Planetary Health

This must be the single most authoritative and comprehensive volume on planetary health taking an integrated systems perspective, one element of which is the relationship between human health and the health of the soil, a connection already apparent to Sir Albert Howard and the founder of The Soil Association, Lady Eve Balfour, as far back as the 1940s, and more recently championed by Vandana Shiva – members will find the video of our June 2021 event on the website. Howard had learned this from his own experience of Indian traditions (see his An Agricultural Testament, 1940) and wrote: ‘the birthright of all living things is health. This law is true for soil, plant, animal, and man: the health of these four is one connected chain.’ It follows that any weakness or defect in the health of any earlier link eventually reaches us and that regeneration of the soil is a key factor in regenerating human health. In other words, humans are systemically integrated in natural systems with complex feedback loops usually dependent on our basic attitude towards and relationship with Nature.

This multi-author book by world authorities in their fields is structured into four parts and 18 chapters, beginning with foundations and moving on to the health of populations, pivoting from threat to opportunity and finally saving ourselves, saving our planet. The final draft was written at the beginning of the pandemic, where the editors remarked that Covid 19 is a planetary health problem reflecting our basic orientation towards Nature where the destruction of habitats promotes the potential spread of zoonotic disease. They were writing before the hypothesis of the lab origin of the virus became more respectable, as well as information about the enormous dangers posed by gain-of-function research, as now noted even by Prof Jeffrey Sachs in his capacity as chair of the Lancet Commission – Sachs dismissed a number of members, including Peter Daszak of the EcoHeatlh Alliance, for not being transparent about having no conflicts of interest. The editors highlight a number of illustrative themes arising out of the pandemic: complex systems, geographical reach, surprises, equity, the human relationship with nature, building resilience, heeding science, and the role of government. They ask if this gives a basis for hope in terms of our realising the precariousness of life on earth as well as our capacity for rapid and massive change.

Early in the book, the editors identify key systemic drivers of biophysical change in the dimensions of climate, pollution, rapid biodiversity loss, reconfiguration of biogeochemical cycles, pervasive changes in land use and land cover; and depletion of resources including fresh water and arable land. The important point is that ‘each of these dimensions interacts with the others in complex ways, altering core conditions for human health’ whether in terms of air, water, food or exposure to disease. In addition to the themes highlighted above, they add the need to reduce vulnerability, quantifying externalities, the role of political power, stewardship, winners and losers, urgency, and the fact that we are in new ethical terrain prefigured by pioneers such as Tony McMichael, Barry Commoner, René Dubos and Rachel Carson. Current global responses tend to be vertical and top-down using technological fixes and simplistic metrics as a response to the dark side of development. The overall context includes population, consumption, equity and rights, which are contextualised in the chapter on a changing planet with its arresting analysis across different factors.

The next section on the health of populations covers food and nutrition, infectious disease, noncommunicable disease risks, the relationship between environmental change, migration, conflict and health, mental health and happiness, and the impact of climate change. Overall, we are witnessing the ecological consequences of economic growth and the great acceleration since World War II. We now face a triple challenge of providing nutritious diets to the burgeoning population, doing so in a context of changing climate, increasing water scarcity, degraded arable land, declines in fisheries in pollinators, and other biophysical changes; and we need to achieve this by reducing the ecological footprint of our food production systems. I found it interesting that the editors chose to cover mental health and happiness in two separate chapters in the light of evidence for the impact of environmental change. There is a clear link between happiness and human health in terms of social bonds, prosocial behaviour, trust and spending time in Nature.

The third part begins with consideration of planetary health in relation to energy and urbanisation, with a separate and a robust chapter on controlling toxic exposures, which frequently receives insufficient attention. Here the authors highlight the inadequacy of existing regulations and the need to recast these taking a planetary health approach with the help of green chemistry (p. 380). Needless to say, new economic and business models are essential, and are addressed in two significant chapters. The authors rightly stress the inadequacy of GDP as the measure of progress, discussing other possible indicators - as well as doughnut economics - that will prioritise well-being (see diagram on p. 411). In this respect, various branches of economics can make positive contributions that will also involve a recasting of the relationship between six forms of capital. Governance systems as well as business models are in need of an overhaul as many are currently incompatible with planetary health, seeking to externalise environmental and social costs. Industrial beef production is a case in point, but its replacement by synthetic alternatives within the existing industrial food system raises other significant issues.

The chapter on planetary health ethics is crucial in developing a framework of appropriate principles. These will need to take into account intergenerational responsibility, extending rights to the more than human world, distributive justice, the precautionary principle, and the right to know – the authors identify action points in each of these areas and note that formative documents should incorporate the following attributes: a social movement, a scientific framework and an attitude towards life that fosters resilience and adaptation. Nor should such a document he produced by and those in power as it will reflect their own vested economic and political interests.

The last part sets out paths to a better future, citing Davey’s ten ways to save the world, which would be a good start: transitioning to renewable energy, conserving forests, combating soil degradation, better water management, protecting biodiversity, curbing overfishing and ocean pollution, building greener cities, reducing waste and improving recycling, strengthening reproductive healthcare, and transitioning towards a healthier diet. Much of this is incorporated in the UN sustainable development goals, but early indications of their implementation point towards centralised draconian and authoritarian measures (viz Dutch farmers) rather than encouraging local and bottom-up self-organising activities in which we can be directly involved. This volume is a truly impressive briefing that could form a sound basis for a common vision of planetary health and practical policy pathways towards its gradual realisation.