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.

Each September, as world leaders descend on New York, duelling narratives compete for attention during the frenetic opening week of the United Nations General Assembly (UNGA). While much of the media circus focused on US President Donald Trump’s attack on multilateralism and the laughs elicited by his “America First” remarks, global cooperation still triumphed, especially when it came to the climate agenda.

For the past decade, Climate Week – running in parallel to the UNGA – has successfully brought together international leaders from business, government and civil society to promote discussion on climate change and reinforce the need for collective, multilateral action on this front.

UN Secretary-General Antonio Guterres spoke of the reality that climate change is moving faster than we are, and the urgent need to deliver on the Paris commitments, particularly to raise ambition for the next round of Nationally Determined Contributions (NDCs), and to mobilise support around the many synergies and co-benefits of climate action.

The secretary-general cited the latest New Climate Economy report, which indicates that climate action and socio-economic progress can be mutually supportive, with estimated benefits of $26 trillion predicted by 2030, compared with business-as-usual scenarios. Other UN leaders such as the head of the United Nations Development Programme (UNDP), Achim Steiner, spoke of how the air pollution agenda is galvanising action in favour of low carbon energy and transport systems. Patricia Espinosa of the UN Framework Convention on Climate Change Secretariat spoke of the need for an inclusive multilateral approach that increases the number of voices around the table and integrates green growth, rights and poverty reduction. But she warned that countries are not living up to their emission reduction pledges as we head for an average global temperature rise of 3°C.

Across the many SDG-related events of the week – 336 by one count – progressive leaders from governments (both national and subnational), international organisations, business and finance spoke of what they are doing on climate action and their vision for change. A panel discussion convened by The Climate Group, Johnson & Johnson and The Rockefeller Economic Council on Planetary Health, of which I am the executive secretary, was one such event, and brought together healthcare leaders from business and government to discuss economic and policy solutions, and how to seize the opportunities presented by tackling climate change and interconnected health environmental crises.

At a national level, a growing number of countries are producing 2050 decarbonisation strategies, many with a net zero emissions goal. France and Sweden have led the way in making such a commitment and in the UK a cross-party consensus for 2050 net zero is emerging (Norway has even brought forward its net zero target to 2030.)

At Climate Week, US Governor Jerry Brown announced that California is seeking carbon neutrality and that this will require profound transformation and technological change. He noted, however, it will be a challenge as a net zero goal is in collision with continued, and in some cases rising demand for, and vested interests in, fossil fuels. The net zero commitments by New Zealand’s Prime Minister Jacinda Ardern also provide huge challenges for her natural resource and agricultural-based economy. Meanwhile, President Hilda Heine of the Marshall Islands launched a net zero strategy, the first for a small island state, in an effort to shame big emitters to action.

Climate Week in New York is also a space for business and finance to show their commitments. The rise of the Green Bond market to an issuance of nearly $180 billion is an impressive signal of the shift amongst the financial community, but a gathering of bankers, asset managers and others indicates that progress is still nascent. Even the asset manager, Blackrock, whose chief executive Larry Fink has called for all businesses to have a social purpose and pursue a strategy for achieving long-term growth, is screening for coal-related investments across its $7 trillion portfolio. Without a realistic carbon price (the consensus of a gathering of finance leaders was that this must be greater than $100/tonne of CO2) and a shift from short termism, incentives are insufficient to shift investors adequately to address climate change risks and opportunities.

Throughout Climate Week, finance and business leaders, as much as political leaders, repeated their concern about the ongoing reliance on coal and oil in the energy mix and how far we are from meeting the Paris Agreement targets. The latest International Energy Agency report on energy transitions shows the high proportion of coal that persists in the G20 energy mix (more than 40% of the mix).

Yet, it was an impressive line-up of companies that spoke of their progress in decarbonisation, not only in their direct operations but throughout their supply chains. Their stories are dominated by the transformation of energy systems, the normalisation and mainstreaming of alternative energy systems driven by digital and material science technologies as well as government policies. The same exponential rate of change is now underway in the electric vehicle market, notably the electrification of China’s bus fleets.

New York City Climate Week 2018 came on the heels of the Global Climate Action Summit in California. In both instances, leaders of countries, governments, cities and business have set out visions, plans and actions on climate change. Much is underway, but it’s short of the level of action needed to really address climate change. A stronger multilateral regime is required, bolstered by these many actors – and by action across a wide range of sectors including agriculture, food, nature-based solutions and health. Let’s hope we can come back in a year from now for the UN secretary-general’s special climate summit and see how many of the initiatives highlighted this past week have mobilised action and made progress.

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

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.

10 Downing Street in London is the official residence and office of UK Prime Minister Theresa May. (Jordhan Madec)

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

The popular argument in support of fossil fuel subsidies is that they make energy more accessible and affordable to consumers. In many cases this is true, but there are untold consequences that the argument leaves out and that is the impact they have on our health.

While subsidies for coal, oil and gas make consumption of these fuels cheaper for consumers, it results in an increase in carbon emissions, which are directly affecting our health in the form of air pollution. The burning of fossil fuels is one of the main contributors to air pollution, which studies show can lead to lung disease, asthma attacks, strokes and heart attacks. Air pollution kills more than 7 million people every year.

Fossil fuel subsidies also put undue pressure on our public health systems by diverting funds that could be used more efficiently for public health services. According to the European Health and Environment Alliance (HEAL), G20 governments in 2014 gave $444 billion in subsidies to fossil fuel companies, while the health costs resulting from the use of fossil fuels in those countries was estimated to be at least six times that amount.

In the UK, for example, health costs from fossil fuel-driven air pollution are almost five times higher than the subsidies paid. And in China, the impact of fossil fuels on public health through air pollution is estimated at about $1.8 trillion – this is more than 18 times what the nation pays to oil, gas and coal producers, thereby helping to fuel a public health crisis that is already causing 1.6 million premature deaths every year.

Removing the subsidies is the answer. It will lead to a reduction in fossil fuel consumption and fossil-fuel related carbon emissions, and thus significantly reduce the number of air pollution-related deaths. The removal of subsidies globally would greatly reduce global CO2 emissions each year compared to a business-as-usual scenario. Removing the subsidies will also free up much-needed funds for low-carbon alternatives such as solar, wind and hydropower, which would contribute to the reduction in the production and consumption of fossil fuels, and help prevent driving the planet far beyond the internationally agreed climate change target of limiting global temperature increases to no more than 2ºC.

Despite the urgency of transitioning to renewable energies and low-carbon societies, global fossil fuel subsidies are still significant – estimated at $373 billion a year, according to the OECD. At the same time, governments have made high-level commitments to increase public spending on working towards the UN Sustainable Development Goals (SDGs). The World Health Organization says achieving the SDG health targets would require new investments increasing over time from an initial $134 billion annually to $371 billion by 2030.

If we can remove the subsidies, funds could then be freed up to be used towards these investments and ensure healthy lives and promote well-being, as called for in SDG 3. The funds could then be used for investing in socially needed projects and policies. These could include policies aiming not just at a transition to a green economy, but also more direct health policies such as healthcare funding or poverty reduction. Making the switch to renewables and healthier energy choices could contribute to achieving higher energy security, and more importantly cleaner air.

By Chukwunonso Gerald Iheoma, Researcher, Secretariat of 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.

Illustrative photo of a latrine (Amy Reed)

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

The term planetary health, and what falls within that field, provokes strong and interesting debate. Where consensus can be found is in the notion that planetary health is cross-disciplinary – involving academics from different disciplines working collaboratively on a common problem – complex and interconnected. It needs input from many academic disciplines, and many academics, each of whom needs to look outside of their own immediate area of research to wider issues that intersect, require trade-offs and involve compromises. This will enable the field to move towards being truly interdisciplinary. Only then will the right action be identified and taken.

For this reason, the planetary health programme at the Oxford Martin School recently convened the first of what is hoped to be a series of seminars open to all members of the university – regardless of faculty, discipline or field – who are intrigued by the concept of planetary health and keen to discover what their research may have to offer.

At the inaugural meeting, invited researchers from University of Oxford’s Climate Econometrics, the Environmental Change Institute, Primary Care Health Sciences, the Smith School of Enterprise and the Environment, the Future of Humanity Institute and Faculty of History joined the Oxford Martin School-based staff of The Rockefeller Foundation Economic Council on Planetary Health Secretariat to hear about the project’s progress so far, plans for the future and opportunities for collaboration.

Discussions highlighted the importance of working across different levels of magnitude – with the macro-level needing to be informed by an accumulation and magnification of (more) micro-level studies whose synthesis will inform the bigger picture. A presently incomplete picture, with diverse data sets, must not be allowed to impede progress towards a better future. Sectors, as well as geographic locations, need to be considered on a global level. The shipping sector, for instance, may be a better target for focus than the US or China, in efforts to limit ocean pollution; multinationals can have a huge impact on consumer behaviour and behavioural change. A focus on the mining sector may help to understand what is driving the desire for the mined minerals and how this may be tackled. Planetary health needs to identify root causes, not just diagnose and treat symptoms.

Degraded land from mining, Poland (Mariusz Prusaczyk)

The discussions also raised questions about how the cause and symptoms should be identified: we are good at defining planetary ill-health, but less clear on what the practical vision of a healthy planet might be. If countries are to be asked to remain inside their planetary boundaries, planetary health must address what their transport systems, agricultural lands, energy grids and cities look like when they do.

How well do we understand the limits of the human body, and the extent to which our current lifestyles push these in negative as well as positive directions (as obesity and the rise in non-communicable diseases suggest they do)? What are the measures of good health beyond just the World Health Organization’s “absence of disease or infirmity”? What are the social determinants of this and do we sufficiently understand how a better environmental can drive good health as much we understand how the current one drives ill-health?

On the one hand, it is common sense to say air pollution is unhealthy, just as we know smoking is unhealthy, but without scientific evidence of levels of harm and a corresponding understanding of how healthy we might be without exposure to such risk factors, policy-makers will be loath to limit revenue and GDP-generating activities. Such quantified understanding will be particularly important if we are to “lock in” good practice to new technologies, urban developments and progress within the timeframes needed to keep our planet within manageable levels of environmental change.

We may overshoot planetary boundaries while we do so, but how far can we overshoot and still be able to (ever) recover? If there has to be trade-offs between population numbers, (average) length of life and current lifestyles – if the planet cannot support 12 billion people all living on average to 100 with an ecological footprint equivalent to the average North American – we must decide what we sacrifice and how: energy consumption, plastic use, a second child, the last 10 years of the current lifespan, or all four for some, none for others as inequality takes on new dimensions. Should we, and if so, how, incentivise people to make their own lives as healthy as possible, and tax into submission those who “choose” not to?

The key to all this is a better understanding of the casual chains that drive behaviours leading to degraded environments and their impacts on human health. The challenge is that these are not simple causal chains, but interconnected causal pathways that weave through complex systems. Each researcher might position their work along a single path, or at a single node of the network, but a planetary health researcher needs to see the entire system, and understand how every other causal chain affects theirs. This is no easy task, requiring academics to step outside of their own discipline into fields, methodologies and approaches with which they are less familiar as they inch towards an understanding of areas they have not considered before.

The solution may be as much about network analysis as it is about the epidemiology of malaria or the physics of diesel combustion, but more likely it is about all three (and dozens more). The answers to planetary health’s questions may lie at the end of research projects that are only now beginning, requiring today’s academics to work on current best estimates rather than certainties.

There is, nonetheless consensus around the idea that “if you’re not sick, you’re healthy” is as old-fashioned an idea for the planet as it is for the body. Better and more accurate early diagnosis of problems is needed so that they can be addressed swiftly and upstream, when doing so is easier. Prevention is better than cure, risk management is better approached through adaptation and mitigation than recovery. The researchers present saw this going beyond sustainability to something more wide-ranging, while also advising caution that the field may be looking too holistically before the specifics have been pinned down; incomplete understanding may shift problems elsewhere rather than solve them entirely. But planetary health research has to start somewhere. There may not be hard boundaries yet, but this should not be a barrier to practical suggestions on how to limit harm we can certainly see, if not yet fully quantify.

The debates are clearly far from over and offer plenty of scope for future discussions. If solutions are to be found, they will be composite approaches from different academic disciplines working together, creating an innovating and forward-looking interdisciplinary space from which equally innovative solutions can emerge. More researchers are welcome to join in as we take this forward.

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 opinions in this blog are those of authors alone, and do not represent the view of the entire 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

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.

Early adopters

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

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 PartnershipUNDP 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.

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Rockefeller Foundation Economic Council on Planetary Health First Meeting 8-9th February 2018, Oxford Martin School, University of Oxford