Understanding planetary health

Planetary Health: Protecting Nature to Protect Ourselves is a milestone—the first textbook for the emerging field of planetary health. I read the book under lockdown at home in Australia, a requirement of the public health response to the COVID-19 pandemic in Melbourne. At the same time, wildfires were raging in the USA that made me recall the devastating 2019–20 Australian wildfire season. Those fires were unprecedented. They killed more than 30 people, burned more than 11 million hectares of land, and resulted in prolonged smoke pollution that has since been linked to more than 400 premature deaths. Ecologists have estimated that about 3 billion animals died in the Australian wildfires. And now, in the southern spring of 2020, the first wildfires of the coming Australian season are already upon us. Wildfires are now overlapping in the northern and southern hemispheres. Something has changed.

We have entered the Anthropocene epoch. This is a new geological epoch in which humans, collectively, are now changing earth systems to such an extent that it will be seen in the fossil record. Wildfires and pandemics are symptoms of the Anthropocene epoch. Climate change is amplifying the intensity and frequency of wildfires. Spillover of novel pathogens such as severe acute respiratory syndrome coronavirus 2 from animals to humans occurs in the context of social and environmental change, including agri-food system transitions, biodiversity loss, urbanisation, and climate change.

In 2014, the concept of planetary health was advanced in this journal through a published manifesto. The subsequent Rockefeller Foundation–Lancet Commission on planetary health published its report on safeguarding human health in the Anthropocene epoch in 2015, defining planetary health as the health of human civilisation and the state of the natural systems on which it depends.

Planetary Health: Protecting Nature to Protect Ourselves is certainly an anthropocentric title for a book. But, that's understandable, and reasonable, for a book edited by two environmental epidemiologists. Based in the USA, Samuel Myers and Howard Frumkin are pioneers of research on health and environmental change, and founders of the field of planetary health. This book will help students and other readers understand planetary health challenges. It is timely because all stakeholders need to know about the Anthropocene and what it means for the future wellbeing of people and, indeed, all other life on earth.

The introductory chapter of the book sets the scene well, providing a compelling rationale for a planetary health approach. Myers and Frumkin are sounding an alarm about health challenges in the Anthropocene. They are not the first medical scientists to do so, and the second chapter offers an instructive historical perspective on planetary health discourse. The book's 18 chapters are clustered in four parts—”foundations”, “the health of populations”, “pivoting from threat to opportunity”, and “saving ourselves, saving our planet”—that follow a logical order moving from foundational concepts in planetary health, through challenges, to solutions. This structure makes it a practical and useful handbook for planetary health education.

© 2020 Matthew Abbott/Panos Pictures

The first part on foundations, includes an excellent chapter “A Changing Planet”, which comprises succinct and clear explications of key concepts, including climate change, land use change, biodiversity loss, and pollution. By the end of part one, the reader is ready to explore the connections between these planetary changes and human health. In the book's second part, it is great to see the attention to mental health and happiness, which don't always receive the emphasis they warrant in this field. Part three focuses on solutions and presents positive stories about action for planetary health. The themes explored include energy and urban transitions, controlling toxic exposures, and economics and business. The authors highlight health co-benefits from renewable energy and sustainable urban transitions. I would like to have seen more about sustainable agri-food system transitions, although this is canvassed to some extent in the chapter on food and nutrition in part two. As I read the chapter on energy and planetary health, written by Ajay Pillarisetti and Kirk Smith, I paused to reflect on the immense contributions to planetary health made by Smith, who died earlier this year. Smith was both an academic and activist, and a generous mentor to many people around the world. His pioneering work on indoor air pollution saved many lives. The final chapters of the book round it out with perspectives on ethics and an aspirational and optimistic vision of the future for planetary health. The format of the book is engaging, with readable text complemented by an interesting mix of figures, tables, and photographs.

The author roster is impressive, and many of the contributors are US experts. This should not be taken as a criticism. The USA has a large, polluting economy and it is crucial that US students read and understand this book, although the themes raised in Planetary Health: Protecting Nature to Protect Ourselves are of global relevance. The editors also point readers to Planetary Health Case Studies: An Anthology of Solutions, an online companion to the book. These case studies take us around the world—from Indonesian peatlands, through rainforests in Madagascar, to river basins in Fiji. There is much to learn about planetary health from these diverse geographies and useful case studies. It is also a strength that interdisciplinary scholars who are thought leaders in planetary health have authored and edited this book. The authors have identified key challenges and propose practical solutions. We will need more books like this—planetary health textbooks that are meaningful for other regions of the world.

This book provides a comprehensive and illuminating overview of planetary health, yet there are two points I would raise. The first is a seemingly modest recognition of Indigenous perspectives on planetary health. While this topic is rightly raised in the history chapter, in my view it warrants more prominence in the section on the way forward. Too often, health researchers focus on measuring and tracking Indigenous health disparities. However, there is much to learn from Indigenous ways of understanding the world. Although planetary health is an emerging discipline in health research and public policy, the concept that human health is dependent on the planet's natural systems is not a new idea for Indigenous peoples. Understandings of the links between the health of people and natural systems are central to Indigenous spiritual traditions and some cultural practices.

Indigenous perspectives on planetary health, for example, informed the International Union for Health Promotion and Education (IUHPE) World Conference on Health Promotion in New Zealand in 2019. Co-Chaired by Sione Tu'itahi, the conference produced legacy documents, including the Waiora Indigenous Peoples' Statement for Planetary Health and Sustainable Development. Tu'itahi now chairs an IUHPE global working group on planetary health, which is striving to bring Indigenous knowledge about planetary health into everyday health promotion practice.

My second point is not specific to this book. Rather, it is a challenge for all of us in the field of planetary health—foregrounding the health of civilisations in planetary health discourse. The current dominant human culture is at the heart of planetary health challenges. And yet, as human ecologist Stephen Boyden has noted, changing this culture is the only solution to these challenges. Human development must be de-coupled from resource use and environmental degradation. There is a pressing need for a change of mindset to ways of living that are in harmony with nature—to “planetary consciousness” in everyday life and in wider socioeconomic and commercial systems. There is much more work to be done to bring this civilisational health perspective into focus. It will require the engagement of scholars and other actors across fields including anthropology, global studies, and political ecology.

The Afterword in the book places the COVID-19 pandemic in a planetary health context. The editors cogently argue that the pandemic is another signal that humanity is out of balance with natural systems. Notably, this pandemic has also shown that massive, rapid change is possible, and this offers hope for a brighter future. However, the pandemic has exposed deep societal inequalities and, for the sake of the wellbeing of future generations, our pandemic recovery efforts must accelerate transitions to a healthy, fair, and sustainable world.

Planetary Health: Protecting Nature to Protect Ourselves is an important book. It is an excellent primer on planetary health. I like it, and hope it is widely read. It certainly is a timely text for burgeoning university courses in planetary health. Planetary Health: Protecting Nature to Protect Ourselves should be on the reading list of all health professionals because they have an important part to play as we strive for planetary health.