At the recent World Health Summit in Berlin, there was a noticeable lack of discussion on the role of the natural environment in health. Co-benefits to human health from ecosystem protection, biodiversity, or urban greening were mentioned far less frequently than the impacts of the socioeconomic environment. This suggests that the global health community is not yet fully engaged with the field of planetary health.

Initiatives such as the Lancet Commission on Global Health and Climate Change, recent work by The Lancet on the synergies between universal health coverage, health security and health promotion calling for more coordination in the global health landscape, and the forthcoming EAT-Lancet Commission report on Healthy Diets from Sustainable Food, all offer a good starting point to address fragmentation. However, they do not go far enough. Human and planetary health should not be viewed as two sides of the same (environmental) coin. Instead, global health and environmental science need to be on the same side if we are to find truly innovative solutions rather than simply manage trade-offs.

The term “planetary health” was first presented in a Rockefeller-Lancet Commission report. Its proponents and funders come from the fields of public and global health, but its conceptual underpinning comes from environmental science – the planetary boundaries and the Great Acceleration of earth system change.

Instinctively, we know that reducing carbon emissions, using fewer artificial fertilizers and protecting ocean marine stocks will in the long-term benefit the health of people as well as the planet. These benefits, however, are difficult to frame through the lens of the Global Burden of Disease (GBD), which encourages an emphasis on the value of the short term and quick wins of treatment over the longer-term investment needed for prevention.

By focussing on the symptoms in humans, we stop short of following the causal chain far enough back to find its true root, and miss an opportunity to heal the planet as well. A truly interdisciplinary approach would go deeper into understanding the problem and look more widely to develop solutions.

Aligning priorities

Planetary health can produce shared outputs that deliver the desired outcomes of both global health and environmental science. One way to bring the two fields fully together is to focus less on the conditions that top the GBD today, and instead project what the burden might be under a range of future climate change scenarios; this may particularly help to support those in the global health community who are acknowledging the risks from climate change and calling for action.

This will better enable global health practitioners, academics and policy-makers to visualise and value a long-term approach in which environmental factors are fully integrated. For this to occur, the blinkered call for only new diagnostics and drugs to tackle antimicrobial resistance must give way to a more holistic approach that integrates not only better stewardship, but also improved livestock and agriculture practices, transformed food systems, and support for improved sanitation which, in turn, can support cleaner energy initiatives.

Second, until the impacts of climate change are more keenly felt by global health professionals, the costs of reducing them will be borne solely by environmental budgets. New economic models that fully capture the externalities of the energy and food systems, and their subsequent impacts on health, will help to drive investment and ensure that this investment is distributed more broadly. However, while the costs are felt acutely, the benefits are diffuse, which means that success risks a dilemma – if we get it right, no one may notice the effort. This makes it imperative that all stakeholders are fully engaged from the beginning, that the co-benefits of collaboration are scoped, and their rewards recorded and clearly communicated.

Third, global health – a field heavily influenced by medical practitioners – often finds the language implicit in the planetary health discussion overly sensationalist and existentialist. While the challenges in planetary health are certainly alarming, planetary health professionals would be wise to think through how they can best deliver their message in an inviting, not alienating, manner.

Finally, we need to consider how and where the best discussions should take place. In the short term, there may be more value in environmentalists presenting at future World Health Summits than vice versa. We need to draw attention away from global health’s focus on short-term health wins towards the larger and longer-term issues of better environmental stewardship, reform of food systems, and the development of new and more sustainable sources of energy.

Global health needs to see the planet, and not just its inhabitants, as our patient.

By Jennifer Cole, Public Health Policy Advisor, Secretariat of the Rockefeller Economic  Council on Planetary Health, University of Oxford; Connor Rochford, Blavatnik School of Government, University of Oxford; and Esther Schroeder, Worcester College, University of Oxford.

The radical transformations demanded by climate change and planetary health require effective leadership to enable society-wide shifts in values and behaviour, and the management of “trade-offs”. Leadership can come from the public sector, private sector, academia, the media or elsewhere, but it is essential from those in senior political office.

It was effective leadership from heads of state alongside business leaders, governments, mayors, civil society and others that enabled the 2015 Paris Agreement on climate change and its subsequent rapid ratification as a global treaty. This was a remarkable moment based on consensus and multilateral cooperation.

Yet, since then, multilateral coordination and cooperation have been weakened, particularly by positions taken by the Trump presidency, most notably around climate policy. In response to this and the visit of US President Donald Trump to the UK in July, 135 leading climate change researchers based in the United Kingdom – including 15 at Oxford University and four associated with the Rockefeller Foundation Economic Council on Planetary Health – wrote to British Prime Minister Theresa May, urging her to challenge Trump’s position on climate change.

The letter from the UK research community pointed out that Trump’s “policy of inaction” on climate change means that annual energy-related emissions of carbon dioxide from the United States are projected to rise over the next two years, just as they have done in the past. Between 1990 and 2016, the real gross domestic product per capita of the US rose by 44% and its emissions climbed by 2.4%. Over the same period, however, the UK’s GDP per capita also increased – in this case by 46% – but its annual emissions of greenhouse gases fell by 41%, showing that it is possible to achieve economic growth while strongly reducing annual emissions of greenhouse gases.

Prime Minister May’s response to the letter is one of assured UK leadership on climate change. She commits the UK to effective implementation of the Paris Agreement, fulfilling British commitments, encouraging others to do the same and promoting more ambitious action – the UK’s 2008 Climate Change Act and more recent the Clean Growth Strategy provide a credible underpinning to the United Kingdom’s strategy.

May also highlights that the UK is taking a lead on climate resilience in the lead up to the 2019 UN Climate Summit and ministerial engagement in the California Global Climate Action Summit this September, a place where sub-national leadership on climate change will come together to tackle the issue.

Another example of climate leadership came recently from the UK press. Within days of the departure of climate-sceptic editor of the Daily Mail, Paul Dacre, the new editor has published an article from former Conservative minister Michael Howard linking this summer’s heat wave to climate change. As political leaders and others help build national consensus on climate change, a shift in messaging from the UK’s popular media opens up opportunities for enhanced action and ambition on climate.

In a similar way, planetary health – the intersection of environmental change, human health and well-being – will require effective leadership from many actors and across different sectors (finance, health, business, media) to achieve high-level consensus. Let’s hope this is the case as leaders of the climate policy community prepare for the Conference of the Parties to the UNFCCC (COP24) in Katowice, Poland, at the end of the year where they will need to agree on the Paris Agreement Rulebook and the implementation of a “just transition” to decarbonisation.

By Sam Bickersteth, Executive Director, The Rockefeller Foundation Economic Council on Planetary Health

We are nearly two decades into the 21st century, yet nearly 2.3 billion people – one-third of the global population – still lack basic sanitation. This appalling state of affairs causes unnecessary disease and death. Poor sanitation is linked to transmission of such diseases as cholera, diarrhoea, dysentery, Hepatitis A, typhoid and polio; it also contributes to malnutrition. Poor sanitation not only affects human health, but it can also damage ecosystems and the health of our planet.

In 2010, the United Nations General Assembly recognized access to safe and clean drinking water and sanitation as a human right, and called for international efforts to help countries provide safe, clean, accessible and affordable drinking water and sanitation. Today, this call is enshrined in UN Sustainable Development Goal 6 – ensure availability and sustainable management of water and sanitation for all. Targets for the goal include achieving by 2030 access to adequate and equitable sanitation and hygiene for all and end open defecation (Target 6.2). There is also a call to expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes (Target 6.a), and to support and strengthen the participation of local communities in improving water and sanitation management (Target 6.b)

These are ambitious goals, as are most of the SDGs, but they can be achieved and in some cases are starting to be achieved.

Jennifer Cole, public health policy advisor with the Secretariat of the Rockefeller Foundation Economic Council on Planetary Health lays out in the report, Sanitation in the Context of Planetary Health, opportunities and challenges for meeting the SDGs on sanitation. By applying a planetary health approach across the triad of public health, environmental health and economic opportunities, policy-makers and environmentalists can begin to think in terms of not only the disposal of human waste, but also of resource recovery and reuse – and its potential to generate clean energy and the reduction of greenhouses gases – and recovery of nutrients for agriculture, as well as reduced exposure to disease pathogens.

One particular challenge for densely populated human settlements is how to dispose of large quantities of human waste which, if not safely managed, impact on human health, the environment and economic prosperity. The World Health Organization estimates that total global economic losses associated with inadequate water supply and sanitation to be 1.5% of GDP (US$260 billion), with poor sanitation costing some countries, especially in the developing world, as high as 7.2% of annual GDP. This reflects the cost of healthcare treatment, productivity time lost to sickness and seeking treatment, and productivity time lost to accessing sanitation facilities.

Poorly managed sanitation can also create environmental challenges. Ill-functioning latrines and septic tanks can leak into soil and water, and untreated wastewater released directly into the environment can pollute rivers. Untreated waste flowing into our waterways can cause eutrophication – excessive plant growth due to the high concentrations of phosphates and nitrates it contains – which can severely damage freshwater and coastal marine ecosystems. And let us not forget the link between sanitation and greenhouse gas emissions. Pit latrines can produce higher greenhouse gas emissions than open defecation as more of the carbon in fecal matter forms methane rather than CO2 during breakdown, so capturing this methane for clean energy also needs to be considered.

 

As developing nations industrialize and urbanize, incorporating sanitation and waste management strategies into wider environmental policies can offer an array of benefits. Good waste management practices allow nutrients in waste and wastewater to be reused as agricultural fertilizer, and biogas released from the breakdown of waste can be used as fuel and generate electricity. For example, capturing methane emissions from human waste for biogas compared with losing them to the atmosphere could prevent a 6% annual increase in India’s greenhouse gas emissions. Using this biogas to provide clean energy to households that currently use traditional cooking stoves could potentially avoid more than 4% of the country’s GHGs, worth over US$1 billion on the international carbon market, and reduce black carbon – a cause of human morbidity and premature mortality – by a third.

Challenges to implementing and maintaining improved sanitation vary between locations based on economic status, rural or urban settings, and even cultural barriers. All of these need to be addressed if SDG 6 and its targets are to be achieved by their 2030 deadline. While the developed world is showing immense progress in collecting, treating and reusing waste, much more needs to be done in developing countries. But if we provide affordable and the right equipment and education in hygiene practices, we can reduce the senseless suffering from preventable diseases and loss of life.

By Mark Schulman, Editor, Secretariat of the Rockefeller Foundation Economic Council on Planetary Health

There is no doubt that current agriculture and food systems are significant drivers of planetary ill-health. Impacts include land degradation from poor production practices, high levels of species extinction, unhealthy diets driving rising levels of obesity, diabetes and other non-communicable diseases, and nearly 25% of global greenhouse gases from land use change, agriculture and deforestation.

The annual EAT Forum held in June 2018 in Stockholm generated plenty of discussion on how to fix “the broken food system”. The host, Sweden, offered some innovative approaches to reducing the impacts of current food systems. For example, a recent Climate Change Act commits the Nordic country to zero emissions by 2045. In addition, the Swedish Green Party (a member of the current ruling coalition) is considering a tax on the intensive meat industry and there is also discussion on copying French legislation on banning the disposal of edible food. Senior Swedish officials anticipate that animal-based investments may become the stranded assets of the future – just as with fossil fuel-based energy businesses – with a predicted mass shift to plant based-diets. Highly successful crowd-based funding of new food markets shows the interest in change among consumption and investors.

A group of experts, advisers and investors were challenged to put their money where their mouth is. Insurance companies, fund managers, pension funds, banks and foundations are all finding ways to shift investments towards more sustainable and less damaging agriculture. Several groups are focussed on better knowledge of investments and are setting up scorecards of impacts in relation to biodiversity loss, emissions and waste management as well as benchmarking good practice. Far-sighted leadership of investors and behavioural nudges and changes have made a difference, such as the fast emergence of the Green Bonds market. But, better data for better decision-making is needed – such data will need to sit alongside engaging narratives for change and framed by values.

Investment, innovation and wider system transformation in agriculture and land use, however, still lags behind other areas such as energy despite its centrality to current and future planetary health. While latest estimates show that $250 billion was invested in renewable energy last year, it was reported that only $10 billion flowed to land-based investments. But hopefully that imbalance will start to change as groups like the Food & Land Use Coalition, chaired by Unilever CEO Paul Polman and a member of The Rockefeller Foundation Economic Council on Planetary Heath, encourage business to help drive changes in land use and food production to reduce environmental destruction.

According to the International Renewable Energy Agency (IRENA), disruption and transformation of the energy sector is well underway driven by decarbonisation, digitalisation and decentralisation as mainstream renewable technologies can be expected to provide average costs at the lower end of the fossil fuel cost range by 2020. The notion of zero coal and low-emissions transport and energy systems emerged just a short 5 or 6 years ago, but in Stockholm – in response to the challenges of the food system – the concept of low or zero meat diets was considered.

Just as the future of coal has been discussed, now is the time for a discussion on the future of meat, particularly intensive meat production and consumption (with all the disruptions, political, economic and social that may emerge). Technologies are emerging and new dietary norms could emerge faster than expected.

There was a consensus at the EAT Forum that society, economies and leaders have a binary choice between a bleak future of resource constraints and global warming, or to take advantage of the opportunities for transforming a new way of managing our food systems. There is a sense of optimism that this is achievable with the right combination of vision, leadership, investment, knowledge generation, partnership and collective action.

By Sam Bickersteth, Executive Director, The Rockefeller Foundation Economic Council on Planetary Health

Sam Bickersteth weighs up the prospects for serious climate action in a year of economic and political uncertainty, technological innovation, and climate change impacts.

Nationally Determined Contributions (NDCs) – the national climate action plans – sit at the core of the Paris Climate Agreement. Over the past two years, there have been several international initiatives to support their implementation.

The NDC Partnership provides a mechanism for exchanging lessons learned. In May 2017, the LEDS Global Partnership, UNDP and GIZ convened representatives from 80 countries at the Global NDC Conference to take stock of progress in delivering NDCs. The Climate Finance Accelerator illustrates the considerable activity underway to finance NDCs in countries that are progressive on climate policy. As we look ahead in 2018, what can be expected of the NDCs?

NDCs set out carbon emissions reduction targets. They vary in level of ambition and realism but when added up they are insufficient to keep global temperature rise to less than 2C.   Consequently, the Paris Agreement presents them as an initial statement of ambition, which will need to be ratcheted up through mechanisms of reporting and review.

Will the world dodge further emissions growth in 2018?

There has been substantial progress in decoupling emissions from economic growth: PwC’s Low Carbon Economy Index reported that global carbon intensity declined by 2.6% in 2016. But nonetheless, total greenhouse gas emissions have traditionally risen in step with global prosperity and in 2017 they increased by 2% after three years of plateauing. With global economic prospects for 2018 looking good at an estimated 3.7%, the highest for seven years, there are serious risks of an upturn in emissions.

The question is whether, with nearly all countries having acceded to the Paris Agreement, global emissions will start to fall despite the expected economic growth? Will the relationship between growth and emissions be truly broken? Can we expect other countries to emulate Ethiopia by tackling poverty reduction alongside a decrease in emissions? Better still that decarbonisation is directed towards addressing the absurd levels of inequality where billioniares who make up just 1 percent of the world’s population are reported to own 82 percent of the world’s wealth.

Global policy as a driver for national action

In 2018, the UNFCCC is focussed on developing the rule system for the Paris Agreement. The so-called Talanoa Dialogue of parties to the Agreement is designed as a collaborative opportunity to review progress and ramp up longer-term ambition. The Paris Agreement only comes into force in 2020, so the horizon for the Talanoa Dialogue is several years beyond that.

We may, understandably, expect developing countries to increase their calls on the global stage for accelerated action by the large, polluting nations to cut emissions in the pre 2020 period, as well as to call for more finance to assist their national actions.   Other mechanisms are required to emphasise the urgency of action particularly by the large polluters. It is important to ensure that NDCs sit at the heart of all national policy making with an appropriate pathway to decarbonisation. What are, therefore, some of the other drivers for NDC progress over the next 12 months?

Climate related disaster risk is on the agenda

Last year was also the hottest non-El Nino year on record and we saw an increased awareness of human impacts on oceans in part awakened by the BBC’s Blue Planet 2 series. Impacts of sea level rise are driving people from their island homes in countries such as Vanuatu. Forward-thinking politicians, policy makers, businesses and financiers have been giving attention to these climate threats in part alarmed at losses from climate related disasters. These were reported to be $330bn last year by MunichRe, second only to record-breaking losses in 2011. They understand the need to value climate risk as climate related financial disclosure starts to become mandatory and hence many businesses are setting science based targets for their own emissions.

Action by subnational actors adds up

Cities and subnational states and regions are clubbing together to take action in the Under 2 Coalition – a cohort of like-minded local governments that have committed to moving toward net zero carbon emissions by 2050. All of this indicates the on-going integration of climate actions into the policies and plans of governments, both local and national, and businesses.

Accelerated ambition requires finance and, for developing countries, new green finance instruments are emerging through the launch of green bonds, targeted use of national and international public funds and demonstration projects.   NDCs will only succeed where they are integrated into the national plans and budgets (as set out in 10 Propositions for Success – integrating international climate change commitments into national development planning).   However, CDKN has examined the evidence of financing for NDCs in four African countries, and shown that budget allocations are currently limited and in many cases reliant on donor support.   The clamour for international climate finance particularly for adaptation will continue through 2018, but as Green Climate Fund finance flows more widely their ability to catalyse larger funds from national public and private sources will be examined.

Fourth Industrial Revolution and trade could impact emissions

CDKN has been considering how emerging technologies (fast developing as the Fourth Industrial Revolution – 4IR) can be harnessed to drive NDCs. The current exponential rate of change is illustrated by wind and solar power costs continuing to fall such that two-thirds of new power installed last year was renewable. Similarly, the Government of India has announced that all cars sold will be electric with many other countries setting ambitious targets. Artificial intelligence, blockchain and new advanced materials could all improve efficiency of and access to energy systems. Drones can be used for remote sensing and better use of agricultural inputs or even plant trees.  With $90trillion worth of infrastructure systems to be built by 2030 and most of it in developing countries there is an enormous potential to provide NDC coherent technology solutions. To achieve this, governments need to establish policies and capacities that facilitate early adoption of 4IR technologies and to understand their potential.

Besides technology, trade has the potential to be an enabler for NDCs.   CDKN has concluded that there are opportunities for triple wins with the potential for free trade agreements (of the type that the UK is considering post Brexit) that could deliver commercial, climate and developmental outcomes with minimal trade-offs in tariffs, trade in services, and product standards.

During 2018, there will be many political and economic distractions but it is important that the NDCs remain as the locus of climate action at both international and national levels.   Efforts at NDC mainstreaming will drive climate action into normal planning, budgeting and implementation processes. This hard work of translating the NDCs into sectoral actions across key sectors of energy, transport, infrastructure and land use will need to go on, competing with other priorities. As anticipated in the Paris Agreement it will take time to build foundations for the essential deep decarbonisation that all economies must follow and the next round of NDCs have an opportunity raise ambition and be better aligned.   Whether this will result in a reduction of emissions at global scale is far from certain.

This post originally appeared on https://cdkn.org/