“Humanity is waging war on nature. This is suicidal.” – UN Secretary General Antonio Guterres’ “The State of the Planet” address at Columbia University: Dec. 2, 2020.
And that, in a nutshell, is why the war on nature is a public health issue, why Canadian health-sector organizations and health professionals are increasingly addressing this issue and why the first National Day of Action on Planetary Health is happening on Oct. 6.
Regrettably, however, concern has been raised in some quarters that the health sector has been working in the area of planetary health instead of focusing on its “primary responsibility” of delivering health care. That concern is misplaced, as it fails to recognize that the health sector’s role is not only to treat and care for people with all manner of health problems, but also to protect people from harm, prevent disease, injury and premature death and promote health and wellbeing; work that is primarily (but not exclusively) the role of public health.
Public health has a long and proud history of addressing the broad upstream environmental, social and economic determinants of health. That history of action dates back at least to the Renaissance, but was also evident in the 19th century as public health practitioners combatted the ills of industrialisation, poverty and rapid urbanization. They continue to do so in the age of the social, commercial and ecological determinants of health, addressing the ill effects of poverty and marginalization, unhealthy living conditions, unscrupulous commercial practices and ongoing environmental damage.
Today, we understand that the Earth’s natural systems are the most fundamental determinants of our health, the bedrock underpinning our wellbeing: clean air and water, food, fuels, materials, waste removal, UV protection by the stratospheric ozone layer and, for the past 12,000 years of the Holocene, a relatively stable and benign climate; these are often described as the ecological determinants of health.
In recent years, Earth scientists have identified a set of nine systems that are “critical for maintaining the stability and resilience of Earth system as a whole” – climate change, ocean acidification, stratospheric ozone depletion, biogeochemical flows of nitrogen and phosphorus, excess global freshwater use, land system change, the erosion of biosphere integrity, pollution with chemical, plastic particles, GMOs and other “novel entities,” and atmospheric aerosol loading – and have proposed “planetary boundaries.” Crossing those boundaries takes us into zones of increasing risk.
But the most recent Planetary Health Check (2024) found that we have already crossed six of those nine boundaries (and since then, evidence shows we have passed a seventh, ocean acidification). Moreover, for all seven the trend is toward a worsening situation. The total costs to society and especially future generations is rarely acknowledged, enabling destructive projects to proceed under false pretenses (the new voodoo economics).
Importantly, given that Indigenous peoples live in close relationship with more than 80 per cent of the world’s biodiversity and nature is declining less rapidly in these lands than others, we have much to learn about planetary stewardship from our Indigenous colleagues.
The health implications of crossing planetary boundaries are both profound and obvious. Put simply, “destabilizing the Earth system is fundamentally threatening human health.” The paper’s authors, leading researchers in both planetary boundaries and planetary health, note that while “there has not been a comprehensive assessment of the total associated burden of disease, the scale of many known impacts suggests a large global burden over the coming decades.”
Moreover, they caution that “large-scale shifts in the Earth system can also destabilize human societies, with potentially severe and unforeseeable effects on a range of additional determinants of health.”
Importantly, they also note that the health impacts of these global and local environmental changes “disproportionately impact future generations, Indigenous peoples, low-income regions and other marginalized groups who tend to be the least responsible for destabilizing the Earth system.”
Put simply, “destabilizing the Earth system is fundamentally threatening human health.”
The profound implications of declining planetary conditions have not been lost on the health sector. Following the 2015 report of the Rockefeller-Lancet Commission on Planetary Health, the Lancet created a new journal, Lancet Planetary Health, while the Rockefeller Foundation and others supported the creation of the Planetary Health Alliance.
The Alliance – a “consortium of over 480 universities, non-governmental organizations, research institutes and government entities from 80+ countries” – reports there is a multitude of new courses, lecture series, degree programs, faculty positions and cross-university initiatives emerging across the globe. There are now more than 20 university-level centres focused on Planetary Health.
Here in Canada, the Association of Faculties of Medicine of Canada (AFMC) in 2023 declared the health of the planet a Code Red emergency. It called for the “immediate implementation of planetary health education and research, and the transition to climate-resilient and low-carbon health systems in order to build a healthy, sustainable and just future for all.”
Their Declaration on Planetary Health has since been endorsed not only by academic health institutions in Canada and around the world, but by a large number of other prominent health sector organizations.
In November 2024, “in response to the urgent need for transformation within our health systems, addressing the impacts of climate change on health today and in the future” the AFMC published its Roadmap for Planetary Health and Sustainable Health Systems for Canadian Medical Professionals.
The AFMC is not alone: The Royal College of Physicians and Surgeons of Canada, which certifies all medical specialists in Canada (including public health and preventive medicine specialists), recognized in its 2023-2026 Strategic Plan that “three complex societal issues are impacting the care specialist physicians deliver and need to be addressed collectively by our membership.” One of those three is planetary health and sustainable health care. The Royal College has subsequently established a National Advisory Committee on Planetary Health and has created an online course on sustainable health-care systems.
The Canadian Association of Physicians for the Environment and the Canadian Association of Nurses for the Environment also are among a large number of national and provincial health sector organizations across multiple disciplines working on issues of planetary health and sustainable health care systems. Many are working together on the first National Day of Action on Planetary Health scheduled for Oct. 6 and are also banding together to form the Canadian Coalition for Planetary Health and a Wellbeing Society.
It is important to note that the Core Competencies for Public Health in Canada: Release 2.0 this past August identifies the health implications of the planetary crises and actions to address them, as well as knowledge of the interconnections between people, animals and the environment, as a core competency – part of “the essential knowledge, skills and attitudes necessary for the practice of public health.”
So, in what conceivable way could planetary health not be within the scope and mandate of public health? Ignoring planetary health would be a gross dereliction of duty by the public health profession, a breach of the ethical obligation to protect and improve the health of the population and to narrow health inequalities.
