Planetary health event summary

Planetary health Improving human health by healing the planet The human health impacts of accelerating global environmental change are likely to be the biggest humanitarian challenge of

Planetary health

Improving human health by healing the planet

The human health impacts of accelerating global environmental change are likely to be the biggest humanitarian challenge of this century

Samuel Myers, research scientist, Harvard School of Public HealthSummary of a meeting hosted by The Rockefeller Foundation

Introduction from the Rockefeller Foundation

Since its birth more than 100 years ago, The Rockefeller Foundation has worked in public health because it believes good health underpins human progress Its efforts have ranged from developing the vaccine for Yellow Fever

to strengthening disease surveillance systems to advising several Asian and African governments on their new Universal Health Care coverage efforts

Over time, this focus on public health has flowed into work on the Foundation’s other three “pillars”: improving cities, ecosystems and livelihoods Bolstering these pillars, the organization believes, best helps meet its two primary goals: advancing inclusive economies that expand opportunities for more

The Planetary Health meeting was convened by The Rockefeller Foundation and The Lancet

with support from The Rockefeller Foundation.

broadly shared prosperity, and building greater resilience by helping people, communities and institutions prepare for, withstand and emerge stronger from acute shocks and chronic stresses

In this century, the link between environmental change and human health has become ever more apparent Malaria is arriving in new places as temperatures climb Global environmental change is causing rare plant species to vanish along with the forests that harbor them Such plants could be a key ingredient

in a life-saving medicine The alarming rate at which these changes occur could have catastrophic consequences not just on our health, but also on the systems and structures that form the bedrock of humanity The very survival

of our species and civilization is thus at risk All this begs the question: What

if the environment is unable to take care of us because we have not taken care of it?

To consider this interdependency and address the potential health crisis implied by dramatic environmental change, in July 2014 The Rockefeller

Foundation and British medical journal The Lancet convened a meeting on

“The Future of Planetary Health” at the Foundation’s Bellagio Conference Center in Italy More than 30 high-level participants, including scientists, entrepreneurs, public health experts, business executives and government leaders met to better understand planetary system disturbances, and to explore possible solutions to future threats Insights from the meeting flowed into a subsequent smaller Rockefeller Foundation–Lancet Planetary Health Commission meeting

“The Future of Planetary Health” was the third in the Foundation’s series of high-level meetings focused on imagining a very different future by 2025

in its four pillar areas By bringing together diverse, sometimes opposing perspectives, the Foundation hopes to help develop vital strategies and solutions that will fortify humanity’s ability to anticipate and adapt to rapidly emerging opportunities and challenges For more information on the series, please go to www.visionariesunbound.com The Economist Intelligence Unit wrote this summary report, with the exception of the Introduction and Conclusion, which were written by The Rockefeller Foundation

Planetary Health

brought together

more than 30 experts

to explore ways to

improve human health

by healing the planet

to tropical disease such as Dengue fever as temperatures rise in higher latitudes and natural habitats like forests disappear, and a rise in famine, flood, drought and intense storms stemming from climate change

Now is the time for a focused study on the complex, interdependent and powerful impact of natural systems change on our human health, say prominent scientists such

as Richard Horton Ignoring or failing to address these changes, Horton, The Lancet

editor-in-chief argues, threatens our social fabric, systems, structures and civilization

As evidence mounts and attention shifts to this urgent area, a number of ideas are emerging Many of these surfaced at a July 2014 “Future of Planetary Health“ meeting, hosted by The Rockefeller Foundation They range from harnessing data, analytics and predictive modeling to build the business case for different policy and natural resource

The progress we’ve

made in global health

use decisions; to storytelling to inform and incite action; to bringing new players, such

as millennials and local communities into the fold to lead behavioral change

Five of these are believed to be particularly applicable to help solve some of the critical, enmeshed challenges They are outlined below These ‘future solutions’, or key recommendations, emerged from discussion among five working groups that focused on the human health impacts of changes in our planet’s climate, biodiversity, land-use and in its marine and freshwater ecosystems:

1 Better governance structures for managing global resources: Coveted global

“commons” such as freshwater, air, forests and oceans have not been sufficiently protected, because market economies often fail to fairly value healthy commons, or

to extract costs for damaging them To help protect the ocean commons and reduce overfishing, the Oceans Working Group proposed an oceans-focused United Nations agency To provide a viable commercial alternative to the current fishing industry, the group recommended establishing and scaling up a sustainable aquaculture industry

by 2030 Other suggested goals included developing a global fisheries lab to measure and monitor the health of wild fisheries through, for example, innovative technologies such as deep-sea robots monitoring progress in rebuilding fish stocks

2 Evidence-based input about the likely impact of land-use changes to influence decision-making: Those who make land-use decisions often fail to grasp the positive and negative impacts of their decisions on the health of often distant ”downstream” communities, particularly in areas with robust agro-industrial development around rapidly growing cities To better inform natural resources management and public health decisions, the Land Use Working Group proposed case studies to explore the human health impact of ecosystem changes on such areas as infectious diseases, nutrition and mental health Such studies may demonstrate how alternative approaches that explicitly account for the public health consequences of environmental change can increase system sustainability and resilience To provide city leaders with real-time, relevant information for key decisions, the group also recommended generating relevant health and environmental data through personal and site-based monitoring Such quantifiable measures might trigger a range of market-based solutions, such as payments for ecosystems services or tax incentives

3 More evidence-based information about the potential benefits of ecosystems protection to spur policy change: Policy makers will be more apt to craft laws and incentives and fund programs that protect vital ecosystems with quantitative measures

of their benefits The Biodiversity Working Group proposed the increased use of national

”natural capital” accounts, forecasting models and environmental-impact statements

to help measure the long-term human health impacts of environmental change to motivate businesses, communities and government to change their behavior

4 New business models to deliver scarce resources to underserved and vulnerable regions: Vital goods and services like water often fail to reach the poor in small and remote villages because infrastructure costs are prohibitively high But many innovative financing and delivery schemes have emerged that make this possible and protect the environment Such models—including microfinancing, crowdsourced

Are we able to act

funds and payment-for-ecosystem-services programs—were the cornerstone of the Freshwater Working Group’s proposal to help bring clean water to the world’s 1 billion people with insufficient to no water supply Suggested building blocks include web-based proposal templates for communities to begin fund-raising efforts, and a global Water Corps to advise communities on building and maintaining water infrastructure Small-scale water-collecting solutions like cisterns, open data for stakeholders to track water distribution and conservation progress, and alternative payment currencies such as “water coin” (like Bitcoin) were among other recommendations.

5 The creation of an entirely new field to focus attention, resources and action

on this urgent area: At watershed moments in history, new institutions and ways

of thinking have surfaced for a singular focus on critical issues The Climate Change Working Group called for an entirely new discipline to tackle accelerating and complex problems linked to the environmental change–human health nexus in a rapid and

will never see the

light of day until it

is finished But they

continue to work.

Derek Yach,

senior vice president,

Vitality Group

calibrated way It recommended communications campaigns and convening investors and funders within a year to finance and focus on the programmatic aspects of this new field The commission and future work will explore this undertaking.

As we pass critical environmental thresholds, the threats are great to both human health and survival We can intervene and shift bit by bit the trajectory of environmental change and these threats We can collaborate across many sectors that are directly impacted by these changes, such as environmental science, food production, construction and public health

But without a distinct focus by public-health practitioners on the accelerating, complex and profoundly interdependent drivers of ecological change and human health, our very civilization is at risk Only then will all the critical players in the private sector, government and science fall into place, to advance research, policies and action at global, regional and local levels

Human health and the environment have been interwoven since the beginning of time Temperate conditions helped societies thrive in lush coastal regions like Mesopotamia, the Mediterranean and the Mississippi Delta over five millennia Rainfall quantity and soil quality in an agrarian world first determined health and wealth and drove the development of a merchant economy, as cotton, fish and timber were bought, sold and traded As a result, some societies prospered and others floundered These forces ebbed and flowed, largely with the earth’s natural order

The coal furnaces and factories of the Industrial Revolution changed all that A surge

in production brought prosperity to many But the belching smokestacks of the 1800s rained toxins on many homes and farms and triggered lung infections; progress in the use of chemicals and fertilizers improved lives, but also often brought unintended health consequences, such as other diseases Medicine made great gains over that time, as public-health systems and resources to fund them triggered medical innovation, treatment and cures But scientists struggled to keep pace with the spate

of new illnesses

Still, in no other era has the natural rhythm of our planet’s weather, air and use patterns changed so dramatically as in our own, largely due to humanity’s very visible hand While the world is much wealthier than it was a century ago, the wealth accumulation has come at a price to our planet’s lungs and our own Paradoxically, while illness triggered by discrete environmental impacts such as pollution has decreased with improvements in medicine, water and food safety, the vulnerability of our health increases due to unpredictable climate change patterns Rising affluence and rapid population growth are likely to accelerate the pace of environmental change and threats to human health

land-Scientists and policy makers are sounding the alarm They are calling for deeper and broader research into the interdependent and complex nature of the relationship between our environment and our health so that governments, organizations and companies can respond more effectively They are also calling for institutional change

to address threats to our enmeshed environmental, human health and social and economic systems as we cross critical thresholds By devising the right strategies and spotting opportunities to shift the trajectory, experts hope to improve our stewardship

of the planet and safeguard human health

Improving human health by healing the planet

To imagine a different future by 2025 and surface strategies that may help us get there, in

July 2014 British medical journal The Lancet and The Rockefeller Foundation convened a

high-level, four-day conversation with experts for an honest assessment of the health of the earth and of humanity—and the connections between the two The meeting aimed to identify gaps in our knowledge and to build an accelerated, global and multi-sectoral plan

to advance research and spur action

It also sought to inform international policy and incite proactive responses before

we cross critical environmental thresholds With the world population set to soar to 9.6 billion by 2050—and with more than half of all people already living in cities— addressing this problem is all the more urgent

Global leaders at the meeting hailed from over 30 institutions, organizations and companies, including Harvard Medical School, the United Nations, the African Development Bank, the X-Prize Foundation, PepsiCo and Monsanto (see list of participants in the appendix)

“The world is undergoing enormous stress Many parts of the world are suffering from the human footprint, which is testing the biosphere’s capacity,” said Richard

Horton, editor-in-chief of The Lancet, at the meeting’s opening “If we transcend

critical environmental boundaries, we get into deep trouble Meanwhile, we struggle with partisan gridlock, stressed financial institutions and fractured nation-states As

we move forward, I have a feeling of immense danger,” he said “How do we present the science to motivate behavioral change?”

The conversation

A useful starting point for understanding the environmental and human health nexus is “planetary boundaries,” or tipping points in our planet’s air, land, fresh water and ocean natural systems that are most influenced by environmental shifts These boundaries were defined in 2009 by a group of 28 internationally renowned scientists (http://www.stockholmresilience.org/21/research/research-programmes/planetary-boundaries/planetary-boundaries/about-the-research/the-nine-planetary-boundaries.html) The framework considers changes in our natural systems, including ozone levels, biodiversity loss, atmospheric greenhouse gases, ocean acidification, land use change (see chart, pp 11), and other environmental changes that threaten the conditions under which humanity can “safely operate.”

If one or more of these boundaries is breached, altered environmental trajectories could cause rapid, nonlinear and irreversible changes in planetary systems that could jeopardize the very survival of the human species Notably, three planetary boundaries have already been crossed—those of climate change, biodiversity and the global nitrogen cycle—according to the framework’s architects Atmospheric CO2has increased by 40% since 1800, primarily from burning fossil fuels and land-use changes that have resulted in increased polar-sheet ice melting, a sea-level rise of 0.19 meters since 1900 and ocean acidification

Planetary Boundaries

1 STRATOSPHERIC OZONE LAYER

This layer of the atmosphere filters out

ultraviolet radiation (UV) from the sun

Its thinning allows more UV to reach the

ground, which can increase the incidence

of skin cancer Though the Antarctic ozone

hole suggested a bypassed threshold,

Montreal Protocol actions have reversed

this trend

2 BIODIVERSITY

Changes in biodiversity due to human

activities were more rapid in the past

50 years than at any time in human

history according to the 2005 Millennium

Ecosystem Assessment High rates of

extinction and ecosystem damage can be

slowed by efforts to preserve threatened

species, critical habitats and connectivity

Further research is underway to determine

whether a boundary based on extinction

rates is sufficient.

3 CHEMICALS DISPERSION

Toxic compound emissions from heavy

metals, synthetic organic pollutants and

radioactive materials can persist in the

environment for a very long time, and their

effects are potentially irreversible Chemical

pollution can result in reduced fertility and

potentially permanent genetic damage

within ecosystems Persistent organic

compounds, for example, have reduced

bird populations dramatically and impaired

reproduction and development in marine

mammals

4 CLIMATE CHANGE

The Earth has already transgressed the

planetary boundary and is approaching

several Earth system thresholds Climate

change is driving the Earth system into

a much warmer state with intensified

climate impacts These include summer

polar sea-ice loss which is seemingly

irreversible and sea levels metres higher

Weakened or reversed terrestrial carbon

sinks due to ongoing deforestation and

agricultural emissions is another potential

tipping point How long remains before

large, irreversible changes become

unavoidable is an open question.

5 OCEAN ACIDIFICATION

Greater ocean acidity, currently more than

30% over pre-industrial levels, reduces

the amount of available carbonate ions,

an essential ‘building block’ used by many

marine species for shell and skeleton

formation Rising acidity threatens the

growth and survival of organisms such as

corals and some shellfish and plankton

species, which would change the structure

and dynamics of ocean ecosystems

globally The boundaries are tightly

concentration is the controlling variable for both the climate and the ocean acidification boundaries

6 FRESHWATER CONSUMPTION AND

THE GLOBAL HYDROLOGICAL CYCLE

Human pressure now largely determines the function and distribution of global freshwater systems Consequences include global-scale river flow changes and vapour flow shifts arising from land use change

Shifts in hydrology may be abrupt and irreversible Because water is increasingly scarce—by 2050 about half a billion people may be water-stressed—a boundary related to consumptive freshwater use and water resilience is a vital index for human development

7 LAND SYSTEM CHANGE

Forests, wetlands and other vegetation types have primarily been converted

to agricultural land, seriously reducing biodiversity, and impacting water flows and the biogeochemical cycling of carbon, nitrogen and phosphorus and other important elements Collectively, these local land cover changes have consequences for Earth system processes on a global scale

8 NITROGEN AND PHOSPHORUS INPUTS TO THE BIOSPHERE AND OCEANS

The biogeochemical cycles of nitrogen and phosphorus have been radically changed by humans as a result of many industrial and agricultural processes Fertilizer production and application results in dramatic increases

of emissions not absorbed by plants When

in rain, these pollute waterways and coastal zones or accumulate in the terrestrial biosphere Large amounts of applied nitrogen and phosphorus end up at sea and can push marine and aquatic systems across ecological thresholds

9 ATMOSPHERIC AEROSOL LOADING

Through their interaction with water vapour, aerosols play a critically important role in the hydrological cycle affecting cloud formation and global-scale and regional patterns of atmospheric circulation, such as monsoons

in tropical regions They also change how much solar radiation is reflected or absorbed in the atmosphere Humans change the aerosol loading by emitting atmospheric pollution and also through land-use change that increases the release

of dust and smoke into the air Inhaling highly polluted air causes roughly 800,000 people to die prematurely each year

The nine planetary boundaries

Source: Stockholm Resilience Centre; www.stockholmreslience.org/Rockefeller Foundation

Scientists are now studying the links between global environmental changes affecting the earth’s essential support systems and human health These primary health impacts

were explored in a background paper presented at the meeting by The Lancet The

paper examines possible strategy and policy shifts to prevent or reduce the damage, and proposes interdisciplinary and collaborative research to better inform decisions The potential range and extent of impacts on human health are startling and beg for action For instance, fisheries, a key global food source, are already collapsing

in many parts of the world due to overfishing The interplay of this alarming trend with rising acidity in our oceans threatens serious further damage (Ocean acidity has increased by around 30% since the Industrial Revolution due to the absorption of carbon dioxide, and could double again by 2050.)

Climate change alone will potentially trigger a rise in under-nutrition, heat-related deaths, some vector-, food- and water-borne diseases, and floods, drought and intense storms, according to the United Nations’ Intergovernmental Panel on Climate Change (IPCC) In 2006, the World Health Organization (WHO) estimated that environmental factors contribute to nearly a quarter of all human diseases, from established risks like air pollution, insufficient or tainted water supplies, and poor sanitation But that number is probably much higher when accounting for the environmental-change-related risks we are only now beginning to understand

Of the nine planetary boundaries, the interplay of four—climate change, biodiversity loss, land use and freshwater consumption—creates perhaps the most immediate challenge to both planetary and human health Our land-uses have a particularly heavy ”ecological footprint.” Forest clearing for farming, timber or land development can erode biodiversity, fragment and pollute watersheds, rob the soil of key nutrients, and reduce the natural infrastructure that serves as buffers against extreme weather events and human vulnerability

The immediate and alarming health impacts of these changes are many and varied They include the rising prevalence and faster spread of disease from insect and mammal carriers, such as Lyme disease, West Nile virus, bird flu and hemorrhagic viruses including Ebola Many waterborne diseases, from cholera to typhoid fever to shistosomiasis, are transmitted through human exposure to polluted waters and to

Areas of risk

Our success with

the easier health

problems may

bring some cause

for optimism But

the next set of

Diseases are also appearing in abnormal locales as weather patterns shift Malaria and Dengue fever have surfaced in Europe, and the West Nile virus on the U.S East Coast As higher latitudes and altitudes become warmer and wetter, they become more suitable environments for “tropical” diseases and their animal and insect carriers These diseases can spread quickly and rapidly become epidemics as air travel and contact with those across the world rise The world is ill-prepared for the migration of diseases to new places, driven by climate change, continued ecosystems degradation, and the rising exposure of people to such diseases

The links between biodiversity loss and human disease transmission are thoughtfully explored in “Biodiversity Loss Affects Global Disease Ecology,” by Montira J Pongsiri

and others in the December 2009 issue of Bioscience, also distributed prior to the

or diesel fuel, industrial emissions, and from indoor, household sources, such as inefficient cook stoves or burning wood, dung or coal, particularly in poor countries Many of these air pollutants also contribute to climate change

Human health will increasingly suffer in the future as a result of the environmental changes that are affecting the basic human needs of water and food In some regions, less water is likely to be available for human use, for sanitation, hygiene and food production due to changes in temperature, rainfall and pollution, and water overuse Pollinators like bees that help trigger and increase food production may also disappear when their natural habitats vanish Lastly, the nutritional quality of the food we eat may fall with a rise in atmospheric CO2 levels For example, in some crops, micronutrients such as zinc and iron fall with a rise in atmospheric CO2 levels.1 Without decisive action, global average temperatures could rise four degrees above pre-industrial levels by the end of the century, posing serious threats to our well-being and to global economic development, according to the IPCC