Planetary health: from concept to decisive action

Planetary health sets the ambitious task of understanding the dynamic and systemic relationships between global environmental changes, their effects on natural systems, and how changes to natural systems affect human health and wellbeing at multiple scales: global (eg, climate), regional (eg, transboundary fire emissions), and local (eg, persistent organic pollutants). By emphasising interconnections between human health and environmental changes and enabling holistic thinking about overlapping challenges and integrated solutions for present and future generations, the concept of planetary health offers an opportunity to advance the 2030 Agenda for Sustainable Development, including identification of co-benefits across targets, encouraging effective cross-sector action and partnerships, and ensuring policy coherence.1 In turn, the agenda of the Sustainable Development Goals (SDGs) offers substantial opportunities to advance planetary health. As the scientific evidence strengthens and public appreciation of humanity's dependence on the state of natural systems increases, now is the time to move from concept to decisive action to protect planetary health.

Moving beyond a conceptual approach to advance actions for planetary health, and for the SDGs, requires monitoring of and reporting on indicators relevant to planetary health that capture the scope, spatial, and time scales of changes to natural systems affecting human health and wellbeing and to assess the effects of potential solutions. A fortified evidence base on planetary health solutions, including their costs, trade-offs, and effects on the most vulnerable and marginalised groups, could accelerate the development, prioritisation, coordination, and implementation of key policy actions to protect planetary health at local, national, regional, and global levels. Monitoring of planetary health can build on existing indicators including for the SDGs to enable additional questions to be addressed—eg, the extent to which social and economic progress in a given country is based on unsustainable exploitation of natural systems and whether specific groups are disproportionately negatively affected. Effective governance, tools, and institutional capacity will be required to bring evidence produced through planetary health monitoring into decision making processes.2

There are established and emergent examples of the effective use of monitoring that can be built on, including The Demographic and Health Surveys. Environmental monitoring includes remote sensing of land cover, pollution, and other aerosols, and citizen science monitoring of biodiversity and habitats.3 Integration of data on the state of natural systems and related human health outcomes, together with effective policy responses at similar spatial and time scales, are envisioned by The Lancet Countdown on health and climate change4 and the developing Planetary Health Watch initiative.5 Both are examples of monitoring that will be crucial for integrated analyses and for the development of integrated tools to address specific policy needs (panel). Important policy needs include using indicators to track environmental and health trends over time and detecting signals of natural system instabilities that portend health risks. The outputs and outcomes of monitoring and reporting can help ensure the design of effective policy, targets, and actions. For example, the well studied relationship between exposure to PM2·5 and health allows quantification of health effects of exposure to PM2·5 in fire emissions associated with land clearance. In Indonesia, where setting fires to peatlands for agricultural production is common practice, human morbidity and mortality estimates could inform and justify peatland protection activities by helping to prioritise which peatlands to protect, and avoiding fires, could help prevent the greatest human health risks in nearby population centers.7 A planetary health understanding could inform interventions that together can protect, or at least minimise harm, to health, peatlands, and biodiversity threatened by fires while reducing greenhouse gas emissions and supporting livelihoods.8