshop participants were encouraged to explore what agency the environment affords us to be healthy and to ask how, if Earth’s natural systems have been damaged irreversibly, might we bounce forward from here? Will health in the future depend on technological enhancements or reengagement with nature? Are solutions most likely to be achieved through open markets or a renewed sense of collective obligation, in which we begin to afford the environment, for its own sake as well as ours, the same level of rights and protections we confer on humans and animals?
We have acknowledged since the 1970s that the environment is deteriorating, but the human race collectively still seems unwilling or unable to act. If shouting apocalyptic warnings doesn’t work, should we instead look for, and act on, smaller early warnings that may seem more manageable? The loss of antibiotics was offered as one example, our apparent inability to achieve most of the UN Sustainable Development Goals (SDGs) without overstepping planetary boundaries another.
The entire population of the world will not change their behaviour overnight, but encouraging some people to take small steps where they can may be more realistic. This could be through low(er) impact transition towns or by re-embedding a sense of self and purpose, so that we want to preserve the planet for future populations long after we as individuals are gone. A reconnection with nature through urban gardening, or by reflecting on the decay and rebirth observed on outdoor walks may help to provide the motivation we need to ensure the planet’s survival, as well as improving mental health.
Eco-villages and transition towns may not be scalable to 9 billion people across the globe (at least, not without radical overhauls of current forms of government), but they can provide evidence on what might work, rather than simply talking about it. They may also help us to understand how to change the process that creates a damaging behaviour, which is likely to be easier than trying to change behaviour alone: if the system makes it harder to waste natural resources people will be more likely to stop. Such communities may also help us to understand the trade-offs that might be required and what we might be willing to give up – in terms of preconceptions and normative frameworks as well as “stuff”.
There was consensus at the workshop that capitalism, consumerism and our obsession with GDP needs to change, but also grudging acknowledgements that this system, however damaging, has proven to be remarkably enduring. Significant socio-political change tends to happens after systemic collapse, not in anticipation and prevention of it. As evolutionary biology suggests that diversity provides the essential blueprints for post-collapse regrowth, there are advantages to understanding what the social equivalents of this might be. Few countries have managed to find the “sweet spot” between development and sustainability, but we need to recognise it when they do and cascade their practices to others.
Connection with nature
Workshop participants also called for reimagining the links between spirituality and science, in particular our sense of self in time and space. As average lifespans in developed countries cascade into the 80s, have we lost the ability to think linearly outside the span of our own adult lives, to reflect on the past, or to care about a future we will not live in?
Assisted dying may be the only way societies can afford their populations to live to 100 (state expenditure on healthcare displays as steep a curve as any of the great acceleration’s other trends), but politicians, civil and religious leaders seem incapable of open discussion about how we will die. Death in the developed world is remote and invisible. Does this make it harder for us to conceptualise the death of other species, or of entire ecosystems? Increasingly, research into the human biome tells us that we are part of ecosystems, not separate from them: if we can reconceptualise where we fit in the greater whole, and slow down enough to reflect on and enjoy it, there may be more incentive to preserve it.
We also need to think more holistically in terms of the health of entire populations and of the environment they live in, not just the health of one individual (me) at any given point in time (now). Doctors and healthcare providers need to move towards a “functional” form of medicine that considers health throughout life – the importance of what we eat, how we move around and how (long) we sleep – alongside the drugs and surgery that can be prescribed when things go wrong.
Planetary health needs to bring on board the medical, psychiatric, public health and social care sectors to help reframe the environment as something we cannot lose without also losing the function of “being healthy”.
If there was a single takeaway from the workshop it was this: we are Anthropocentric and always have been – it is part of our nature. Rather than trying to convince the human race to save the environment, convince it that humans and the environment are one, from the cells that comprise our microbiome to the ecosystems of megacities. Perhaps then we will have an incentive to end the self-harm.
By Dr Jennifer Cole, Public Health Policy Adviser, The Rockefeller Foundation Economic Council on Planetary Health