BACKGROUND:Health is an essential component of climate adaptation and should be integrated into national policies to build resilient and effective systems. We aimed to review national climate adaptation policies to assess health integration globally, regionally, nationally, and sub-nationally. METHODS:In this global policy analysis, we systematically identified national climate adaptation policies for 198 countries in English and 14 other languages. We reviewed Health National Adaptation Plans (HNAPs), National Adaptation Plans (NAPs) or National Adaptation Programmes of Action (NAPAs) when NAPs did not exist, Nationally Determined Contributions (NDCs), and National Communications (NCs). We created a Python application to increase the accuracy of identification of health-related text and applied a standardised scoring metric that assessed five domains-health analysis, health-related actions, planned institutional leads, dedicated budgets and funding mechanisms, and measurement indicators for monitoring and evaluation (M&E)-to compare health integration across documents and countries. FINDINGS:197 countries, all except Libya, were found to have national climate adaptation policies (36 HNAPs, 123 NAPs or NAPAs, 200 NDCs, and 223 NCs). Across these policies, 458 (88% of 522 policies) mentioned health. 159 (81% of 197 countries) further referenced other national health policies. 191 (97%) identified populations disproportionately affected by climate change, whereas only 24 (12%) involved such populations in decision making. Six (3%) countries outlined budgets for health-related actions. Insufficient budgeting and fiscal planning emerged as the weakest aspects of health integration, and sexual and reproductive health and rights, allergies, injuries, violence, and mental health were found to be under-represented in policies. INTERPRETATION:Climate adaptation policies should be comprehensive and outline clear structures to translate plans into action. We need evidence-based inclusion of diseases and health conditions linked to concrete strategies, national and sub-national measurement to track progress, and designated leads to spearhead coordination. Involvement of disproportionately affected groups further bolsters policy relevance and equity, and adequate financing is central to ensuring implementation. FUNDING:None.
BACKGROUND:In river-dependent regions such as the Brazilian Amazon, severe droughts can disrupt care continuity by isolating municipalities and fragmenting supply chains. We assessed how four major droughts affected tuberculosis and HIV care cascades in Amazonas state. METHODS:We analysed monthly data (Jan 1, 2001, to Dec 31, 2024) from all 62 municipalities of the Amazonas state, Brazil, grouped into nine river basins and stratified by sex when available. Droughts were defined by the relative maximum cumulative water deficit value being below -2·0 or river discharge at or below the fifth historical percentile. We prespecified four major drought episodes affecting Amazonas at a monthly resolution: May to June, 2005; May to June, 2010; August, 2015, to April, 2016; and October, 2023, to February, 2024. Outcomes were primary-care consultations, tuberculosis and HIV notifications, treatment interruption, and disease-specific mortality. Additionally, we did a prespecified subgroup analysis stratified by sex for both diseases' indicators to assess whether drought-associated deviations differed systematically between men and women. We fitted Bayesian hierarchical negative binomial models to estimate counterfactual trajectories and summarised effects as incidence rate ratios (IRRs) and excess events per 100 000 population. FINDINGS:The 2015-16 drought coincided with widespread consultation deficits (statewide peak IRR 0·78 [95% credible interval 0·68-0·89]) and pronounced increases in HIV treatment interruption across all basins (statewide peak IRR 6·01 [2·12-15·33]), particularly among men (Rio Negro peak IRR 5·57 [3·02-9·78]). By contrast, the 2023-24 drought coincided with increased care consultations statewide (peak IRR 1·63 [1·25-2·11]) but persistent treatment interruption and mortality signals, including female-predominant increases in HIV treatment interruption in Rio Negro (peak IRR 2·87 [1·27-5·63]) and female mortality statewide (1·97 [1·05-3·39]), with additional basin-level mortality increases in Alto Solimões, Baixo Amazonas, and Médio Amazonas. Tuberculosis notifications increased mainly in 2023-24 in specific basins, especially in Baixo Amazonas (peak IRR 2·09 [1·54-2·76]), Médio Amazonas (1·74 [1·30-2·28]), and Baixo Solimões (1·60 [1·24-2·07]). INTERPRETATION:Severe droughts were associated with basin-specific disruptions in tuberculosis and HIV care cascades in the Brazilian Amazon, with clearer signals in adherence-dependent and downstream outcomes than in case detection. Strengthening resilience will require anticipatory, continuity-focused strategies that safeguard treatment access during climate-related transport constraints. FUNDING:Fundação de Amparo à Pesquisa do Estado do Amazonas and Brazilian National Council for Scientific and Technological Development.
BACKGROUND:The desiccation of the Great Salt Lake (UT, USA), driven by water use and diversion, has reduced water inflow and exposed vast areas of lakebed. Exposed lakebed can release airborne PM2·5, degrading air quality in surrounding communities. Previous research has established links between air pollution and mental health outcomes, but there is little research on the specific mental health effects of declining lake levels and associated dust exposure. We aimed to examine the association between Great Salt Lake water levels, PM2·5 concentration, and major depressive episodes in the surrounding population. METHODS:In this ecological study, we investigated relationships between Great Salt Lake decline, PM2·5 exposure, and mental health outcomes across all Utah counties using hydrological, atmospheric, and epidemiological datasets between 2006 and 2018. These data included in-situ lake measurements (from the US Geological Survey), PM2·5 from ground-based monitoring and reanalysis datasets (from MERRA-2 and AirNow network stations), the Social Vulnerability Index (from US Centers for Disease Control and Prevention), and records of major depressive episodes (from the Substance Abuse and Mental Health Services Administration). All datasets underwent quality control, variable preparation, and calculation of Z scores, and were harmonised both spatially and temporally. We calculated PM2·5 exceedance days based on US Environmental Protection Agency and WHO thresholds for harms, namely more than 15 μg/m3 and more than 35 μg/m3. Statistical analyses included Kruskal-Wallis tests for non-parametric group comparisons, followed by Dunn's post-hoc tests for pairwise comparisons. An ANOVA examined direct (main) and indirect (interaction) effects between factors, with F statistics measuring between-group versus within-group variance ratios. FINDINGS:Great Salt Lake shrinkage was linked to poorer air quality, with decreasing lake area (r=-0·28; p<0·0001) and volume (r=-0·31; p<0·0001) associated with more PM2·5 exceedance days. A dose-response relationship was found between depression severity and pollution exposure: individuals who had fewer high PM2·5 exceedance days had very low depression scores, whereas those exposed to more exceedance days had high and very high scores (H 28·9574; p<0·0001). This relationship showed nuanced differences across seasons (H 152·4771; p<0·0001) and age groups (H 51·8269; p<0·0001). Finally, our analysis showed a direct association between PM2·5 exceedance days and depression severity (F 12·341; p=0·0005), whereas social vulnerability acted as a significant moderator (F 6·979; p=0·0084). This interaction indicates that for a given level of PM2·5 exposure, socially vulnerable populations have a disproportionately higher prevalence of major depressive episodes. INTERPRETATION:This study found associations between PM2·5 exposure and depressive episodes are concerning and warrant further longitudinal investigations, including more precise exposure measurements. Our findings underscore the complex interconnections between environmental degradation, air quality deterioration, and population mental health. By establishing this desiccated air pollution to mental health association, our results show that preventing lakebed exposure is not only an ecological necessity but a crucial public health intervention. Public health protections should focus on proactive watershed management alongside targeted mental health support for the most affected downwind and socially vulnerable communities. FUNDING:US National Aeronautics and Space Administration.
BACKGROUND:Food security is central to global nutrition improvement and public health goals, and healthy diets represent a higher-level aspiration beyond merely avoiding hunger. Climate change poses an increasing threat to food systems by affecting crop yields and food prices. Although climate change-driven risks to hunger have been widely studied, the extent to which climate change undermines the affordability of healthy diets while accounting for socioeconomic responses and regional inequalities remains insufficiently understood. This study aimed to quantify the effects of climate change on the future affordability of healthy diets under alternative socioeconomic and climate scenarios. METHODS:We developed an integrated modelling framework that explicitly couples multimodel crop-yield projections with an integrated assessment model (Global Change Analysis Model [GCAM]). Yield responses from six global gridded crop models driven by four climate models were integrated into GCAM, allowing endogenous socioeconomic adjustments such as land-use shifts, production reallocation, and price responses to emerge under shared socioeconomic pathways (SSPs). Diet affordability was then assessed using the Food and Agriculture Organization of the UN's Cost and Affordability of a Healthy Diet framework across three socioeconomic-climate scenarios (SSP1-2.6, SSP2-4.5, and SSP3-6.0). FINDINGS:Under a high-emissions pathway (ie, SSP3-6.0), climate change was projected to render healthy diets unaffordable for a model-mean of 119 million people globally by 2100, even when CO2 fertilisation effects are included, with the upper end of the model ensemble reaching about 1·6 billion people. In contrast, climate-induced affordability losses were found to be negligible under both a low-emissions pathway (ie, SSP1-2.6; -0·3 million) and a medium-emission pathway (SSP2-4.5; +0·2 million). Under a high-emission pathway, model-mean projections indicated that diet costs could increase by up to 12% in the most affected regions by the end of the century. Under medium emissions, cost increases were projected to remain below 4%, whereas under low emissions, affordability changes were projected to be minimum across regions (within approximately 0·5%). Substantial regional disparities emerged, with the largest and most consistent affordability losses concentrated in low-income regions that contributed least to historical greenhouse gas emissions. Under SSP3-6.0, these disparities persisted particularly in regions of Africa and Asia despite projected three-to-five-fold increases in income over the century, with climate-induced disruptions to food systems increasing the number of people unable to afford a healthy diet through mid-century. INTERPRETATION:Climate change is likely to exacerbate global nutritional inequalities by disproportionately increasing the affordability risks of healthy diets in regions that have contributed least to historical greenhouse gas emissions. Under high-warming scenarios, socioeconomic development alone is insufficient to fully offset these risks, highlighting the structural vulnerability of low-income food systems to climate-driven price shocks. These findings suggest that in the absence of targeted interventions, climate change could continue to undermine progress towards equitable and health-oriented nutrition outcomes. FUNDING:Ministry of Science and Technology of the People's Republic of China; National Natural Science Foundation of China; National Aeronautics and Space Administration Goddard Institute for Space Studies Climate Impacts Group; Future of Life Institute; and Global Alliance for Improved Nutrition.
BACKGROUND:Coccidioidomycosis is an emerging fungal disease caused by inhaling Coccidioides spp spores. As spores reside in soil, activities that disturb soil and generate dust can aerosolise and transport the pathogen. The oil and gas industry has been extensively developed in some regions that are endemic for Coccidioides spp and has been associated with dust emissions. Although several adverse health outcomes have previously been associated with oil and gas development, its impact on coccidioidomycosis risk has not been investigated. We aimed to estimate the association between exposure to oil and gas well development (ie, wells in preproduction) and risk of coccidioidomycosis among residents living near new wells. METHODS:In this case-crossover study, we obtained information on reported coccidioidomycosis cases and oil and gas well development between 2007 and 2022 in Kern County, CA, USA. We then compared exposure to preproduction wells within 5 km of each individual's place of residence during both hazard (ie, the 49-139 days before case onset) and control periods using conditional logistic regression. FINDINGS:During the study period, 658 108 (72·4%) of 909 282 of Kern County residents lived within 5 km of at least one preproduction well, and 116 020 (12·8%) lived within 5 km of 23 or more preproduction wells within a single 90-day period. We estimated that the odds of coccidiomycosis incidence were 12·5% (95% CI 5·8-19·6) higher in the 90 days following exposure to at least one preproduction well within 5 km of an individual's place of residence and that the odds of infection increased by 0·7% (0·4-0·9) for each additional preproduction well developed within this distance. INTERPRETATION:These findings support a previously-unrecognised association between the development of oil and gas wells and transmission of coccidioidomycosis, potentially driven by dust generation. Given the prevalence of oil and gas development in the study region, its impact on coccidioidomycosis incidence might be large. FUNDING:National Institutes of Health, National Science Foundation.
BACKGROUND:Health-system resilience serves as a key contributor in mitigating adverse health impacts during climate hazards. However, quantitative insights into resilience-associated health-care utilisation patterns and targeted adaptation policies remain scarce. We aimed to capture the spatiotemporal health impacts in disaster-exposed counties and their neighbouring counties in China during storms, floods, tropical cyclones, and blizzards or winter storms; understand the association between health-system resilience metrics and hazard-attributable hospitalisations; and develop evidence-based adaptation policies towards climate extremes. METHODS:In this retrospective, observational analysis of county-level aggregated hospitalisation data, we used a propensity score matching-difference-in-differences framework to assess the spatiotemporal changes of nine types of disease-specific hospitalisations in both disaster-exposed and neighbouring regions during storms, floods, tropical cyclones, and blizzards in China. We quantified the relative importance and health gains of health-system metrics during such hazards through random forest approach with interpretable partial dependence plots to derive evidence-based adaptation recommendations. FINDINGS:We included hospitalisation data from Jan 1, 2016 to Dec 31, 2023. In this period, 3241 county-hazard event combinations and 41 747 482 hospitalisations were recorded across 955 Chinese counties. The disaster-exposed regions experienced an initial decline in hospitalisation rates, followed by admission surges after disasters. For example, infectious disease admissions decreased by 11·92% (95% CI -10·53 to -13·31) during the flood-active period but increased by 7·68% (6·46-8·91) after 1-2 weeks of floods. Neighbouring zones were also affected through spillover effects, with infectious disease admissions increasing by 3·18% (1·76-4·61) after 1-2 weeks of the floods. Cardiovascular disease, injuries, infectious, respiratory, and mental disorders were more sensitive across all regions. Particularly for disaster-exposed counties, cardiovascular hospitalisations increased by 14·31% (7·34-21·29) during the tropical cyclone-active period. Notably, compared with low-resilience counties, high-resilience counties were associated with 19·48-30·03% smaller hazard-related relative changes in hospitalisation rates during the hazard-active period and 27·07-31·08% smaller hazard-related relative changes in hospitalisation rates in post-hazard periods. For instance, during the storm-active period, the increase in respiratory hospitalisations was 7·21% (0·67-13·75) in high-resilience counties versus 12·13% (5·20-19·05) in low-resilience counties. Health workforce (relative importance 14·58% during the hazard-active period and 13·80% during the post-hazard period) and service delivery (14·10% during the hazard-active period and 14·17% during the post-hazard period) were identified as key contributors of health-system resilience. Empirical synergistic effects were observed when combining interventions during the post-hazard period, with the combined effect of service delivery (individual contribution 8%) and workforce (individual contribution 4%) exceeding the sum of their individual contributions (16% reduction in cumulative excess admissions) by 33%. INTERPRETATION:Climate hazards are associated with substantial changes in hospitalisation rates in both disaster-exposed and neighbouring regions. Health-system resilience is essential in addressing disaster-health challenges. Targeted adaptation interventions should be context-appropriate and threshold-aware, thereby maximising the public health benefits relative to resilience-oriented investments in health systems. FUNDING:Gates Foundation and the National Natural Science Foundation of China.
BACKGROUND:Substantial improvements in air quality have been recorded following the implementation of China's Clean Air Act (CCAA) in 2013. However, the association between CCAA implementation and individual-level cardiovascular disease (CVD) risk remains unclear. We aimed to examine the long-term association between CCAA implementation and individual-level predicted CVD risk. METHODS:In this prospective, quasi-experimental study, we used data from the China Kadoorie Biobank, a prospective cohort study that recruited participants from five urban and five rural areas across China between 2004 and 2008, with three resurveys conducted after the baseline survey (in 2008, 2013-14, and 2020-21). We included 34 862 individuals (mean age 51·3 years) who participated in at least one resurvey and had no history of CVD at baseline. Participants were classified into intervention (n=25 497) and control (n=9365) groups based on the local government's targets for particulate matter reduction. We estimated the 10-year risk of incident CVD morbidity or mortality using a validated risk prediction model. We used a difference-in-difference model to assess the long-term association between CCAA implementation and predicted risk, with adjustments made for regional confounders and individual-level characteristics, including demographics, lifestyle factors, medical history, and indoor air pollution exposure. The relationship between changes in long-term exposure to PM2·5, PM10, and O3 and predicted risk after CCAA implementation was analysed using a linear model. The estimated risk differences associated with air pollutant changes were estimated based on the magnitude of changes and their corresponding effect sizes. FINDINGS:After the CCAA was implemented, PM2·5 and PM10 concentrations declined in both groups, but O3 concentrations increased. The intervention group showed a 3·95% (95% CI 3·18-4·72%) lower increase in predicted risk than the control group, with larger estimated differences under stricter enforcement. Between 2013 and 2021, each 10 μg/m3 change in PM2·5 concentration was positively associated with a 1·80 (1·34-2·27) percentage point change in predicted CVD risk, whereas each 10 μg/m3 change in PM10 concentration was associated with a 1·24 (0·84-1·63) percentage point change and each 10 μg/m3 change in O3 concentration with a 0·58 (0·33-0·83) percentage point change. Overall, the observed changes in air pollutants during the study period were associated with an average 6·6 percentage point reduction in predicted CVD risk. INTERPRETATION:The CCAA and improved air quality were associated with a slower increase in predicted CVD risk, supporting the necessity for stricter, multipollutant air quality policies to maximise public health benefits. FUNDING:National Natural Science Foundation of China, Kadoorie Charitable Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Key R&D Program of China, Chinese Ministry of Science and Technology, and UK Wellcome Trust.
Escalating heat extremes under climate change are imposing substantial health burdens, with 2023 and 2024 consecutively breaking global temperature records. Mounting evidence suggests that heatwaves elevate the risks of hospitalisation and mortality across multiple disease categories, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and acute kidney injury. Nonetheless, most existing heat-health warning systems remain primarily reliant on population-level predictions, and considering individual differences and disease-specific considerations when defining warning levels would benefit the effectiveness of early prevention for high-risk groups. In this Viewpoint, which is based on the framework of precision public health—delivering the right intervention to the right population at the right time—we propose a framework for personalised digital heat-health early warning tools comprising three dimensions: individualised, risk-stratified prediction models that generate tiered early warnings; personalised health prompts coupled with theory-informed behavioural interventions; and adaptive, equity-oriented alert delivery mechanisms tailored to diverse populations. Such tools have the potential to bridge precision disease prevention and climate adaptation, thereby helping to mitigate heat exposure risks and disease burdens, particularly among high-risk populations. Future implementation research will be essential to address substantial challenges related to feasibility, validation, and equity.
BACKGROUND:In a warming world, understanding where, when, and to what extent human heat tolerance limits will be breached has become increasingly important. Previous projections applied heat limits for healthy young adults to all age groups, overlooking greater vulnerability in older ages. With global ageing, this oversight could seriously underestimate future heat risks. In this study, we aimed to examine the extent to which accounting for age-specific heat tolerance alters global projections of heat limit exceedances. METHODS:We integrated experimentally derived heat limits for young (18-39 years), middle-aged (40-59 years), and older adults (≥60 years) with climate projections and age-stratified population projections to assess where and to what extent these limits could be breached across age groups under 1-4°C of global warming above preindustrial levels. The climate projections include bias-corrected projections of dry-bulb temperature and wet-bulb temperature from 14 Coupled Model Intercomparison Project Phase 6 climate models under the shared socioeconomic pathway 5-8·5 scenario. We also highlighted countries with high exposure risk and low adaptive capacity. FINDINGS:More widespread and imminent breaches of heat limits were estimated among older adult populations than among other populations. Older adults faced more frequent and spatially extensive exceedances under the 1·5°C global warming scenario relative to the preindustrial period than young adults did under 4°C. Using age-specific thresholds more than doubled the global population having 180 h or more of exceedance annually as compared with previous estimates. Older adults in south Asia and the Persian Gulf could face sustained, day-and-night exposure for three consecutive months at 3°C or more warming. We also identified 13 countries under 3°C global warming above the preindustrial period where poverty rates exceed 50% and either at least 10 million older adults or at least 80% of the older adult population experiences 180 h or more of heat limit exceedance annually. India, Pakistan, Bangladesh, Myanmar, and Niger exceed both the absolute (10 million older adults) and proportional (80% of older adults) exposure thresholds. INTERPRETATION:Our results suggest accounting for age stratified vulnerability, intolerable heat will be experienced at much larger scales and for longer durations, affecting far more people than previously estimated. By identifying who and where people are exposed, our findings can inform targeted heat action plans and guide resource allocation and response planning. FUNDING:US National Institutes of Health; US National Science Foundation; US National Aeronautics and Space Administration; Yale Institute for Biospheric Studies; The Rockefeller Foundation.
BACKGROUND:Natural spaces have the potential to improve mental health conditions such as depression and anxiety. Urban woodlands present an opportunity to provide local residents with nearby green and natural areas, when such areas are safe, inviting, and easy to access. We examined a broad programme of woodland improvements in Scotland that targeted less-advantaged communities to identify the effects improved woodland spaces could have on mental health outcomes. METHODS:Individual de-identified sociodemographic data from the Scottish Longitudinal Study were linked with residential histories and mental health prescription records from National Health Service (NHS) Scotland between 2012 and 2016. Geospatial data on the location of urban woodland improved under the Woods In And Around Town (WIAT) scheme funded by Scottish Forestry. We used longitudinal random-effects models to assess the association of between-individual and within-individual changes in improved woodland exposure with the risk of being prescribed antidepressant or anxiolytic medications over the 5-year period. FINDINGS:A total of 129 335 adults were included in the final sample. In the cross-sectional, between-individual analysis, we observed a greater risk (adjusted odds ratio [aOR] 1·10 [95% CI 1·03-1·20] p<0·05) of antidepressant prescription for those living within 800 m (approximately 10-min walk) of an improved woodland compared with those living further away, but no significant difference in the risk of anxiolytic prescription. In the longitudinal, within-individual analysis, we observed lower prescription use for antidepressants (aOR 0·90 [95% CI 0·87-0·93] p<0·01) and anxiolytics (aOR 0·94 [0·90-0·99] p<0·01) during periods spent living within 800 m of an improved woodland when compared with periods spent living beyond 800 m of an improved woodland. INTERPRETATION:We suggest that the greater risk of antidepressant use between individuals reflects the fact that the WIAT improvement programme targeted more socioeconomically deprived areas. However, the significantly reduced risk of mental health prescription for individuals moving from outside of a WIAT area into a WIAT area suggests that the intervention had a positive effect on individuals' mental health over time. These findings point to the value of environmental interventions, such as urban woodland investments, as a preventive public health strategy, especially in deprived areas that tend to have greater mental health burdens and less access to green space. FUNDING:Economic and Social Research Council; GroundsWell Consortium, a UK Prevention Research Partnership.
Achieving environmentally sustainable health systems represents a crucial objective for both planetary and human health. Integrating environmental measures into existing health-care quality measurement and improvement frameworks can greatly advance sustainability efforts. However, current environmental measures have not been evaluated for this purpose. In this Personal View, we evaluate commonly reported measures of environmentally sustainable health care against standard criteria and propose a minimum set of standard environmental sustainability measures compatible with quality reporting standards. Common measures of environmental sustainability were identified at the hospital and health-facility level through a literature review. We created generic, representative measures based on the environmental domain (eg, greenhouse gases, energy) and evaluated them using quality measure criteria established by the Partnership for Quality Measurement. Six generic measures were created and evaluated across the domains of greenhouse gas emissions, water use, energy use, travel, and solid waste. Although all six measures were considered of high importance, two (distance travelled by patients and staff and mass of total [scopes 1, 2, and 3] carbon dioxide-equivalent emissions per year) showed weaknesses in scientific acceptability and feasibility, and one (energy consumed per year) was highly correlated with and less informative than the others. No measures evaluated included a consistent method for standardisation. The proposed minimum set comprises measures of greenhouse gas emissions (scopes 1 and 2), water use, and solid waste production, standardised by adjusted patient-days. To our knowledge, this work presents the first proposed list of environmental measures for use in quality reporting and a pathway for integrating environmental sustainability measures into existing quality measurement frameworks.
Critiques of economic growth are receiving increased scientific and public attention. The post-growth literature discusses how wellbeing can be achieved for all within planetary boundaries. However, current welfare states, which play a crucial role in supporting health and wellbeing, are often seen as growth dependent. The drivers of welfare state growth dependencies and related policy responses remain poorly understood. In this Review, we address this gap and provide an overview of drivers and policy responses, by performing a semi-systematic literature review. The Review identified key drivers that the literature suggests, such as the growth dependence of employment and related welfare funds, rent extraction and for-profit provisioning, increasing inequality, ageing societies, political power of vested interests, and environmental impacts. Policies proposed as responses to these drivers include maintaining employment without growth, using less growth dependent revenues, restricting rent seeking and political power of vested interests, implementing predistributive and redistributive policies, implementing preventive health-care approaches, and mitigating climate change. We argue that a more holistic assessment of policies should consider the interaction between the supply of welfare funding and demand for welfare spending. Finally, we summarise views in the literature on whether welfare state growth independence can be achieved within a capitalist system.
All life on earth is affected by the intensifying impacts of climate change, biodiversity loss, and pollution. Planetary health science is emerging as a crucial framework to address the health of the planet and its inhabitants. Indigenous Peoples’ knowledge systems have evolved over millennia and are grounded in principles such as interconnectedness of all living things. As a discipline, the tenets of planetary health draw upon Indigenous science and approaches; however, the extent of ethical engagement has not been examined. We conducted a systematic review of all articles published in The Lancet Planetary Health up to October 2025, to assess the recognition and integration of Indigenous knowledge systems. 1137 of 1172 articles reviewed contained no Indigenous research features or perspectives. Although the number of articles engaging with Indigenous knowledge systems has increased over time, these publications are predominantly commentaries, with relatively few original research articles. The Lancet Planetary Health was launched with the aim of informing a “radical civilisational transformation”. Based on the findings of this systematic review, we suggest that decolonising planetary health science should be integrated into this civilisational transformation.
