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Building the social foundations of planetary health

By on April 28, 2017

A Filipino physician and 2014 Emerging Voice for Global Health, Renzo R. Guinto, MD is a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. Currently in Harvard, he is president of the Sustainability and Health Student Forum and researcher at Center for Health and the Global Environment. He is a member of the Editorial Advisory Board of The Lancet Planetary Health, and was the Healthy Energy Initiative coordinator for Health Care Without Harm-Asia.

Two weeks ago, I read with much delight the suggestions that my friend Kristof proposed for the future of planetary health. Overall, there is nothing to oppose with his suggestions and observations. In fact, these are the kinds of conversations that are very much needed to push the frontiers of a young idea. I would even say that planetary health, launched in 2015 by The Lancet-Rockefeller Commission, is still undergoing a phase of identity formation, figuring out whether it is a new field, discipline, paradigm, or movement. This is true for all branches of knowledge – even public health itself underwent similar birthing pains.

However, what makes planetary health unique, as compared to other fields or disciplines, is that the domain that it seeks to address, as Kristof already implied, is bound by a very tight timeframe. In general, the pace of human action has lagged behind Mother Nature’s accelerated environmental change – take for example the 21 years it took for countries to negotiate a climate agreement. A fellow Filipino scholar, Laurence Delina, was even suggesting in his new book that a global crisis such as climate change requires rapid action similar to war-time mobilization. While planetary health carries a more constructive, and not a belligerent, tone, it can become a unique opportunity for catching up for lost time – but only if it wants to.

So what should the planetary health community do to accelerate its pace? Kristof proposed that we need to start with the individual. He urged planetary health proponents to curb carbon emissions from air travel, to immerse in local communities (perhaps especially in places already affected by planetary health challenges), and to even take two months off from work (which I suppose is to not just limit personal environmental footprint, but also to give oneself a time for restoring energy and wellbeing). While I do not disagree with these specific activities (and I am sure there are much more), I think what he is implying is that planetary health should be framed as a way of life, not just a novel academic curiosity. We therefore need to think deeper on what actions and behaviors constitute a planetary health way of living, and be the first ones to internalize and practice them and lead the rest of the world by example.

In my young global health (or if you like, planetary health) career, I certainly have emitted way less carbon dioxide to the atmosphere than the likes of Richard Horton or Larry Summers which Kristof mentioned (By the way, Larry Summers is not yet involved in the planetary health community, but maybe we should recruit him.). But as I become more involved in the promotion and development of the planetary health idea, I certainly am learning to appreciate the value of consistency, making sure that I walk the talk. This is to ensure that I do not contribute to global pollution but also to serve as a genuine role model for others and enhance my credibility as a planetary health leader (or simply, planetary healer). We can only convince others to follow suit if we practice what we preach.

For instance, while air travel is not totally unavoidable in our profession, it can be hugely minimized or at least optimized. My most recent flight was a month ago to London, and within a week, I was able to spend time bonding with my aunt, take a short course in Oxford, meet a dozen friends in London, and hold meetings with UK’s leading professors, including the chair of the Planetary Health commission and former director of LSHTM, Professor Sir Andy Haines, who is one of the planetary health leaders I know who is walking the talk. He came to our meeting with his bicycle, biker vest, and helmet, told me that he is skipping the inaugural Planetary Health conference to reduce his travel-related emissions, and preferred to hold more Skype meetings and webinars in the future instead. Leading planetary health thinkers as well as international organizations such as WHO and the Rockefeller Foundation should emulate his example.

To motivate us further, perhaps what should be introduced is a metric that assesses the amount of impact made for every amount of CO2 emitted, say as a result of international travel. Impact can be measured in many ways and may include various elements, but this is a subject for further investigation. Nonetheless, measuring impact over emissions would mean that planetary health advocates and global health leaders must avoid flying to a country to just give an hour-long lecture, or they should maximize doing impactful activities if air travel is unavoidable. Carbon-negative activities like planting trees can also be pursued by individuals to offset low impact and high emission activities. Of course, this way of tracking individual carbon footprint may be both academically interesting and logistically complicated, but the point is that such formula should be kept in mind especially by scientists who engage in planetary health research and leaders who love giving planetary health prescriptions. Another concrete suggestion is for the planetary health community, along with other related communities such as One Health and EcoHealth, to merge their separate convenings and hold longer, less frequent, and more results-oriented conferences instead.

For sure, leading by example is powerful but not necessarily fast in generating results. And so to complement this, Kristof gave a reminder: “Only if planetary health proponents team up consistently and structurally with the people fighting inequality in the world, we have a chance to pull this off in a generation.” I certainly agree that the planetary health community should reach out to other communities as soon as possible, especially those whom we share the same values with. For example, in 2015, during COP21 in Paris, I already made a case on why #ClimateHealth and #HealthForAll are two sister agendas, and therefore the sustainable development and universal health coverage communities should work together more closely. The Commission’s report already recognized that planetary health challenges are rooted in social, economic, and political arrangements, and so engaging with communities and movements working on these areas is necessary. A question that the planetary health community should answer is, who is the effective messenger of the message and builder of bridges? We need to identify individuals and institutions that can navigate these spheres and build alliances founded not merely on branding and academic achievement, but on inclusivity, diversity, solidarity, and trust.

With all fairness, the young planetary health community has already begun putting together the ingredients of a new field. After the release of a landmark report, the Planetary Health Alliance was established and housed in Harvard (Right now, I interact with them a lot, but I’m not even a member myself since it only allows institutional membership for now); The Lancet Planetary Health – dubbed “a new journal for a new discipline” – was launched (and I was privileged to be invited to the Editorial Advisory Board); and an annual conference, which will be inaugurated this weekend (and I am leading a delegation of Harvard’s Sustainability & Health Student Forum). But now that the scientific foundations have been laid, the equally-important social foundation must be built. Maybe it already exists and therefore there is no need to reinvent the wheel. For indigenous peoples and social movements, the oneness of humanity and nature is not a new concept at all, and perhaps for them, planetary health is old wine in a new bottle and the scientific elite, by coining a new term, have gotten it just now. While introduced by Harvard, Rockefeller, and The Lancet, planetary health cannot remain in these elite spaces, and instead be spread as fast as possible across disciplines, sectors, geographies, and generations. Just like for many innovative ideas in history, the success of planetary health does not merely lie on its proponents, but on people from places far and wide who will accept the baton and advance it. As someone who lives in a country at the heart of the climate crisis, I am personally committed to spread this powerful concept to communities where planetary health challenges are most real.

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