The Lancet CommissionsSafeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health
Section snippets
Executive summary
Far-reaching changes to the structure and function of the Earth's natural systems represent a growing threat to human health. And yet, global health has mainly improved as these changes have gathered pace. What is the explanation? As a Commission, we are deeply concerned that the explanation is straightforward and sobering: we have been mortgaging the health of future generations to realise economic and development gains in the present. By unsustainably exploiting nature's resources, human
The scope of the Commission
This Commission assesses the threats to health and to the prospects for development posed by the many environmental changes happening in the Anthropocene epoch. The Commission also identifies major gaps in evidence in the understanding of links between environmental change and health and the effects of interventions and policies to reduce environmental change and protect and promote health. The Commission also outlines research needs and implementation efforts to help humanity to address these
Pressures on the Earth's biophysical systems
The planetary boundaries framework identifies those biological and physical processes and systems important to the maintenance of the Earth's functions that human beings rely on to grow and flourish—the “safe operating space” (figure 4).57, 58 Changes in these systems either manifest at the global or regional scale (eg, climate change) or at the local scale (eg, biodiversity loss) but show such similar trends, effects, or interactions that they can add up to a global issue. Substantial changes
Key factors mediating human induced environmental changes
The scale and pace of the human induced environmental changes are ultimately driven by the context of human civilisation in the Anthropocene. Three key factors in mediating these changes are unsustainable consumption or overuse of resources (that in turn is closely linked to affluence); population numbers; and available technologies that determine the effect of a given level of economic activity on the environment. Moreover, these factors interact, usually to multiply each other's impact on the
Urbanisation
Most of the world's population now live in towns and cities and, for the foreseeable future, most population growth will be in urban areas (figure 7).98 By the middle of the 21st century, another 2–3 billion people will need to be housed in the cities of the world—more than 1 million people every week. Most urban population growth is projected to take place in small and medium sized cities in low-income and middle-income countries.106
Rapid economic development and urbanisation is making cities
The unfinished agenda of environmental health
The 2006 study,32 published by WHO on the burden of disease from direct environmental causes, identified the largest disease burdens related to environmental exposures as including diarrhoeal disease, undernutrition, acute respiratory infections (particularly from household air pollution), malaria, and some categories of unintentional injuries. The total number of healthy life years lost per person from environmental exposures was 15 times higher in developing countries than in developed
Challenges to achieving planetary health
The challenges for humanity from global environmental change can be broadly categorised into three categories (see appendix for a broader discussion of challenges).
Firstly, conceptual and empathy failures (imagination challenges), such as an over-reliance on GDP as a measure of human progress, the failure to account for future health and environmental harms alongside present day gains, and the disproportionate effect of those harms on the poor and people in developing nations—ironically the
Overview
Present trends have the potential to reverse health gains and to destabilise human civilisation unless collaborative and coordinated policies are put in place to reduce the risks. We believe that a course correction is required, which would be to address the unfinished agenda of ill health that is mainly related to poverty, to adapt to environmental change that cannot be prevented, and to achieve equitable human development within finite environmental limits. Just as the Lancet Commission on
Ethics and values
The UN IPCC pointed to the ethical challenges posed by climate change and this Commission suggests the need to widen the perspective to consider the range of interacting environmental changes. Principle 21 of the Stockholm Declaration of 1972 (modified by Principle 2 of the Rio Declaration) recognises the right of countries to exploit their own resources, provided that their activities do not damage the environment of other states or the global commons.337 Although, in many cases, national
Governance to secure planetary health
Achievement of improved governance for planetary health necessitates action at global, national, and subnational levels. Action has to be taken before irreversible changes in key Earth systems occur, which will require decision making under uncertainty (panel 13) about the critical thresholds or rates of deterioration of these systems. Decision makers tend to overestimate the carrying capacity and resilience of their system because their knowledge of complex systems involved is incomplete.407
The potential to capitalise on the post-2015 Development Agenda
Progress towards the Millennium Development Goals has been mixed—across goals and between regions.66 As the MEA pointed out, “any progress achieved in addressing the Millennium Development Goals of poverty and hunger eradication, improved health, and environmental sustainability is unlikely to be sustained if most of the ecosystem services on which humanity relies continue to be degraded”.3 The Millennium Development Goals did not effectively address unsustainable environmental trends or
Addressing gaps in knowledge
Our overview has uncovered substantial gaps in knowledge that have to be addressed to improve planetary health. A transparent interdisciplinary process of research agenda setting is needed, which takes into account the needs of decision makers and builds on the restricted knowledge available. This scarcity of knowledge on planetary health is shown by the relatively small number of high quality systematic reviews available on topics related to planetary health and the high frequency of
Opportunities for action by key constituencies
Several key constituencies can have pivotal roles in promoting planetary health: health professionals; academics and research funders; governments; the UN; and corporations and citizens, including those who are often marginalised by prevailing sociopolitical systems and who are most susceptible to disruptions in natural systems.
Health professionals can have an influential role in promoting planetary health. Using their voice individually and collectively, through advocacy and outreach, they can
Propositions to address imagination (conceptual) challenges
To advance planetary health, policies should:
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Account for depreciation of natural capital and nature's subsidy so that economy and nature are not falsely separated. Policies should balance social progress, environmental sustainability, and the economy.
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Support planetary health by addressing the unfinished agenda of environmental health challenges (which are mainly related to poverty), increasing resilience to emerging threats, and tackling the driving forces of environmental change
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