Planetary health

Planetary health is a multi- and transdisciplinary research paradigm, a new science for exceptional action, and a global movement. Planetary health refers to "the health of human civilization and the state of the natural systems on which it depends". In 2015, the Rockefeller Foundation–Lancet Commission on Planetary Health launched the concept which is currently being developed towards a new health science with over 25 areas of expertise.

Background and milestones
There are a number of ideas, concepts that can be understood as precursors to the concept of planetary health. According to Susan Prescott, the term "planetary health" emerged from the environmental and holistic health movements of the 1970-80s. In 1980, Friends of the Earth expanded the World Health Organization's definition of health, stating, "health is a state of complete physical, mental, social and ecological well-being and not merely the absence of disease - personal health involves planetary health" James Lovelock created the term "Planetary Medicine" in 1986. In 1993 the Norwegian physician Per Fugelli wrote: "The patient Earth is sick. Global environmental disruptions can have serious consequences for human health. It's time for doctors to give a world diagnosis and advise on treatment." In the 1990s, a model curriculum Terra Medicine (Planetary Medicine) was developed at the Catholic University of Eichstätt-Ingolstadt as part of the Altmühltal Agenda 21 project. In 2000, James Lovelock published his book "Gaia: The practical science of planetary medicine".

Milestones
Fourteen years later, a commentary in the March 2014 issue of the medical journal The Lancet called to create a movement for planetary health to transform the field of public health, which has traditionally focused on the health of human populations without necessarily considering the surrounding natural ecosystems. The proposal recognized the emerging threats to natural and human-made systems that support humanity.

In 2015, the Rockefeller Foundation and The Lancet launched the concept as the Rockefeller Foundation–Lancet Commission on Planetary Health. The Planetary Health Alliance was founded in December 2015, from the Harvard University, together with the Wildlife Conservation Society and other partner organizations. The Rockefeller Foundation Economic Council on Planetary Health at the Oxford Martin School was established on 1 June 2017 to further define the new discipline of planetary health. The open-access journal "Lancet Planetary Health" published its inaugural issue in April 2017. In 2022, on the occasion of the 50th anniversary of the first UN environmental conference "United Nations Conference on the Human Environment" in Stockholm 1972, the UN published the report: 'UN Conference Stockholm+50: A Healthy Planet for the Prosperity of All - Our Responsibility, Our Opportunity'.

The Royal Netherlands Academy of Arts and Sciences published a comprehensive report in June 2023 on the state of planetary pealth research and the future research agenda, which has relevance not only for the Netherlands but also internationally (Planetary Health Advisory Report).

Research paradigma and agenda
Drawing from the definition of health – "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" - as well as principles articulated in the preamble of the constitution of the World Health Organization, the report elaborated that planetary health refers to the "achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems – political, economic, and social – that shape the future of humanity and the Earth's natural systems that define the safe environmental limits within which humanity can flourish."

The Lancet Commission's report laid down the overarching principles guiding the idea of planetary health. One is that human health depends on "flourishing natural systems and the wise stewardship of those natural systems". Human activities, such as energy generation and food production, have led to substantial global effect on the Earth's systems, prompting scientists to refer to the modern times as the anthropocene.

A group of Earth system and environmental scientists led by Johan Rockström from the Stockholm Resilience Centre proposed the concept of nine planetary boundaries within which humanity can continue to develop and thrive for generations to come. According to a 2015 update, four of the planetary boundaries – climate change, biosphere integrity, biogeochemical flows, and land-system change – had already been exceeded.

The report concluded that urgent and transformative actions are needed to protect present and future generations. One important area which required immediate attention was the system of governance and organization of human knowledge, which was deemed inadequate to address the threats to planetary health.

The report made several overarching recommendations. One was to improve governance to aid the integration of social, economic, and environmental policies and for the creation, synthesis, and application of interdisciplinary knowledge. The authors called for solutions based on the redefinition of prosperity to focus on the enhancement of quality of life and delivery of improved health for all, together with respect for the integrity of natural systems.

International research agenda for planetary health
In June 2023, the Royal Netherlands Academy of Sciences presented their planetary health report ''Planetary Health. An emerging field to be developed'' based on a two-year consultative process.Many knowledge gaps were identified in the field of planetary health. A review of the literature and subsequent consultation with experts resulted in a longlist of more than one hundred specific knowledge gaps. Knowledge for the health impacts of global environmental change on human health are incomplete, pathways are poorly understood, the effectiveness of mitigation and adaptation measures are still unclear, how timely policy and behaviour change can be realised. The KNAW concluded that: "Filling all Planetary Health knowledge gaps requires an international collaborative effort in research funding". The Academy will cooperate with international partner and ‘umbrella academies’ (such as EASAC, FEAM and ALLEA) how to take this agenda forward."

Issues
Planetary health concerns itself with governance and stewardship which pose a threat to the sustainability of the human civilization, environment, and planet. Specifically, it seeks to confront three main types of challenges: "imagination challenges", such as failing to account for long-term human or environmental consequences of human progress; "research and information challenges", such as underfunding and lack of scope in research; and "governance challenges", such as delayed environmental action by governing bodies determined by unwillingness, uncertainty, or non-cooperation.

A primary ethical focus of planetary health research is human cooperation and non-cooperation in the form of conflict, nationalism, and competition. As one goal, the Lancet Commission on Health and Climate Change plans to use an accountability mechanism to track human cooperation and study the link between health, climate, and political action.

Likewise, nutrition and diet are important contributors to and indicators of planetary health. Scientists speculate that human population growth threatens the carrying capacity of the planet. Diets, agriculture, and technology must adjust to sustain population projections upwards of 9 billion while reducing harmful consequences on the environment through food waste and carbon-intensive diets. A focus of planetary health research will be nutritional solutions that are sustainable for the human species and the environment, and the generation of scientific research and political will to create and implement desired solutions. In January 2019, an international commission created the planetary health diet.

Planetary health aims to seek out further solutions to global human and environmental sustainability through collaboration and research across all sectors, including the economy, energy, agriculture, water, and health. Biodiversity loss, exposure to pollutants, climate change, and fuel consumption are all issues that threaten human and climate health alike, and are, as such, foci of the field. A number of researchers think that it is actually humanity's destruction of biodiversity and the invasion of wild landscapes that creates the conditions for malaria, and new diseases such as COVID-19.

Planetary Health Alliance
The Planetary Health Alliance is an informal global consortium of over 340 universities, NGOs, government entities, and research institutes with over 20,000 newsletter subscribers. The Alliance aims to support the development of "rigorous, policy-focused, transdisciplinary field of applied research aimed at understanding and addressing the human health implications of accelerating change in the structure and function of Earth's natural systems."

Several PHA Regional Hubs function as locally rooted communities that bring PHA members together in geographic clusters to collaboratively advance planetary health research, education, policy, and outreach relevant to specific local contexts.

In 2022, the inaugural Planetary Health European Hub was held in Amsterdam, with 72 institutions represented. The inaugural meeting was organized by the Planetary Health Alliance, the European Environment and Sustainable Development Advisory Councils Network (EEAC Network), and Natura Artis Magistra (ARTIS). The PHA Europe Secretariat has been located in the Netherlands. It is jointly coordinated by Maastricht University and the University Medical Center Utrecht (UMC Utrecht).

Comparison with other fields
Planetary health is considered a response to existing fields and paradigms such as public health environmental health, ecohealth, One Health and international health.

While there may be competing definitions of global health, it is loosely defined as the health of populations in a global context, a response to the cross-border movement of health drivers as well as risks, and an improvement over the older concept of international health with its new emphasis on achieving equity in health among all people. Some scholars hold that advocacy of planetary health amounts to an over-expansion and totalization of health.

The editor in chief of The Lancet Richard Horton wrote in a 2014 special issue of The Economist on planetary health, that global health was no longer able to truly meet the demands which societies face, as it was still too narrow to explain and illuminate some pressing challenges."Global health does not fully take into account the natural foundation on which humans live – the planet itself. Nor does it factor in the force and fragility of human civilizations."

Judith Rodin, president of the Rockefeller Foundation, declared planetary health as a new discipline in global health.