Enough tough talk! It’s time for the tough action(s) to promote local to global planetary health

Since the emergence of the SARS-COV2 pandemic, numerous scholars have highlighted the inextricable relationships between pandemic emergence and human civilization’s unhealthy relationship with the environment. Baybutt and Dooris (2021), highlight five possible strategies for engaging with the complexity of the pandemic and the role of public health therein. One recommendation is to leverage the potential of eco-social approaches to public health such as OneHealth, Ecohealth and Planetary Health. In this commentary, we seek to build on this recommendation. While a full review of these concepts is beyond the scope of this commentary (readers can see Buse et al., 2018; Oestreicher et al. 2018 for a more fulsome description of these and related environmental health ‘fields of practice’), here we point to the need for urgent actions that: 1) recognize the interconnected nature of human and ecological systems, and 2) provide co-benefits that are good for people and the planet.

In the wake of nearly 50 years of robust evidence on human-induced environmental change – actions that accelerate harmful ecological change (e.g. ocean acidification, climate change, biodiversity loss) (IPCC, n.d.; Millennium Assessment Board 2005) – there remains a gulf in actions which effectively redress these challenges. To date, actions that are occurring are too little, too late. Suddenly, in the wake of public health emergency orders that sought to limit the movement of human populations to reduce virus transmission, COVID-19 control measures reduced global travel, and environmentalists were cautiously optimistic that this ‘pause’ in emissions could have positive environmental implications. For example, air quality improved in many localities and likely averted thousands of premature deaths; yet our overall reduction to GHGs that cause climate change was only in the realm of about 7% (Reilly, Henry Chen, and Jacoby 2021). These actions, though unprecedented, made only a temporary difference and were not on a scale that moves the needle on redressing climate change. As economies seek to roar back into action, there is little evidence of the will and intent to integrate the principles of transformative sustainability and social justice into ‘restart plans’, even though stark social and global inequities deepened during the pandemic and significant environmental events are cascading (UNEP, 2020; Whitmee et al. 2015).

How can eco-social approaches to public health generate positive momentum in protecting and promoting health from the local to planetary level for current and future generations? Eco-social approaches are those that which attend to the reciprocal relationship between ecological and social change, and which prioritize rapid planetary-scale transitions to promote human health and societal stability (Hancock 2015; Parkes et al. 2020). This thinking is embedded in the need for “supportive environments” as identified by the Ottawa Charter for Health Promotion, and yet health promotion has yet to fully realize such a goal. Ours is an age where climate change can be touted as both the greatest health threat and also opportunity of our time’, UN Secretary General António Guterres offers an additional insight, that ‘making peace with nature is the defining task of the 21st century. It must be the top, top priority for everyone, everywhere’ (EKOenergy ecolabel 2020). The idea is not new, but the urgency is. For example, James Robertson has said sanity is about finding balance within ourselves, humanity is about finding balance between ourselves and other people, and ecology is about finding balance between humanity and nature (Robertson 1978). How can contemporary political and health responses help bring balance and sanity? Guterres suggests that Indigenous knowledge (and forms of stewardship) ‘distilled over millennia of close and direct contact with nature, can help to point the way. Indigenous peoples make up less than 6 percent of the world’s population yet are stewards of 80 per cent of the world’s biodiversity on land … With Indigenous peoples living on land that is among the most vulnerable to climate change and environmental degradation, it is time to heed their voices, reward their knowledge and respect their rights’ (EKOenergy ecolabel 2020).

Eco-social approaches to health are also important as they hold a recognition of the interdependence of human, animal, and environmental health, such that a holistic approach to the wellbeing of all will lead to improved health outcomes and enhanced resilience. By necessity, these approaches foster collaboration between people, disciplines, sectors, and communities on local through to global scales and acknowledge that no one component can be truly healthy unless they are all simultaneously healthy (Hueffer et al. 2019). Pandemics are potent reminders of these interconnections, as greater than 60% of emerging diseases in humans originated in animal hosts (Wendt, Kreienbrock, and Campe 2015). Furthermore, the impact humans have on the environment, domestic animal-wildlife and consequently human-animal interactions affect how zoonotic diseases develop and spread. Human originated impacts such as the industrialization of wildlife habitat, the expansion of intensive agricultural enterprises, and rapid anthropogenic driven climate and environmental change, all effect the potential for endemic wildlife pathogens to become zoonotic disease threats (Zinsstag et al. 2011; Gibbs and Paul 2014; Wendt, Kreienbrock, and Campe 2015; Hueffer et al. 2013). Future zoonotic pandemics cannot be reliably prevented until sustainable relations between humans, animals and environments are achieved (UNEP, 2020). An important component of this is planetary health justice (i.e. for humans, animals, and the environment) on local through to global scales.

Eco-social approaches have recently gained traction in the human and animal health professions and the millennia-old insights of Indigenous peoples of the interconnectedness of all living beings and their environment (Kutz and Tomaselli 2019) is increasingly being acknowledged. In these inclusive and holistic views, health is more than the absence of illness; it is a state of individual and community well-being with a focus including physical, behavioral, mental, emotional, cultural, and spiritual health. This view of health is built on a cross-cultural, interdisciplinary understanding, and is by nature inclusive, synergizing western science with Indigenous Ways of Knowing. Also important to these relationships is reconciliation with Indigenous peoples and other groups that have experienced historical patterns of systemic marginalization. Unlike conventional Western Science which tends to reduce problems to a gene or molecule, integrated eco-social approaches require a constructionist approach where many parts are integrated back into the whole of the ecosystem. This deep and simultaneously broad integration of knowledge provides opportunities to understand ‘Wicked Problems’.

Yet, despite calls, for example by the Wildlife Conservation Society urging ‘world leaders, civil society, the global health community, and institutions of science to holistically approach the prevention of epidemic/epizootic disease and the maintenance of ecosystem integrity’ (Manhattan Principles 2004), almost 20 years later, the same calls are being made around COVID-19. Eco-social fields often align themselves with Indigenous worldviews that recognize this interdependence within and throughout our world and promise a pathway forward for the western world to heal its broken relationship with nature in upstream ways. Using eco-social approaches also reminds us that it is at the community – and lived experience – level where health inequities exist, where novel interactions between humans, animals and environments lead to new disease emergencies and where existing pathogens are sustained within cycles of poor health (Rossi and Garner 2014).

In the age where societies’ most sophisticated technology and surveillance systems have been built, COVID emerged against the backdrop of the over 200 emerging disease threats the WHO addresses annually (Lee et al. 2020) and a range of other diseases and toxins that keeps people, animals and environments in poor health. In short, COVID is a symptom of a complexity of poor interrelated health inequities. It represents what happens when we have an unhealthy, unbalanced relationship with the world around us. Fighting to prevent spillover is a fire-engine approach. Although handling crises is much needed, more attention to building resilience in health at its root sources is imperative and an emphasis on building back better to a more just, equitable, and sustainable future is crucial. Prioritizing concrete public health actions that emphasize local to global planetary health, focus on decarbonization, innovate around just transitions to a clean economy, and reconcile relations between humans and nature are the tough actions that are required to achieve a livable future for current and future generations.

I hope that you enjoy reading the papers in this issue and I welcome any comments you may have relating to the journal. I encourage you to submit contributions to the International Journal of Health Promotion and Education which connect to and follow on from the four editorial themes set out so far this year.