Planetary health: The missing priority in CIHR’s new strategic plan

“At the heart of this assessment is a stark warning. Human activity is putting such strain on the natural functions of Earth that the ability of the planet’s ecosystems to sustain future generations can no longer be taken for granted.” – Millennium Ecosystem Assessment, 2005

“Protect and preserve the source of human health: Nature . . . the original source of all clean air, water, and food.”  – WHO Manifesto for a Healthy Recovery from Covid-19, 2020

“The state of the planet is broken. Humanity is waging war on nature. This is suicidal.” – Antonio Guterres, UN Secretary General, at Columbia University’s World Leaders Forum, Dec. 2, 2020

The Canadian Institutes of Health Research (CIHR) recently released its Strategic Plan 2021-2031 (the Plan) and an accompanying Framework for Action on Global Health Research (the Framework). For a pair of documents that are supposed to address the issues important to the health of Canadians and the world and direct research toward them, they are disgracefully and unforgivably ignorant of modern thinking on the fundamental importance of what has come to be called the ecological determinants of health and the concept of planetary health.

Given its title of A Vision for a Healthier Future and with powerful statements on the vital importance of nature for our health from globally important sources in recent years (I could provide a much longer list than the three above), a new Lancet journal and a global alliance devoted to the topic of planetary health, you would think CIHR would pay quite a lot of attention to this aspect of health.

Think again! Apparently, CIHR has absolutely no idea we even live in an environment, never mind that it is of fundamental importance to the health of Canadians. If you think I exaggerate, take a look at the Plan’s title page, which features a tree and this statement in the description of the tree:

“In this metaphor, the root system of the tree refers to the deep (and often unseen) foundations that shape the visible outcomes that we refer to as health disparities. These systems include political, social, economic, and historical structures that influence the core (the trunk of the tree).”

What is wrong with this picture? What is missing? Well, for starters, the tree is presumably located in something we call the environment, a simple fact of which CIHR seems entirely oblivious. Yet we live 100 per cent of the time within natural ecosystems. So as a fundamental determinant of our health, the environment matters – but not, it seems, to CIHR.

In fact, there is almost no mention of any aspects of the environment in this Plan, which is supposed to guide health research in Canada for the next decade. The word “environment” itself appears just four times and two of those  – “an environment of exceptional creativity” and “changing realities in (research) work environments” – do not refer to the physical environment itself. Only twice is the word used (rather vaguely) in the sense of the physical environment, as part of the discussion of Priority D: Pursue health equity through research.

Apparently, CIHR has absolutely no idea we even live in an environment.

And that is more mention than any of the following, which do not appear at all in the Plan – not once:

• Ecology, ecological, ecosystem (except in several references to creating “a vibrant health research ecosystem”);
• Nature;
• Planetary health, planetary, planet;
• Earth, ocean;
• Climate change;
• Biodiversity, extinction;
• Anthropocene;
• Pollution, pollutant, contaminant, ecotoxicity.

The same is largely true of CIHR’s Framework for Action on Global Health Research. Here, surely, one would think, the concept of planetary health would be an important focus? Not a chance! The term does not appear at all, nor do any of the following:

• Ecology, ecological, ecosystem (except in several references to a more coherent and connected global health research ecosystem);
• Nature, except with respect to the nature of an issue;
• Earth, ocean;
• Biodiversity, extinction;
• Anthropocene;
• Ecotoxicity.

And the following are barely mentioned:

• Climate change, one reference to a 2011-2018 program, nothing current;
• Pollution, one reference as part of non-communicable disease (NCD) prevention and child health;
• Environment gets a passing mention as an issue in the area of globalization and with respect to prevention of NCDs and health emergency response.

I don’t know where the people who lead CIHR have been for the past few decades as the evidence of the health implications of climate change, pollution, loss of biodiversity and other aspects of global change have piled up. But wherever it is, they have clearly not been paying attention.

I am relieved that I am not a health and environment researcher, looking to CIHR to understand, promote and fund my field of work. If I were, I think I would give up in despair and move to a more receptive country or find a more fruitful field of work.

But as a citizen and as an inhabitant of Earth, I am outraged that this important national body has so completely ignored what is arguably the most important threat to health, globally and in Canada, in the 21st century.

In his speech, UN Secretary General Guterres added:

“Making peace with nature is the defining task of the 21st century. It must be the top, top priority for everyone, everywhere.”

Everyone, everywhere, it seems, except at CIHR.